Bipolar Disorder Symptoms

Bipolar disorder a manic -depressive psychosis

2012-02-03T05:25:00.000-08:00

Bipolar disorders, classically known as “manic–depressive psychosis,” is a serious, chronic, and relapsing mental disorder. Despite the growing efficacy of available pharmacological tools, bipolar-affective disorders have continued to be a significant source of morbidity and mortality, doing serious harm to the quality of life of sufferers. They are the sixth cause of disability worldwide
serious- and chronic as they are, represent a heavy financial and social burden – both direct (hospitalizations ) and indirect (constant days missed from work and loss of productivity).
The incidence of bipolar disorders amounts to approximately 8% of the adult population, in nowadays

The consequences of the disorder and its subsequent relapses for the individual and for family members, combined with the high risk of mortality by suicide suggest that a multiple
therapeutic effort must be made, going beyond while at the same time supportive of drug therapy.

Irritability of men and women

2012-01-11T02:32:00.000-08:00

Many have experienced a period in a relationship when your partner starts to annoy you. Literally everything he does, cause irritation and discontent. At such times, many are beginning to think that love has passed and continue the relationship is simply meaningless. However, do not make such hasty conclusions. Perhaps the problem is not in a partner and not you, and your life span. It happens that sometimes the irritation caused by external factors, we move into a relationship. Dissatisfaction with their jobs, social status, etc. may have an impact on our irritability. Well, where else can you throw this irritability, but not as a loved one. However, in rare cases, the true cause of irritability is truly in deed your second half. So, feeling irritable, you should calm down and understand its true causes. Otherwise, you can not make a deliberate stupidity.

The men in cases of irritability often because of external grievances. Seldom the real cause is an object of adoration. Problems at work can cause irritability, which is manifested in the relationship. If a man is often irritable and constantly breaks down on you, then perhaps he had the other. He wants to be with her and searches for reasons to quarrel with you, or you have not seem him such an ideal, as before. Sometimes it is difficult to understand why men appear irritable. Sometimes it happens simply because of a bad mood, and then all around angry. At such moments, one needs to look into the most inner feelings and to find the true problem.

Women have more based reasons for anger. The main reason, that just drives men crazy, this month. During this period, women's better not to touch it. They are so irritable that the scandal will be enough, even the slightest reason. A very long period of irritability women have during pregnancy. Not every man can withstand the nine months just to understand and loving support. During this period women are very irritable and tearful. There are even deeper depression. Woman to be happy in this period, it is necessary to fulfill all her wishes and try not to upset her. Husbands in this period, of course, have to hard, however, and women are not easy, but on the contrary, even several times heavier. So surround a woman with love and care.

Irritability in women appears in the moments when she realizes that the man who is beside her, she does not fit. This case often occurs in men. It becomes difficult to tell the person that you are no longer a couple, especially if your relationship went far away. Therefore, the only reason to leave, to make life easier for each other and do not continue the relationship in a lie, a quarrel. A quarrel can cause irritation in response to any action of the partner. When a woman starts to show his irritation, then the relationship simply doomed.

Of course, those are the ideal relationship in which partners do not show their anger. However, nowadays it is almost impossible. After all, we are surrounded by so many negative factors and influences. Dissatisfaction at work, the unstable situation in the country, poor environment. All this affects our health and our emotional state, sometimes causing irritability. But if you love one another, then you must understand these negative aspects of emotion, talk normally and be sure to come to an understanding.

Bipolar Symptoms In Men

2011-10-12T06:35:00.000-07:00

Bipolar Symptoms In Men

Bipolar disorder, also known as mood disorder, is a psychological condition that consists of a certain set of extreme ‘mood swing’ patterns, affecting a person deeply by disrupting their lifestyle and health , characterized through recurrent episodes of extreme high or exuberant mood or mania and deep sorrow or depression.

Around 6 million people suffer from bipolar disorder in United States and that goes for 2 percent of the male population, and 1.4 percent of the children population. It is thereby very important to be aware about the causes of bipolar disorder, along with bipolar symptoms in men.

What causes you to feel “high” and “low”

People suffering from bipolar disorder experience persistent periods of elevated moods and bouts of extreme sadness (known as depression) in varying frequency. A small percentage of people experience only the sudden high moods. A larger percentage suffers from the lows and the depression. Most people suffering from bipolar disorder experience both the highs and lows, and often these two moods follow each other closely, offering a very mixed scenario. Each person suffering from bipolar disorder experiences a distinct and unique set of mood swing patterns, and hence it is very important to select the right psychologist or therapist with good experience, as every new case is new challenge in terms of the behavior pattern of the patient.

The behavior and mood swing patterns in a male suffering from bipolar disorder are very confusing and are hence perceived wrongly as a flaw in character or inflated ego by people around them, and thus the timely diagnosis of bipolar disorder is often delayed, affecting the sufferer even more. It is very important for one to be aware of the bipolar symptoms in men, so that those who are found to be suffering from this condition can be subjected to treatment as early as possible.

Why Problems Vary

The bipolar symptoms in men vary for the two stages – namely mania and depression. In the manic feeling or highs a person might feel over confident and full of energy, over-exuberant and irritable over issues of difference with others. At such times, people going through mania stage tend to talk rapidly and loudly, with no response to the social cues in a conversation, eat and sleep less, perform a lot of activities at the same time , leave them half finished, and indulge in reckless activities like reckless driving, going often on a spending spree etc. On the other hand, when the depression stage sets in, the same person might find his or her spirits diminished, energy sapped, and might indulge in over eating and excessive sleeping. People going through depressed stage tend to turn into social recluses, withdraw from friends and interactions with others, experience bodily pains and even suicidal tendencies in extreme cases.

It is extremely necessary for people around those suffering with bipolar disorder to observe the bipolar symptoms in men, and report the same in time to the nearest therapist so that appropriate treatment can begin for treating them.

Personality disorders tend to fall into three groups

2011-09-29T03:34:00.000-07:00

Personality disorders tend to fall into three groups, with their own complex sub-groups:

Suspicious

Paranoid, where you are suspicious of other people, sensitive to rejection and have a tendency to hold grudges.
Schizoid, where you are unable to make contact with other people, preferring your own company and developing a rich fantasy world.
Schizotypal, where you have odd ideas and difficulties with thinking. Other people see you as eccentric and you may see or hear strange things.

Emotional and impulsive

Antisocial: where you don't care about other people’s feelings, get easily frustrated and aggressive, and find it difficult to develop close relationships. You do things on the spur of the moment without feeling guilty and are unable to learn from unpleasant experiences.
Borderline or emotionally unstable: where you do things without thinking and find it hard to control your emotions. You may feel empty inside or so bad about yourself you self-harm. Although you make relationships quickly, you can easily lose them. You can also feel paranoid or depressed and may hear noises or voices.
Histrionic: where you tend to be self-centered and over-dramatise events. Your emotions are strong, but change quickly. You worry a lot about your appearance and crave excitement.
Narcissistic: where you crave success, power and status. You seek attention and tend to exploit others for your own gain.

Anxious

Obsessive-compulsive: where you are perfectionist, worrying about the detail in everything. You are cautious and find it hard to make decisions. You have high moral standards, worrying about doing the wrong thing and judging other people. You are sensitive to criticism and may have obsessional thoughts and behaviours.
Avoidant: where you are very anxious and tense, worrying about insecurities. You feel inferior to others and want to be accepted. You are sensitive to criticism.
Dependent: where you rely on others to make decisions for you and do what others want you to do. You find it hard to cope with daily tasks, feeling hopeless and incompetent and easily feel abandoned by others.

Personality disorder

2011-09-29T03:33:00.000-07:00

You may have a personality disorder if:

Parts of your personality make it hard for you to live with yourself and other people
Experience doesn’t teach you how to change the unhelpful parts of yourself
You find it hard to make or keep relationships with friends, family and work colleagues
You find it hard to control your feelings or behaviour
You find that you upset or harm other people because you’re distressed

The cause of a personality disorder is not clear, but there is some evidence that, similar to other mental disorders, genes, brain problems and background can play a part. It’s thought one in ten people has some form of personality disorder.

Sleep problems lead to Parkinson's disease

2011-08-18T02:12:00.000-07:00

Sleep disorders associated with rapid eye movements and accompanied by nightmares and very vivid dreams, involve a risk of developing Parkinson's disease, the researchers found.

Alex Iranzo, a neuroscientist at the Hospital of Barcelona conducted three studies in order to prove a link between these two disorders, writes The Times of India. The latter finding he used a test that determines the level of dopamine in the brain. It was found in patients with Parkinson's disease it is lowered.

With a deficit of dopamine Parkinson's disease in a black substance - the area of the brain associated with learning and coordination of movements. Due to lack of the hormone dopamine in humans develops tremors, muscle rigidity. In turn, the hormone released when a person experiences the pleasure of eating, sex, drugs.

The scientist watched over the health of a control group of volunteers for three years. After that period, hormone levels fell by 8% due to age-related changes. But a group of people with sleep disorder reduction was 20%.

When completed a three-year period, three of 20 patients with sleep disorders were diagnosed with Parkinson's disease, and reduce the concentration of dopamine in their recorded at 30%.

Depression leads to stroke

2011-08-16T03:46:00.001-07:00

American scientists have come to the disappointing conclusion: Depression increase the risk of strokes. With women who take antidepressants are at particular risk.

This is the conclusion reached by experts analyzing the data collected during the study Nurses' Health Study, which began in 1976. Under the supervision of physicians were 12 thousand women aged 60 years. From time to time, scientists have evaluated their level of depression, and asked whether they accept the anti-depressants.

At the beginning of the experiment depression was found in 22% of the member experience. Six years later, scientists have recorded a 1033 stroke. Experts estimate that depression increased the risk of stroke by 29%. Among women who took antidepressants, the risk increased to 39%.

According to Dr. Catherine Reksroud, led the study, depressed women are more often alone, a lot of smoke, have extra pounds and led a sedentary lifestyle.

Perhaps the depression is triggered inflammation that can injure blood vessels in the heart and brain.

Music and Depression

2011-07-05T01:51:00.000-07:00

Since ancient times, known beneficial effects of music on human health. Sounds heard by miracles, healing, uplifting spirit, excite, delight, sadden. Music heard in the current streams, hitting the key sources, the noise of rain, thunder mountain streams, ceaseless motion of the oceans and seas. Music can be heard in the breath of wind, rustling leaves, chirping of birds ... It is through music, people constantly transmit their feelings and sensations, it is through music, he expressed his religious feeling and it was with her help, he sends his sorrows, their joys, their love and all their deepest experiences. Indian philosophers said that at the beginning of human history there was no language, was, as the song goes, "eternal music." People expressed their thoughts and feelings sounds: low or high, long or short. The depth of tone indicative of the strength and power, and the pitch expressing love and wisdom. Our ancestors, the Slavs spoke in a singsong voice - the echoes of their everyday speech can be heard today in the church, when reading the Gospel, the Apostle and the Book of Psalms. Novgorod veche was a pure opera, with arias, duets and choruses. In castles and palaces, singing and music sounded almost around the clock, creating a favorable psychological background of the life of the rulers. Music can heal our grief and melancholy. It makes us relive and revive the memory of dear to our hearts memories. Music changes the perception of time and space. Music affects respiration, pulse and blood pressure. Music reduces stress and increases immunity. Music elevates the power of spirit. Music helps plant growth, lulls children, makes the shelves march to war. Music can inspire creativity. Many writers and poets were told that their works have conceived or when listening to music, or immediately thereafter. His music is capable of drumming ward off evil spirits, sing the praises of the Virgin Mary, to appeal to the Buddha for the sake of universal salvation, captivate and soothe, revive and transform. Music - a breath of soul and consciousness. Through music the soul manifests itself in the world. When awakened higher consciousness in man, when he would develop in themselves the possibility of more subtle perceptions, he will hear that a grand symphony that sounds in space from one end to the universe, and then he will understand the deep meaning of life. From the first cry to the last dying breath we are covered by the sea sounds and vibrations every second of our lives. This original sound of the creator, we are angels and atoms, is the essence from which so ok tailored reality and dreams, creatures and Reality.

Depression and Men's Health

2010-12-07T04:38:00.000-08:00

According to WHO, nearly 40% of men aged 40, 50% in the age of 50 suffer from erectile dysfunction (ED). Despite the large number of diseases that can lead to erectile dysfunction, ED is often caused by the peculiarities of the psyche men. And if we take into account the fact that the violation of any organic ED necessarily accumulates a psychological component, then it becomes clear how important are psychological causes of erectile dysfunction among all other causes. A high co-morbidity of depression and ED. The risk of developing depression during their lifetime for men is 5-12%.

Almost every man sooner or later faced with a violation of potency - weak or absent erections. The unexpected lack of potency - is not a disease and not a cause for despair, and the signal of violations of internal processes. Impotence can be caused by both psychological and physical reasons. Often, the violation of potency cause stress - one of the most frequent companions of the modern business man. Potency is sensitive to vitamin deficiency, lack of protein, minerals and amino acids, it can trigger chronic disease. Faced with erectile dysfunction, men need to remember that the potency - it is part of a single functioning organism, the failure of which may lead to an annoying male weakness. It is therefore important to restore power to take care of that present in the diet rich in vitamins vegetarian food, meat, fish, nuts and pumpkin seeds and other "providers" of vitamins and minerals. In order to effectively deal with the violation or the weakening of potency, it is necessary to pass a general examination in the first place - the presence of diseases and disorders of the genitourinary system, seeking treatment for chronic diseases, to draw attention to a multivitamin. Peculiarities of the potency - its cyclical nature, many men lack or weakening of erectile dysfunction caused by one of the above reasons, it becomes an occasion for shyness, distressing thoughts and feelings before the permanent repetition of this unpleasant situation. Anxiety, depression, confusion provokes stress, as a result of accidental failure of the body because of fatigue or ill health can lead to persistent erectile dysfunction. Today, in violation of the potency of faces, almost half of mature males, aged 35-40 years. In order to avoid such unfortunate events as the problems with potency, it is important to pay attention to the first symptoms, the first erectile disorders - have a reason to do your health, contact a professional and restore confidence in himself and his masculinity.

Healthy Baby and Pregnancy Vitamins

2010-07-20T06:10:00.000-07:00

Prenatal natural vitamins are expressly for women who are pregnant or nursing their children. Many doctors recommend that pregnancy nutrients be taken prior to conception and even following the baby is born for general health of mother and child. It is very crucial to both the health of the baby and the health of the mother that she take vitamins just in case her diet does not provide enough of the nutrients she and her baby need. The nutrients folic acid, calcium and iron are especially important.

Women can have a higher blood count when they replace loss of iron by taking a multivitamin supplement with iron. Another benefit from taking such a supplement it can also cause them to have less tiredness and more energy. Women who have tender breast can find a vitamin E supplement helpful.

Women over the age of thirty five need to take extra calcium every day. Women from the age of thirty five until menopause need 1,000 mg of calcium every day. 1,500 mg per day is needed after menopause. Women who take estrogen after menopause only need 1,000 mg per day because of the effects of estrogen on their bodies they will not require the extra calcium. The Journal of the American Medical Association revealed that taking prenatal vitamins for six weeks or longer before getting pregnant offered some protection against neural tube defects in the baby. The key element seems to be folic acid.

Psychotherapy and psychoanalysis depression

2010-07-17T05:25:00.000-07:00

The most important condition for psychotherapy of depression and depressive personality is organized atmosphere acceptance, respect and patient effort in understanding. Most works on psychotherapy and psychoanalysis emphasize the special style relations, specially adapted to the treatment of depressive patients. We want to emphasize how important is it therapeutic position in the treatment of depressive patients. Because these patients have the "radar" for the finest checking their fears of criticism and rejection, psychotherapist should be specifically seek permanent non-judgmental and emotionally.

For obvious reasons, patients with disabilities more effective psychotherapy requires opposite conditions. Their assumptions about their own unworthy of love and the horrors of rejection is so thorough and accurate that, not having the freedom to follow closely the face of the psychotherapist and without confirming the invalidity of their worst fears, they would be too disturbing to speak freely. Psychotherapist must devote sufficient time to demonstrate acceptance, before even waiting conscious rejection from depressed patients can become public scrutiny and gradual correction.

If contact depressed patients with anger and other negative feelings are encouraged, they often explain why can not observe their own risk and hostility towards psychotherapists: "How can I angry at someone who so badly need me?". It is very important that the psychotherapist does not support such reasoning.

Instead, it should draw attention to the fact that this issue contains a hidden assumption that anger leads to a separation with people. For depressed individuals often becomes a discovery that freedom, with a tolerance of negative feelings increases intimacy, while the state of falsehood and lack of contact with the data leads to feelings of isolation. Anger is contrary to normal dependence only if the person from whom experienced addiction, responds to this pathologically - circumstance, which defines children's experience of many depressed patients.

Depression and Antidepressants

2010-07-17T05:12:00.000-07:00

Depression is the most common serious mental disorder worldwide
* Depression affects approximately 121 million people worldwide and is the fourth leading cause of disability and premature death.
* The World Health Organization projects that by the year 2020, depressive disorders will become the second-leading cause of disability worldwide.
* Depression is the most prevalent mental health condition in the United States, affecting approximately 19 million American adults each year.
* Studies indicate that depressive episodes occur twice as frequently in women as in men.

Depression and Antidepressants:

Antidepressants increased the risk of suicidal thinking and behavior (suicidal) in short-term studies in children and adolescents with MDD and other psychiatric disorders. Anyone considering the use of any antidepressant in a child or adolescent must balance the risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidal or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

Depression Definition and Considerations

2010-07-17T04:29:00.000-07:00

Depression may be declared as activity sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or addition for abbreviate periods.

Alternative Names:

Blues; Discouragement; Gloom; Affection changes; Sadness; Melancholy
Considerations
Depression is about ranked in agreement of severity - mild, moderate or severe. The amount of your depression, which your doctor can determine, influences how you are treated. Affection of abasement include:

* Trouble sleeping or boundless sleeping
* A affecting change in appetite, about with weight accretion or loss
* Fatigue and abridgement of energy
* Animosity of worthlessness, self-hate, and inappropriate guilt
* Extreme adversity concentrating
* Agitation, restlessness, and irritability
* Inactivity and abandonment from accepted activities
* Animosity of abasement and helplessness
* Recurring thoughts of afterlife or suicide
Low cocky admire is accepted with depression. So are abrupt bursts of acrimony and abridgement of amusement from activities that commonly accomplish you happy, including sex.

Pregnancy Womens

2010-07-13T06:57:00.000-07:00

Pregnancy is a very beautiful moment in a woman's life, however hormonal changes occur in our body that alters its normal behavior. This is the reason why it's important for us women to take good care of our teeth and gums while we are pregnant. These hormonal changes increase the risk of developing gum disease because it makes gums more sensitive, which makes it easier for gingivitis to develop, and this can affect the health of the unborn baby. Molar pregnancy is a complication during pregnancy that only occurs in 1 in 1,000 pregnancies.

Spotting is the most common sign. Hyperemesis and uterine enlargement beyond that expected for gestational dates could also be an indication. Call your doctor right away if you notice unusual spotting, so your health care practitioner can do an ultrasound check and do a blood test to measure levels of hCG. Moles can be partial or complete. Complete moles are more likely to be associated with medical complications. Pregnancy-induced hypertension, formerly known as preeclampsia, a pregnancy-related complex of symptoms that may include edema, hypertension, and proteinuria, may occur.
In other words, this type of molar pregnancy only includes the "placental parts," with no babies present in the uterus. The egg is still being fertilized by the sperm cell. However, the egg cell is unfilled, hence, no baby will be developed. The placenta grows in time, thereby creating the concept of conception. This is because the placental growth produces the pregnancy-related hormone known as the hCG.

Symptoms of Early Menopause and Pregnancy

2010-07-08T06:01:00.000-07:00

Early menopause and pregnancy symptoms share some of the same symptoms making it very important for you to see your doctor if you suspect either and you are over 35. You want to rule out anything else more serious.
If you are in early menopause, there is a variety of symptoms that will occur to a greater or lesser degree for all women. Some women are lucky enough to barely notice these things but for many others, the symptoms can be moderate to severe which may require medical intervention.

There are the well known hot flashes and night sweats. Unexplained changes in things including your menstrual cycle, blood sugar levels, sudden depression, and irritability have been noted. Your moods might be extremely variable, you may lose interest in sex, or become suddenly depressed. Your hair growth and quality may change. Dryness of the vagina and water retention is common. Chronic headaches, extreme fatigue and sleep problems are also experienced by many women. Yeast infections, cramps, body aches and pains, as well as changes in blood sugar levels. You will likely experience irregularity in your period and bleeding, this is due to the ups and downs of hormone levels.

What causes Depression?

2010-07-02T04:54:00.000-07:00

There are a number of possible causes of depression:

- Depression can be a reaction to a distressing situation like loss or stress (reactive depression). Some women experience depression following the birth of a child (post-natal depression).
- Depression can be part of an illness like bipolar disorder in which the person experiences extreme moods without any reason –very high and very-excited or very low and depressed.
- Depression can be unrelated to any outside cause, but associated with a chemical imbalance in the brain (endogenous depression). Sometimes the person may be affected so much that he or she experiences the symptoms of psychosis and is unable to distinguish what is real.
- Children and teenagers can also become depressed. This can show itself in different ways to depression in adults, and they are best helped by a doctor who is a specialist in this area.

Menopause and Depression

2010-07-02T04:27:00.000-07:00

Everybody dreams of a good sex life and very few actually are able to achieve it. People keep questioning about the secret to a good sex life but few are able to find it. Now, the cat is out of the bag and everybody can have a satisfactory sex life. Magic power coffee, is the answer to all your problems regarding your sex life. You can enhance your sexual desires with this 100% natural product. The side effect of using this product is limited to a satisfied and magical sex life. Menopause is a the final physical transition in women's reproductive lives. It poignantly signals that a part of life... the possibility of bearing new life into the world through our physical bodies is now irrevocably gone. Whether we have had the experience of motherhood or not, whether we are still shepherding our offspring into their own futures or whether they are all firmly ensconced in their own lives.... something potential is lost-and-gone-forever when we make this passage.

As women we make different choices regarding our willingness to tolerate the physical symptoms the hot flashes, disturbed sleep and undependable memory being among the most most prominent. We may even choose to chemically postpone the onset of the experience altogether by taking hormone supplements. For those of us who decide to suffer the process more or less naturally however, it is worth noting that perimenopause and menopause are powerful and universal psychological experiences and not just physical ones.

Antidepressant medications and Sex Life

2010-07-02T03:40:00.000-07:00

Our world today focuses on "quantity sex" not "quality sex", we are more tripped when we hear of people who either sleep around or have more than one sex partner - we are all the more elated when we hear of group sex or orgies - yes, we have become that crazy about quantity. To prevent depression, anxiety and panic attack, you need a qualitative sex life that is both pleasurable and meaningful.

When you think about it, antidepressant medications often interfere with our joy of living. Here are just two examples why people turn to herbal treatment for depression. The first one is that they may interfere with libido or sex drive and a large number of patients experience sexual dysfunction. Secondly they may actually increase suicidal thoughts and or behavior especially at the beginning of the treatment. The most effective and popular herbal depression remedy on the market to-day is Gingko Biloba.This is not only good for depression but can also improve the flow of blood to the genital area. It improves memory and because it improves circulation all round, it can enhance brain performance. It is also an excellent antioxidant. But just one herb is hardly going to resolve herbal treatment for depression. The brain chemical serotonin is responsible for not only our good moods but also our sex drive and appetite. Any treatment whether herbal or just simple lifestyle changes can have a profound effect on our serotonin levels.

Depression symptoms

2010-06-17T05:18:00.001-07:00

Clinical depression is an illness, a medical condition. It significantly affects the way someone feels, causing a persistent lowering of mood. Depression is often accompanied by a range of other physical and psychological symptoms that can interfere with the way a person is able to function in their everyday life. The symptoms of depression generally react positively to treatment.

What are the symptoms:

Depression has a variety of symptoms and will affect everyone in different ways. Symptoms include: feeling extremely sad or tearful, disturbances to normal sleep patterns, loss of interest and motivation, feeling worthless or guilty, loss of pleasure in activities, anxiety, changes in appetite or weight, loss of sexual interest, physical aches and pains, impaired thinking or concentration.

Modern teens get stressed on a regular basis. Some of this teen stress is caused by the changes that are occurring in their bodies - reaching puberty can be stressful for many a teen. But our modern lifestyle and education system can also be big causes of teen stress.

Our school system is a big contributor to teen stress. There's the everyday stress of how friends and classmates perceive us. It doesn't matter to the average teen that everyone who they think is judging them is almost certainly going through the same struggle themselves. At this age, it can often be a case of "everyone else is against me", which can be one of the major causes of teen stress in itself. Then you can add in the pressure of seemingly constant exams and tests. Parents contribute to the stress here by expecting their teen offspring to always perform well in class so that they can get to college and eventually get a high paying job. SATS scores are always being compared and, of course, there is the extra pressure incurred if the scores aren't high enough to get through the next level of education.
Is it any wonder that our modern education system is high up there amongst the causes of teen stress? So what can be done to help relieve the causes of teen stress? First and foremost is helping your teenager to realize that it's not just them. If we're not careful, our teenage years can be quite isolated. Modern teens can easily retreat to their rooms and surround themselves with loud music, computer games and other distractions. You need to help your teen to relax once in a while. Exercise can help and playing a regular sport is an advantage. But for the athletically challenged, there are other ways. These can involve simple mind exercises that relieve the tension that has built up and manifested as teen stress.

Stress and Women

2010-06-17T03:56:00.000-07:00

Stress incontinence is often caused by a weakening of the pelvic floor muscles. As these muscles lose tone, your bladder can drop from its normal position. When this happens, the urethra may not close all the way, resulting in leakage. When you cough, sneeze, laugh, or work out, the extra pressure on your abdomen may cause you to wet your pants.

Who's At Risk:

Just about any woman, from your teenage daughter to your grandma. Women go through many physical changes in their lives, and any of them can result in weakened pelvic floor muscles:

- Menopause
- Getting pregnant and having a baby
- Having surgery
- Menstruation

Natural remedies can help. You'll want to look for a remedy that contains both water-soluble pumpkin seed extract and soy germ extract. Pumpkin seed has a long history of use for urinary problems, and soy extract contains phyto-estrogrens, which are especially helpful for post-menopausal women. These remedies are safe and effective, with few, if any side effects.

A number of sociocultural studies indicate that stress may increase the risk of alcoholism. In other words, an individual's ability to cope with stressful situations may indicate his or her vulnerability to alcoholism.

A study in Alcoholism: Clinical & Experimental Research has found that individuals with a family history of alcoholism exhibit a dysfunction in their stress response prior to the development of alcohol dependence, while individuals without a family history of alcoholism exhibit a dysfunction in their stress response following the development of alcohol dependence.

Pregnant Women's and Depression

2010-04-09T05:21:00.000-07:00

Women are generally very emotional and sentimental in first few days of pregnancy. Near about 20% pregnant women need antidepressant treatment every year. Actual ratio is definitely bigger than that as women are taken very softly in the pregnancy period and this turns into neglecting psychological diseases. Safety measures in pregnancy and over cautious subjective view make them more emotional and depressed. It may cause serious psychiatric effects on a pregnant woman. Antidepressants can harm the child of a pregnant woman. But even the depression can harm the baby. So, it depends on the severity of the disease and the decision of the caretakers of a patient.
Depression in a pregnant woman can cause some problems to a newborn. Those are irritability, less attentiveness and slowness in activities. Short gestation period is also one of these affects. The intake of antidepressants can cause some serious problems like pulmonary hypertension, weight reduction and cardiac defects in the newborn baby. Identifying depression is very difficult in pregnancy. Generally, women become emotional, homesick and hyper in pregnancy. Over attention and some physical changes make them upset.
Symptoms of Depression
One of the first things we notice about others, and sometimes even about ourselves, is that people become sad. It's a part of being human. At times some people dip below a certain level, they begin not only to feel sad, but they begin to feel that their life is hopeless. Activities that used to be fun are no longer gratifying. Sometimes the signs are there, but we don't necessarily connect the dots ourselves, which is why diagnosis by a professional is needed. It's not a black and white issue, and often people slip into the lower levels of experience and it can be hard to recognize that symptoms may be connected and that you might have depression. The professional will examine the factors, and the two most important are hopelessness and a loss of interest in your daily activities. There are so many factors that a physician or psychologist, or other professional will examine, which include, but are not limited to a change in sleep habits, eating habits, feeling worthless, fatigue, trouble concentrating, thinking about death or suicide, feeling unworthy or guilty for no reason, feeling restless. Sometimes the symptoms can be misleading. For example, maybe a person is having headaches and body aches, digestive problems, has a low energy level, or maybe it is a general lethargic feeling. The symptoms may just look like a cold, or something else, but in fact may be depression. Like any medical condition, it is best to get a diagnosis as early as possible. Your doctor is the first one to consult. If you are in fact experiencing depression, your doctor will make the appropriate referral.
The situation:
1. Difficulty concentrating, remembering details, and making decisions
2. Fatigue and decreased energy
3. Feelings of guilt, worthlessness, and/or helplessness
4. Feelings of hopelessness and/or pessimism
5. Insomnia, early-morning wakefulness, or excessive sleeping
6. Irritability, restlessness
7. Loss of interest in activities or hobbies once pleasurable, including sex
8. Overeating or appetite loss
9. Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
10. Persistent sad, anxious, or "empty" feelings
Sudden changes in mood, low energy are very usual symptoms in all pregnant women. If a pregnant woman is upset most of the time, addicted to drugs or alcohol and stagnant low in energy, then these are few symptoms of depression in pregnancy. Poor prenatal care leads to unhealthy pregnancy in many cases. If the disease is at a primary level, it can be treated with psychotherapy sessions. These can be taken in combination with medication too. In such cases doctors and therapists need the permission of the caretakers of the patient. Those women, who have very minute clinical depression, can choose to be pregnant. But before planning so, you need to stop all the antidepressant medicines at least before 6 months. It should be done with the advice of your gynecologist and psychiatrist. In the case of severe clinical depression, there is no point in taking the risk for both, baby and the mother.

Depressive bipolar signs

2010-04-08T06:11:00.000-07:00

Bipolar complaint symptoms fall into three main categories. These are the manic manifestations, psychotic symptoms, and depressive bipolar condition characteristics. Manic bipolar condition characteristics are numerous. They all share a particular feeling, though. Everything is faster, grander, and generally bigger than life. An individual in a manic state might be more active than normal. He or she may think and talk faster than he or she ordinarily does. Everything about that person is exaggerated, including their overwhelming feeling of self importance. Such a person may have grand schemes and adventures in the works. When these plans do not pan out, that person will broadly speaking position the blame on some extraneous factor if, in point of fact, he/she takes the time to consider it in the least. Usually, it's simply off to the next idea. These are the not only whimsical behaviors, but are actually bipolar disorder signs. When manic, people tend to be reckless. They can finally end up doing things that effect their personal human relationships or may go so far as landing them in jail. This may be observed by someone who is not tuned in to bipolar disorder manifestations as simply an issue with their conduct. The truth is that people need curative to do better. It isn't just a point of making up one's mind to do the correct thing. There are, in addition physical bipolar condition characteristics of mania that may be rather obvious. A person who feels little or no requirement for food or sleep may come to be in a manic state. While some may well be in a position to function this way, at any rate for awhile, a good number of us need rest and sustenance to maintain ourselves. Psychotic bipolar disorder signs come mostly with mania, but can come often with mixed moods and often times with depressive bipolar disorder characteristics. Psychosis merely denotes a chance with reality. This can enter the sort of hallucinations, both auditory (hearing voices, etc.) and visual. Delusions, or false beliefs, are also bipolar condition characteristics. For instance, an individual may falsely feel that he/she is actually some famous historical figure. During depression, bipolar condition signs can often be easily seen if one is willing to look carefully. Apathy can be a signal of depression, but other clues are even more telling. Indecisiveness and low pride seem to go together in depressive bipolar signs.

Bipolar Disorder - Causes, Symptoms and Treatments

2009-11-12T06:15:00.000-08:00

A bipolar disease is a serious mental problem where the patient constantly subjected to severe mood swings. It is a strange mental disorder where the patient undergoes maniac events at higher swings and extreme depressions and lower moods. Manic-depressive disorder, the other name of the bipolar disease is a mental illness that caused in early adulthood of humans. Recent researches shows that even preteen children and teenagers can also be affected by bipolar disease.

This bipolar disease can dent a person badly with frequent mood swings by throwing into depressions. Millions of people across the world are already the victims of this chronic mental sickness. This sickness causes lot of problems in a patient's day to day life thus affecting his social and family relations. This disorder even drags patients into committing suicides at extreme moments of depression.

Causes:

There aren't any specific scientifically proved causes for bipolar disease. This mental disorder generally develops in a person who has been undergoing far too many problems. The family problems, partner relations and other social related issues generally lead a person to grow bipolar disorder in him. Often the problematic living and working environment can cause this manic-depressive disorder. Some studies say that extreme stress and depression can lead to bipolar disease. However some researches claim that bipolar disease is caused due the improper balance of chemicals in the brain.

Symptoms:

The frequent swinging of the mood is the primary symptom of bipolar disease. At the highest end of it, in manic event, patient tend to feel so energetic and happy than before, highly satisfied and sometimes go over confident. During this manic episode, patients tend to do some weird things which sometimes might put them in danger. After the completion of this manic event, patient tend to develop the opposite character .i.e. extreme depression. In this period, patient normally experience extreme ends of sadness, frustration and hopelessness.

This is the period of time where patient finds his day to day life difficult to cope with. It consider to be the dangerous time where sometimes patient might become suicidal. These two events, manic episode and depression episode generally follow each other on a cycle. Each episode lasts for a day, week or months depending upon the mental condition of the patient. The intensity of the manic and depression events varies from patient to patient.

Available Treatments:

First of all, it's very difficult to diagnose bipolar disease. There aren't any lab tests possible to conclude whether this disorder occurred to a person or not. It's only the doctor who concludes the disease after collecting some information from patient about his personal experiences. There are no instant treatments to cure the disease at once. A scheduled course of medication will be prescribed by doctor which includes anti psychotics, antidepressants and mood stabilizers. Apart from this, a regular counseling by doctor will minimize the symptoms of the disorder. Parents and family members of the patient can play a good role by providing better living conditions.

If you are having trouble identifying the symptoms of bipolar disorder, you may want to begin by taking a look first at mania, and then at major depression. Understanding these two, not as extremes of bipolar disorder, but as individual mental conditions, can help you come to terms with the symptoms of your own disease.

It is normal for you to function normally between your extreme episodes in this disorder. That does not mean by any rate that you are safe from the worst of the condition. The symptoms of the next phase of it may come so suddenly you never get a chance to recover from them. That is why you cannot flirt with the disease in any way. Deal with it seriously, rather than kid with it. If you kid with it, it could end up really dealing you a deadly blow, at the worst possible time.

Be careful that you do not end up treating the symptoms of bipolar type of disorder rather than the disease. If there is anything that that can achieve, it is only to make the condition worse. As a matter of fact, it is to avoid things like that that a psychologist often takes a lot of meticulous care in diagnosing the condition.

Types of Depression

2009-06-23T05:53:00.000-07:00

20-35% of people suffering from depression, unable to lead normal lives. Other periods alternate with periods of depression of normal self. A third severe depressive downs ups alternate with incredible mood. Below are descriptions of the most common types of depression.

Clinical Depression

When depression is expressed, which requires treatment, it is called clinical. As worsening symptoms indicate severe depression. This condition is still sporadic.

Distimia

Apart from occasional depression, there distimia - depression, which is prolonged, repeated again and again for a long time. If a person suffering from distimia develop symptoms of clinical depression, suggests a double depression.

Bipolar disorder

This condition, also known as manic-depressive syndrome, characterized by sudden inexplicable shifts is very poor and very good mood. Scientists believe the cause of this disorder shortages of certain substances necessary for the brain. With the help of medication bipolar disorder is treated in 80% of cases.

Seasonal Depression

The reason for this depression is not only in the individual, but also in the environment. According to researchers, some people are stronger than others to suffer from a lack of natural light. Treatment of this type of depression is based on ensuring the necessary level of lighting man.

Who falls into a depression?

* Women compared with men, nearly 2 times more likely to suffer clinical depression. The frequency of bipolar disorder does not depend on sex. Depression affects equally the representatives of different ethnic groups.
* Depression often occurs in people aged 25-40 years. Especially, this disease is widely prevalent among people born after 1945 Perhaps this is due to social factors (the increase in the number of single-parent families, changing social roles, the influence of stress). However, depression affects people of all ages, even children. Specialists believe that this problem facing the 2% of children and 4-8% of adolescents. It circumvents it by the people and the older generation.
* Often suffer from depression, people with a hereditary predisposition to the disease.
* Often depression is accompanied by another illness, mental disorders, alcohol and drug addiction.
* Marriage can be both positive and negative factor in the development of depression. Compared with the single, people who have a permanent partner, less likely to suffer from clinical depression. On the other hand, depression often develops in those who become dissatisfied with their partner. Less often, men suffer from depression, living in a happy marriage.

Fitness against depression

2009-06-23T05:37:00.000-07:00

Trying to escape from depression? And what about that ... swim away from it? Or go on a bike? Try it certainly is!

Physical exercise - one of the best ways to overcome clinical depression.

Exercise can improve mood and alleviate the unpleasant symptoms. In conjunction with psychotherapy and medication, physical activity helps to get rid of depression forever.

Physical workload affect neural mediator - substances that provide a link between brain neurons. Depression is a violation of the balance neuromediators serotonin and nor epinephrine, and training helped him recover.

Exercise stimulates the formulation endorfinov - hormones of joy. In addition, they reduce the amount of cortisone (stress hormone), relieve muscle tension and improve sleep. During the depression people experience stress. Another symptom of depression - sleeplessness, which also affects the quality of life. Solving these problems will help to cope with the disease.

High self-esteem - the key to victory over depression. One of the signs of depression - a frustration, the inability to assess its external and internal beauty. Exercise rid you of excess kilograms and naturally improve your self. You will regain confidence and satisfaction.

By nature, enjoy the beauty of trees, flowers and the surrounding areas, even the neighbor dog. Depression is often not seen many and varied aspects of life.

Training - this time you have devoted yourself personally, when you can solve their problems and feel better. Tell yourself: «I am a good man, I have been useful, exercises will strengthen my heart, protect me from disease and give me many years of healthy, active life».

As a first step?

Depression reduces the motivation of people, dulls the desire to engage in something useful for themselves. Hardly anyone would want to deal with them when you feel broken and bleeding.

Most likely, the first thing is to contact a counselor or a doctor, who will pick up drugs to fight on the psychological front. In addition to health care, start to train - at least 30 minutes a day! Do not drop exercise, even if you choose a suitable antidepressant: Physical activity helps to keep emotions under control. Ask your doctor what exercises suit you best.

Think about what kind of sport you are most like. Race walking? Weightlifting? Make a choice and start studying!

Do not expect that, once you reach tangible results. Excessive expectations - mortgage failures. If you do not have enough forces on the normal training, shorten its duration. If you are unable to train today - never mind. Home - remember that regular exercises are a major tool towards freedom from depression.

How to survive the miscarriage?

2009-06-23T05:29:00.000-07:00

Upon learning of the pregnancy, the woman thinks about how her life changed with the birth of a child. She picks up baby name, mentally subject the children's room. Many hesitate to share good news with family and friends ...

But sometimes bad luck happens. Suddenly, there is bleeding, and the doctor tells a terrible sentence. Or, at the time of ultrasound in the second trimester - when the future mom seems that the main difficulties behind us - found that the baby's heart is not beating. This is the collapse of all hopes.

Regardless of the date on which a miscarriage, the feelings of bitterness, frustration and even anger seized the woman entirely. Ambient call to come to terms with the loss, especially if the miscarriage occurred at an early stage. They can not understand the grief of the mother failed, because I did not feel a special connection with the invisible child. In addition, the surrounding is often forgotten about the child's father, who also needs support.
Here are some tips to help you cope with grief:

* Let go of guilt. You may want to ask myself how many: «What do I do?». In fact, you, of course, nothing to blame. Perhaps the cause of miscarriage were congenital abnormalities in the development of the fetus. You simply can not change anything.
* Mourn for the child, let out a heavy feelings. Friends, relatives and other well-wisher will be advised as soon as possible to return to normal life, but it is important for you to experience what happened. Do not force the event. If you regularly work, it is a week of vacation to come to you.
* Seek support. Try to be surrounded by people who understand you. To sense the loss of a little blunt, required days and weeks. Support your loved ones ease the suffering. Talk to a psychologist or discuss the situation with a woman who also once had a miscarriage.
* Do not listen to what you say. Lover will tell you impolitic things. Even if their intentions are perfect, comments like «It happened because ...» or «It was not the last pregnancy» will bring more harm than good. Do not take these words to heart.
* Do not hold evil on a partner. Perhaps you think that a man going through a less due to the loss of a child. This is not necessarily so. Restraint does not mean that a man indifferent. Everyone copes with emotions in his own way, each - their ways of dealing with stress.
* Do not be nasty to you. Against the backdrop of emotions about their loss, to hear the news about the pregnancy or the birth of successful friends and relatives simply unbearable. Anger and resentment can arise from a thought that other women had become mothers, and you do not. This is a predictable reaction. Unfortunately, it can save time only.

After a miscarriage, some women want to immediately conceive another child, the other for a long time not thinking of motherhood. The most appropriate time for the next attempt to establish a conception doctor. Throughout this difficult period, try to be open to a man - this will help you both cope with the pain of loss.

When To Call a Doctor

2009-05-28T07:02:00.000-07:00

If you have bipolar disorder, call 911 or other emergency services if you:

* Think you cannot stop from harming yourself or someone else.
* Hear voices that are new or more upsetting than normal.
* Want to commit suicide, or you know someone who has mentioned wanting to commit suicide.

Warning signs of suicide include:

* Use of illegal drugs or drinking alcohol heavily.
* Talking, writing, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives.
* Spending long periods of time alone.
* Giving away possessions.
* Acting aggressive or suddenly appearing calm.

What Increases Your Risk

2009-05-28T07:00:00.000-07:00

Bipolar disorder can be passed down through families. If anyone in your family has been diagnosed with bipolar disorder, your risk of developing it is higher.

If you have bipolar disorder, changes in sleep or daily routines can increase your risk for a manic episode. Antidepressant medicine can trigger a manic episode in someone who has bipolar disorder. But this may occur before someone is diagnosed with bipolar disorder, while he or she is seeking treatment for an episode of depression.

A stressful event may trigger an episode of mania or depression.

Your risk of either a depressive or manic episode increases if you do not take your medicines as prescribed by your doctor. It is common for people to stop taking their medicines during a manic phase when they feel good. Even if you are feeling better, you must take your medicines regularly to control bipolar disorder.

Alcohol or drug use or abuse puts you at a high risk for having a relapse of mood disturbances

What Happens if you have Bipolar Disorder

2009-05-25T01:33:00.001-07:00

With bipolar disorder, you alternate between episodes of depression and mania. In between, you may return completely to normal or have some remaining symptoms. The extreme mood changes may come on suddenly or appear more slowly.

During a manic episode, you may be abnormally happy, energetic, or very irritable for a week or more. Initially, you may feel incredibly productive or creative. You may feel powerful and seductive and think there is nothing you can't accomplish. But as a manic episode progresses, you may behave wildly and irresponsibly, spending a lot of money, getting involved in dangerous activities, and sleeping very little. You may also have a hard time functioning in your job and relationships.

After a manic episode, you may return to normal, or your mood may swing in the opposite direction and you may feel useless, hopeless, and extremely sad. When you are depressed, you may have trouble concentrating, remembering, and making decisions. You may have changes in your eating and sleeping habits. And you may lose interest in things you have enjoyed in the past. Some people become suicidal or harm themselves during episodes of depression. Some feel as if they can't move, care, or think.

Men tend to have more manic episodes, while women have more episodes of depression.6

Initially, stress may trigger depression or mania. But as the illness progresses, mood swings may not be caused by any specific event. Without treatment, your bipolar disorder may get worse, causing you to move more often between mania and depression.

People with bipolar disorder are more likely to have one or more risk factors of cardiovascular disease, including obesity, high blood pressure, and diabetes.7 Your physical health will be watched closely by your doctor.

Types of bipolar disorder

2009-05-25T01:31:00.000-07:00

* Bipolar I. Considered the classic form of the illness, bipolar I causes recurrent episodes of mania and depression. The depression may last for a short time or for months. You may then go back to feeling normal for a time, or you may go right into a manic episode.

* Bipolar II. If you have bipolar II, you will experience depression just as in bipolar I. But the episodes of mania are less severe (hypomania). People with bipolar II have more depressive episodes than hypomanic episodes.

* Rapid-cycling bipolar disorder. If you have rapid-cycling bipolar disorder, you will experience at least four episodes of depression, mania, or both within a 12-month period. You may go directly from an episode of depression to an episode of mania, or you may have a short time lapse between the two extreme moods. The mood swings are the same as with other types of bipolar, but the frequency of mood swings distinguishes rapid-cycling bipolar disorder from the other subtypes.

Some people may have bipolar disorder with mixed symptoms, in which episodes of depression and mania occur together. Symptoms include sadness, euphoria, and irritability. Other symptoms can include agitation, lack of sleep, appetite changes, and possibly, thoughts of suicide. This makes the disorder challenging to treat and very frustrating for you and for those around you. It can also lead to hospitalization if your daily functioning becomes impaired.

In addition to changes in mood, some people with bipolar disorder also have symptoms of anxiety, panic attacks, or symptoms of psychosis.

Symptoms of bipolar disorder in children can be very different than those in adults and can be confused with other childhood mental disorders, such as depression or attention deficit hyperactivity disorder (ADHD). Bipolar disorder in children significantly interferes with a child's ability to function in school, with friends, and at home.

Some other conditions with symptoms similar to bipolar disorder include depression, schizophrenia, and attention deficit hyperactivity disorder (ADHD).

People with bipolar disorder—men more often than women—may have substance abuse problems, especially during manic episodes.4 Abusing alcohol or drugs may affect treatment and interfere with taking medicines as prescribed. Other disorders that may occur along with bipolar disorder include:5

* Obsessive-compulsive disorder.
* Panic attacks or panic disorder.

These illnesses need to be treated along with the bipolar disorder.

Bipolar Disorder Symptoms

2009-05-25T01:29:00.000-07:00

Bipolar disorder causes extreme mood swings, from feeling overly energetic (mania) to feeling very sad or having low energy (depression).

Mania may cause a person to:

* Feel extremely happy or very irritable.
* Have a very high opinion of himself or herself (inflated self-esteem).
* Not need as much sleep as usual (feel rested after 3 hours of sleep).
* Talk more than usual.
* Be more active than usual.
* Have difficulty concentrating because of having too many thoughts at the same time (racing thoughts).
* Be easily distracted by sights and sounds.
* Act impulsively or do reckless things, such as go on shopping sprees, drive recklessly, get into foolish business ventures, or have frequent, indiscriminate, or unsafe sex.

Depression may cause a person to:

* Feel sad or anxious for a significant time.
* Feel hopeless or pessimistic.
* Have slowed thoughts and speech because of low energy.
* Have difficulty concentrating, remembering, and making decisions.
* Have changes in eating and sleeping habits leading to too much or too little eating or sleeping.
* Have decreased interest in usual activities, including sex.
* Have suicidal thoughts.
* Not enjoy things he or she normally would enjoy.

Who is affected by bipolar disorder?

2009-05-25T01:28:00.000-07:00

Over 3 million Americans—about 1% of the population, or 1 in every 100 people—have bipolar disorder, with similar rates in other countries. Bipolar disorder occurs equally among males and females. It often begins between the ages of 15 and 24.

The cause of bipolar disorder is not well understood, although evidence suggests that the disorder runs in families.3 Your living environment and family situation may also play a role in the disorder. Episodes of depression and mania may be caused by a problem with certain brain chemicals called neurotransmitters.

Antidepressant medicines can trigger a manic episode in a person who has bipolar disorder. But this may occur before someone is diagnosed with bipolar disorder, while he or she is seeking treatment for an episode of depression.

Sleep deprivation or substance abuse, including caffeine, can cause a person with bipolar disorder to have a manic episode.

How is bipolar disorder treated?

2009-05-21T03:12:00.000-07:00

The sooner bipolar disorder is identified and treated, the better your chances of getting it under control. One of the most important parts of dealing with a manic episode is recognizing the early warning signs so that you can start treatment early with medicine that is especially for manic phases.

A variety of medicines is used to treat bipolar disorder. You may need to try several before you find the right combination that works for you.

* Most people with bipolar disorder need to take a medicine called a mood stabilizer every day.
* Medicines called antipsychotics can help get a manic phase under control.
* Antidepressants are used carefully for episodes of depression, because they cause some people to move into a manic phase.

People often have to try several different medicines before finding what works for them. Regular checkups are important so that your doctor can tell if your treatment is working.

Counseling for you and your family is also an important treatment. It can help you cope with some of the work and relationship issues that your illness may cause.

Charting your mood is one way you can start to see your patterns and symptoms. Keep a notebook of your feelings and what brought them on. If you learn what triggers your mood swings, you may be able to avoid them sometimes.

People often stop taking their medicines during a manic phase because they feel good. But this is a mistake. You must take your medicines regularly, even if you are feeling better.

How is bipolar disorder diagnosed?

2009-05-21T03:10:00.000-07:00

Bipolar disorder is hard to diagnose. There are no lab tests for it. Instead, your doctor or therapist will ask detailed questions about what kind of symptoms you have and how long they last. To be diagnosed with bipolar I disorder, you must have had a manic episode lasting at least a week (less if you had to be hospitalized). During this time, you must have had three or more symptoms of mania, such as needing less sleep, being more talkative, behaving wildly or irresponsibly in activities that could have serious outcomes, or feeling as if your thoughts are racing. In bipolar II disorder, the manic episode may be less severe and shorter.

Your urine and blood may be tested to rule out other problems that could be causing your symptoms.

What are the symptoms?

2009-05-13T07:06:00.001-07:00

The symptoms depend on your mood swings. In a manic episode, you may feel very happy, energetic, or on edge. You may feel like you need very little sleep. You may feel overly self-confident. Some people spend a lot of money or get involved in dangerous activities when they are manic.

After a manic episode, you may return to normal, or your mood may swing in the opposite direction to feelings of sadness, depression, and hopelessness. When you are depressed, you may have trouble thinking and making decisions. You may have memory problems. You may lose interest in things you have enjoyed in the past. You may also have thoughts about killing yourself.

The mood swings of bipolar disorder can be mild or extreme. They may come on slowly over several days or weeks or suddenly over a few minutes or hours. The mood swings may last for a few hours or for several months.

What causes bipolar disorder?

2009-05-13T07:04:00.001-07:00

The cause of bipolar disorder is not completely understood. We know that it runs in families. It may also be affected by your living environment or family situation. One possible cause is an imbalance of chemicals in the brain.

What is bipolar disorder?

2009-05-13T07:02:00.000-07:00

Bipolar disorder is an illness that causes extreme mood changes from manic episodes of very high energy to the extreme lows of depression. It is also called manic-depressive disorder.

This illness can cause behavior so extreme that you cannot function at work, in family or social situations, or in relationships with others. Some people with bipolar disorder become suicidal.

Having this disorder can make you feel helpless and hopeless. But you are not alone. Talking with others who suffer from it may help you learn that there is hope for a better life. And treatment can help you get back in control.

Family members often feel helpless when a loved one is depressed or manic. If your loved one has bipolar disorder, you may want to get counseling for yourself. Therapy can also help a child who has a bipolar parent.

Bipolar Disorder Treatment Overview

2009-04-08T06:06:00.000-07:00

Although mood changes and other symptoms associated with bipolar disorder are challenging, they can be managed effectively. Treatment usually includes medications (such as mood stabilizers) and professional counseling, and often a combination of both is needed.

Bipolar illness is a serious disorder that has a big impact on both the child and his or her family. Successful treatment requires that the child and family members understand what happens in bipolar disorder and that the family members help make sure that the child follows the treatment.

It can take time for you and your child to accept that the child has a serious, long-term condition that requires ongoing treatment and constant monitoring. However, keep in mind that by working with your child's doctor, you and your child can find effective treatment for the condition.

You and your child's doctor can discuss which treatment is right for your child. Older children and teenagers may want to participate in their own treatment decisions.
Initial treatment

The first step in determining appropriate treatment for your child with bipolar disorder is evaluating the severity of his or her symptoms. If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if he or she is out of touch with reality (psychotic) or unable to function, the child may need a period of hospitalization. Also, many medications can make the symptoms of bipolar disorder worse, and if your child is taking one of these, he or she may need to taper off and stop the medication. This should only be done under the supervision of a doctor.

Initial treatment usually includes medications and counseling.

Medications. Medications most often used include:

* Mood stabilizers, such as lithium (for example, Eskalith or Lithobid), divalproex (Depakote), carbamazepine (for example, Tegretol), lamotrigine (Lamictal), oxcarbazepine (Trileptal), or valproate (Depacon).
* Antipsychotics, such as olanzapine (Zyprexa) or risperidone (Risperdal), which your doctor may combine with a mood stabilizer for more effective control of manic episodes.
* Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac), or other types of antidepressants to control episodes of depression. While antidepressants can be helpful for some children, they might also trigger mania. A doctor will usually prescribe antidepressants with other medications that help regulate mood, and he or she must carefully monitor the child.

Before prescribing medicine to treat bipolar disorder, your doctor will check your child for possible suicidal behavior by asking a few questions. See a list of questions your doctor may ask your child.

Professional counseling.Counseling works best when symptoms of bipolar disorder are controlled with medications. Several types of therapy may be helpful, depending on the age of the child.

These include:

* Cognitive-behavioral therapy, which focuses on modifying certain thinking and behavior patterns.
* Interpersonal therapy, which focuses on social and personal relationships and related problems.
* Problem-solving therapy, a brief type of cognitive therapy that helps you find immediate solutions to problems.
* Family therapy, which can help educate and comfort the entire family.
* Play therapy for very young children.
* Psychological education and support groups.

Ongoing treatment

Ongoing treatment of bipolar disorder includes long-term treatment with medications and may include professional counseling.

Some children and adolescents do not respond to the first medication they try, and they may need to try several different medications to find relief from the symptoms. A combination of medication and professional counseling may be the most effective treatment.

An important part of ongoing treatment is making sure your child takes the medication as prescribed. Often people who feel better after taking bipolar medication for a period of time may feel that they are cured and no longer need treatment. However, when a person stops taking medication, symptoms usually return, so it is important that your child follows the treatment plan.

Medications for bipolar disorder have side effects that need to be managed. Some things you cannot change, such as increased urination (common with lithium). But you can deal with some side effects like weight gain (common with several medications used to treat bipolar disorder) by increasing exercise and reducing calorie intake. You can work with your child and his or her doctor to find ways of coping with side effects. If side effects from a medication are intolerable, the doctor may have to change the dose or the medication.

Some medications, such as lithium carbonate (Eskalith or Lithobid, for example) and divalproex (Depakote), require ongoing blood monitoring every few months. Your doctor may have to adjust the amount of medication your child is taking so your child has the right amount of medication for treatment.

During initial treatment, your doctor may prescribe a medication such as an antipsychotic for a short time to help your child deal with immediate symptoms. Once your child's long-term medications kick in and symptoms improve, he or she will need to taper off and stop the short-term medication.

Other ongoing treatment includes:

* Academic adjustments. If your child is in school, he or she may need a reduced homework load or school schedule during severe depressive or manic episodes. You can work with the school to find ways to help your child maintain performance requirements until the symptoms are under control.
* Relaxation and exercise. Steps your child can take at home to improve symptoms include:
o Getting regular physical exercise, such as swimming or walking, to help reduce stress.
o Avoiding the use of drugs, alcohol, tobacco, caffeinated beverages, and energy drinks.
o Eating a balanced diet.
o Getting enough sleep and keeping a regular sleep-wake cycle. (Children and teenagers need more sleep than adults.)

Sometimes treatment for other conditions can make your child's bipolar disorder worse. For example, treating depression with antidepressants can trigger or worsen a manic episode. Treating attention deficit hyperactivity disorder (ADHD) with stimulants may also trigger severe mania, depression, and even psychosis (loss of touch with reality). Treatment with corticosteroids for conditions such as asthma may also trigger a manic episode. Medications that intensify bipolar symptoms may need to be stopped altogether or changed to a different dose or medication. Sometimes an additional medication (such as a mood stabilizer) can solve the problem. However, each child responds to medications differently, and it may take several tries before your doctor can identify an effective medication or combination of medications for your child's conditions.

Learning as much as you can about childhood and adolescent bipolar disorder may help you recognize mood changes in your child as they begin to occur. Catching and treating these mood changes early may help reduce the length of the manic or depressive episode and improve the quality of your child's life.

Treatment if the condition gets worse

If your child's condition gets worse while he or she is undergoing treatment for bipolar disorder (including medications, counseling, and lifestyle changes), the doctor may give additional treatment. You and your doctor should:

* Make sure your child is taking medications as prescribed and following other treatment recommendations.
* Determine whether ongoing symptoms are caused by another disorder (such as attention deficit hyperactivity disorder or post-traumatic stress disorder), and treat the other condition if necessary.
* Identify and reduce stresses that may be making symptoms worse.
* Adjust the dose of medications if the current dose is not effective.
* Add or change medications if the current ones are not working.

A brief hospital stay may be necessary, especially if your child is showing any warning signs of suicide. The warning signs of suicide change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

For older children with severe bipolar symptoms who have not responded to medications, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals

What Happens when people are affected by Bipolar Disorder

2009-04-08T05:43:00.000-07:00

Often the first signs of bipolar disorder are severe moodiness, unhappiness, or other symptoms of depression. It is common for children with bipolar disorder to be diagnosed first with only depression and then later to be diagnosed with bipolar disorder after a cycle of mania or hypomania (a less severe form of mania).

A first manic or hypomanic episode can be triggered by a stressful situation or may occur without an obvious cause. It can also be started by certain medications used to treat other conditions. Drugs (such as antidepressants or stimulants) that are used to treat depression, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD) are sometimes prescribed to children with bipolar disorder who have not yet been correctly diagnosed. These drugs can trigger sudden bouts of mania, sometimes with bizarre, aggressive, or psychotic behavior. (However, these medications are sometimes effective for children with bipolar disorder when they are combined with a mood-stabilizing drug.)

In adults with bipolar disorder, mood swings usually occur over weeks or even months. In children, cycles usually occur more rapidly, sometimes within the same day (rapid, ultra rapid, or ultradian cycling). Frequently, children with bipolar disorder have difficulty getting going in the morning but then have intense energy later in the day. Often the mood shifts are continuous, rarely returning to a normal mood between extremes. Sometimes elements of depression and mania or hypomania may be present at the same time (a mixed state). These rapid and severe mood changes may make your child appear constantly irritable, and they can significantly interfere with your child's ability to function at school, at home, and with peers.

Children with mania can be more irritable and prone to temper tantrums or destructive outbursts than adults with mania. In a depressive episode, children may complain of headaches, muscle aches, stomachaches, or fatigue. They frequently miss school or talk about running away from home. They become socially isolated and overly sensitive to any kind of rejection or criticism.

While all teens may be rebellious or make bad choices from time to time, teenagers with bipolar disorder are more likely to show poor judgment, take risks such as breaking the law or having unprotected sex, and believe they are more powerful or important than they really are (delusions of grandeur) during manic episodes. A teen in a depressive episode may withdraw from social activities, do poorly in school, and have problems concentrating and sleeping.

Obsession with sex (hypersexuality) is common in children and teens who have bipolar disorder. Even young children may touch themselves, use sexual language, and approach others in a sexual way. Adolescents with bipolar disorder may be obsessed with sexuality and engage in risky sexual behavior. Hypersexual behavior is common in children who have been sexually abused; however, many children with bipolar disorder experience hypersexuality without having been molested.

People sometimes confuse bipolar disorder in children with other conditions with similar symptoms, such as oppositional defiant disorder, anxiety disorders, or attention deficit hyperactivity disorder (ADHD). Frequently children with bipolar disorder are misdiagnosed with another such disorder or are diagnosed with one of those conditions and bipolar disorder.
There is some evidence of a link between ADHD and bipolar disorder, the conditions have distinct features that you can usually identify.

A child or teen with bipolar disorder may behave irresponsibly, take risks and not think about the consequences, or have difficulty making and keeping friends. Older children and adolescents with undiagnosed bipolar disorder frequently use alcohol and drugs. If your child is using drugs or alcohol and having behavioral problems, you may want to schedule an evaluation to determine whether your child is suffering from a condition such as bipolar disorder.
In young children

Bipolar disorder in children may be different than in teens and adults. They may outgrow the disorder and no longer have this diagnosis later in life. In children younger than age 9, bipolar disorder frequently appears as depression or irritability. During a depressive episode, a young child may become withdrawn, have a short attention span, feel guilty for no reason, and have low energy that can last for hours, days, or weeks. Your child may throw temper tantrums, become easily frustrated, and become explosively angry. Irritability and temper tantrums can also be part of manic episodes.

In children, it can be difficult to tell the difference between a depressive and a manic episode, especially if cycles are rapid or symptoms of depression and mania occur together. Irritability may progress into severe, seizure-like temper tantrums when the child is told "no." A bipolar child may kick, bite, hit, and make hateful comments, including threats and curses. During tantrums, which may last for hours, a child may destroy property or become increasingly violent.
In older children and adolescents

During a manic episode, an older child or adolescent may have high energy levels and feelings of extreme happiness (euphoria). He or she may need less sleep and may talk rapidly and continuously. He or she may be aggressive and get into fights and may use sexual language when it is not appropriate or engage in risky sexual behavior. An adolescent with bipolar disorder may suffer consequences from manic behavior such as suspension from school, arrest as a result of fighting or drug use, or an unwanted pregnancy or sexually transmitted disease (STD) from unsafe sexual behavior.

During depressive episodes, an adolescent may become withdrawn or quiet, do poorly in school, and stop participating in activities he or she once enjoyed (such as quitting a sports team). Your adolescent may cry often, sleep too much, and feel that he or she doesn't belong. He or she may speak of death or suicide. You should take any threats of suicide seriously, because children with bipolar disorder have an increased risk of suicide.

Substance abuse in adolescents with bipolar disorder is common, and your child's health professional may recommend an evaluation for both substance abuse problems and bipolar disorder if your child appears to suffer from either condition.

Watch for the warning signs of suicide. These change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

What is bipolar disorder in children and teens?

2009-04-08T05:30:00.000-07:00

When children older than age 6 or teens have bipolar disorder, they have mood swings with extreme ups and downs. When they are up, they have brief, intense outbursts or feel irritable (mania) several times almost every day. When they are down, they feel depressed and sad.

In the past, experts thought bipolar disorder was the same in children and adults. But recent studies of children and teens show that their symptoms are different than those of adults, and they need different treatment.

What causes bipolar disorder?

Experts don't fully understand what causes bipolar disorder.

It seems to run in families. Your child has a greater risk of having it if a close family member such as a parent, grandparent, brother, or sister has it. Parents may wonder what they did to cause their child to have bipolar disorder. But there is nothing a parent can do to cause or prevent it.

What are the symptoms?

Children and teens with bipolar disorder have mood swings with extreme ups (mania) and downs (depression). These intense moods quickly change from one extreme to another without a clear reason. Some children may briefly return to a normal mood between extremes. Many children change continuously between mania and depression, sometimes several times in the same day. Sometimes children with bipolar disorder have symptoms of both mania and depression at the same time.

Times of mania or depression may be less obvious in children and teens than in adults.

* During a time of mania, children and teens may:
o Feel irritable and throw violent temper tantrums.
o Touch their genitals, use sexual language, and approach others in a sexual way.
o Not sleep much and go about the house late at night looking for things to do.

* During a time of depression, children and teens may:
o Say they feel empty, sad, bored, or down.
o Complain of headaches, muscle aches, stomachaches, or fatigue.
o Often spend time alone and may easily feel rejected or criticized.

How is bipolar disorder diagnosed in children and teens?

This disorder can be hard to diagnose in children and teens. The symptoms can look a lot like the symptoms of other problems, such as attention deficit hyperactivity disorder (ADHD), alcohol and drug abuse problems, or conduct disorder. Bipolar disorder can often occur along with these problems.

If your doctor thinks your child or teen may have bipolar disorder, he or she may ask questions about your child’s feelings and behavior. Your doctor may also give you and your child written tests to find out how severe the mania or depression is. The doctor may do other tests (such as a blood test) to rule out other health problems. He or she may ask if your family has any history of mental illness or problems with drugs or alcohol. Any of these problems can be linked to bipolar disorder.

Why is early diagnosis of bipolar disorder important?

Children with this disorder are more likely to have other problems. These include alcohol and drug abuse, trouble in school, running away from home, fighting, and even suicide. Treating the disorder as early as possible may keep your child from having these problems.

Watch for the warning signs of suicide, which change with age. Warning signs of suicide in children and teens may include thinking too much about death or suicide. Watch also for things that can trigger a suicide attempt such as a recent breakup of a relationship or the loss of a parent or close family member through death or divorce.

How is it treated?

The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed well. Treatment usually includes both medicine (such as mood stabilizers) and counseling.

An important part of treatment is making sure your child takes his or her medicine. Children and teens with this disorder sometimes stop taking their medicines when they feel better. But without medicine their symptoms usually come back.

Medicines for bipolar disorder in adults have been well studied. But not much research has been completed about how the medicines work and if they are safe for children and teens.

Accepting that your child has bipolar disorder can be hard. The disorder can be a serious, lifelong problem. Your child will need long-term treatment and will need to be watched carefully. By working with your child's doctor, you can find a treatment that works for your child.

Expert: Pigman had "mental disorder"

2009-02-19T03:55:00.000-08:00

PASADENA - A psychiatrist who examined George Wood Pigman IV three days after his arrest for stabbing his girlfriend to death with barbecue tongs testified Tuesday that Pigman suffers from a mental disorder.

Pigman was found naked and covered in blood on a rooftop May 7, 2005 shortly after 21-year-old Eimi Yamada, a Japanese exchange student, was discovered dead in her apartment a block away. He has pleaded not guilty by reason of insanity.

Dr. Joseph Ortego, a supervising clinical psychiatrist at the mental health facility inside the Twin Towers county jail, examined Pigman on the morning of May 10, 2005. After first believing Pigman was in a drug-induced psychosis, Ortega later diagnosed Pigman with bipolar disorder.

Pigman, now 27, was committed to the hospital May 9 after he was deemed a danger to himself or others after sitting naked in his prison cell, spitting at prison guards, and behaving aggressively and in a sexually inappropriate manner.

Pigman was agitated and combative when he was first arrived at the facility, according to a report written by the nurse who initially examined him. The nurse believed that Pigman was intentionally behaving "over the top" and wrote that he "seems to be deliberately trying to answer questions illogically," according to deputy district attorney Teresa Sullivan, who read from the nurses notes.

Ortego felt differently when he examined Pigman the next morning. Pigman had been given sedatives
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the night before and was calm and able to answer questions, Ortego said. He also firmly denied having any mental illness.

"My impression was...that he was trying to look good," Ortego told public defender Darby Williams, Pigman's attorney. "It seemed like he wanted to look better than he was."

After his initial examination, Ortego diagnosed Pigman with a psychotic disorder that he believed resulted from abuse of methamphetamine or other drugs. Results from a drug screening of Pigman's urine administered that day later ruled drugs out, however.

Pigman was discharged to the jail's general population a few days later but was then recommitted on May 24, 2005 when he was again deemed a danger to himself or others. This time, he was suffering from "grandiose delusions," according to Ortego.

He told Ortego "he was staring at the sun and the more blind he became the closer to God he would become."

"He believed that if he dies, the universe goes down with him, but he can resurrect it," Ortego said.

Pigman also claimed that he had been communicating with President George W. Bush and rapper 50 Cent.

"He was clearly psychotic and he didn't seem to be putting on a show," he said.

After that examination, Ortego changed his diagnosis of Pigman to Bipolar I disorder, a mood disorder characterized by alternating manic and depressive episodes.

Pigman is the son of George Wood Pigman III, a professor and executive officer for the humanities at Caltech. In years previous to the murder, Pigman IV had attended Pasadena City College, where he worked on the school newspaper.

During cross-examination in court Tuesday Sullivan focused on whether it was possible that Pigman was "malingering," or faking symptoms to gain an advantage. Sullivan pointed out that no testing was done to determine whether Pigman was malingering, but Ortego insisted that such testing is rarely conducted.

"I do not think he was malingering," he stated flatly.

"I think the diagnosis was solid," he said later.

Sullivan also noted that Ortego had no contact with Pigman on the night he stabbed Yamada to death and therefore had no knowledge of his mental state while the crime was being committed.

"My opinion was he was in a manic phase during that period," he said.

Sullivan finished the day by recalling Sheriff's deputy Anthony Delaney, who drove Pigman to jail. Delaney said Pigman had already had his defense strategy laid out.

"He said, I shouldn't be telling you this, but I think the only way to fight this is temporary insanity."

New treatment approach needed for management of depression with bipolar disorder

2009-02-19T03:54:00.001-08:00

In a study published in The American Journal of Psychiatry, a team of researchers led by Mayo Clinic psychiatrist Mark Frye, M.D., attempted to identify what factors make some people with bipolar depression more likely to experience treatment-emergent mania (TEM).

Bipolar disorder, also known as manic-depressive illness, is a mental illness characterized by severe mood instability that can be serious and disabling. The deep mood swings from high (mania) to low (depression) may last for weeks or months, causing great disturbances in the lives of the person who has the illness, along with family and friends. Drugs known as mood stabilizers have proven effective at controlling the manic phase of the illness, but treating the depressive phase is more problematic. Antidepressants, although effective for some individuals, can trigger a rapid mood switch from depression to mania, a phenomenon called treatment-emergent mania.

"TEM is a serious and sometimes volatile adverse event, and we wanted to better understand who was at risk for developing this problem," says Dr. Frye. People experiencing mania often exhibit poor judgment and impulsivity that can lead them to engage in highly unsafe or personally damaging behaviors, resulting in hospitalization, arrest and/or incarceration.

Dr. Frye's team did a secondary analysis of data obtained in an earlier study led by Robert Post, M.D., and the Bipolar Collaborative Network. In that earlier study, researchers followed 176 study participants diagnosed with bipolar depression to measure the effectiveness of three different antidepressants. The secondary analysis led by Dr. Frye focused on 44 patients who experienced TEM after starting an antidepressant. Dr. Frye's team compared this TEM group to 84 patients who responded favorably to an antidepressant and 44 patients who stopped taking the antidepressant due to lack of effectiveness or worsening depressive symptoms.

"We found that people who had minimal manic symptoms or a "mixed depression" presentation were at greatest risk for experiencing TEM," says Dr. Frye.

Experts have begun to acknowledge that the common understanding of bipolar illness, once thought to be a disorder with two distinct phases (a manic upswing and a depressive downswing), may be incomplete. A recent study of over 1,300 patients conducted by Joseph Goldberg, M.D., Mount Sinai School of Medicine, reported that two-thirds of the depressed bipolar patients had minimal or mild manic symptoms "mixed" together.

"We're learning that this illness does not occur in two neat, clear-cut phases, but rather a mix of the two," says Dr. Frye. "Our data would suggest that people with mixed depression may need to stay away from antidepressants and work with their health care providers to find alternative treatments, such as mood stabilizers, to help manage the depressive phase of their illness." Further research is encouraged to better understand the best treatment for these mixed presentations.

http://www.mayoclinic.org/

Is it really bad to be sad, in february.

2009-02-11T03:36:00.000-08:00

WHY be miserable?
OK, so it's February and you're feeling fat and broke after the excesses of the holiday season, but there's really no need. Misery is inconvenient, unpleasant, and in a society where personal happiness is prized above all else, there is little tolerance for wallowing in despair. Especially now we've got drugs for it.

Antidepressants can help banish sad feelings - not just the life-sapping black dog of clinical depression, but the rough patches that most people go through sometimes, whether it's after losing a job, the break-up of a relationship or the death of a loved one. So it's no surprise that more and more people are taking them (see graph).

But is this really such a good idea?
A growing number of cautionary voices from the world of mental health research are saying it isn't. They fear that the increasing tendency to treat normal sadness as if it were a disease is playing fast and loose with a crucial part of our biology. Sadness, they argue, serves an evolutionary purpose - and if we lose it, we lose out.

"When you find something this deeply in us biologically, you presume that it was selected because it had some advantage, otherwise we wouldn't have been burdened with it," says Jerome Wakefield, a clinical social worker at New York University and co-author of The Loss of Sadness: How psychiatry transformed normal sorrow into depressive disorder (with Allan Horwitz, Oxford University Press, 2007). "We're fooling around with part of our biological make-up."

Perhaps, then, it is time to embrace our miserable side. Yet many psychiatrists insist not. Sadness has a nasty habit of turning into depression, they warn. Even when people are sad for good reason, they should be allowed to take drugs to make themselves feel better if that's what they want.

So who is right? Is sadness something we can live without or is it a crucial part of the human condition?

Hard evidence for the importance of sadness in humans is difficult to come by, but there are lots of ideas about why our propensity to feel sad might have evolved. It may be a self-protection strategy, as it seems to be among other primates that show signs of sadness. An ape that doesn't obviously slink off after it loses status may be seen as continuing to challenge the dominant ape - and that could be fatal.

Wakefield believes that in humans sadness has a further function: it helps us learn from our mistakes. "I think that one of the functions of intense negative emotions is to stop our normal functioning, to make us focus on something else for a while," he says. It might act as a psychological deterrent to prevent us from making those mistakes in the first place. The risk of sadness may deter us from being too cavalier in relationships or with other things we value, for example.

What's more, says Paul Keedwell, a psychiatrist at Cardiff University in the UK, even full-blown depression may save us from the effects of long-term stress. Without taking time out to reflect, he says, "you might stay in a state of chronic stress until you're exhausted or dead". He also thinks that we may have evolved to display sadness as a form of communication. By acting sad, we tell other community members that we need support.

Then there is the notion that creativity is connected to dark moods. There is no shortage of great artists, writers and musicians who have suffered from depression or bipolar disorder. It would be difficult to find enough recognised geniuses to test the idea in a large, controlled study, but more run-of-the-mill creativity does seem to be associated with mood disorders. Modupe Akinola and Wendy Berry Mendes of Harvard University found that people with signs of depression performed better at a creative task, especially after receiving feedback that was designed to reinforce their low mood. The researchers suggest that such negative feedback makes people ruminate on the unhappy experience, which allows subconscious creative processes to come to the fore, or that it pushes depression-prone people to work harder to avoid feeling bad in the future.
my source http://www.newscientist.com/article/

Bipolar disorder and Schizophrenia are Genetically Linked

2009-02-11T03:29:00.000-08:00

A new study suggests that if schizophrenia runs in a family, there's a good chance that bipolar disorder does as well (and vice versa). The findings, published today in the journal The Lancet, suggest that the two disorders are caused by some of the same genes.

"These findings say that [schizophrenia and bipolar disorder] are related, above all, for genetic reasons," says lead study author Paul Lichtenstein, a genetic epidemiologist at the Karolinska Institutet in Stockholm, Sweden. "[Therefore] it might not be a good idea to view these disorders as separate entities."

Lichtenstein and his colleagues (researchers from both the U.S. and Sweden) scoured the entire Swedish population for anyone with schizophrenia or bipolar disorder by reviewing psychiatric discharge data from all Swedish hospitals between 1973 and 2004.

They identified 35,985 people with schizophrenia (0.40 percent of the population) and 40,487 people with bipolar disorder (0.45 percent of the population). To figure out if and how some of these patients were related, the researchers searched for these individuals in Sweden's multi-generation register, a population database that links nearly every person born in Sweden (population: around 9 million) to his or her parents. This way, they were able to identify parents, children and siblings who shared the diseases.

They discovered that if mom or dad had schizophrenia, a child was 9.9 times more likely to have the disorder (characterized by delusions, hallucinations, and social withdrawal) as well as 5.2 times more likely to have bipolar disorder than someone without a schizophrenic parent. Conversely, someone with at least one parent with bipolar disorder (marked by extreme highs and lows in mood, or periods of mania and depression) was 6.4 times more likely to be bipolar and 2.4 times more likely to have schizophrenia (than those sans a bipolar parent).

Having a brother or sister with one of the psychiatric conditions also upped a person's odds of having both disorders. Those with schizophrenic siblings were 3.7 times more likely to be bipolar and 9 times more likely to have schizophrenia; those with bipolar siblings were 3.9 times more likely to have schizophrenia and 7.9 times more likely to be bipolar.

According to Lichtenstein, this data illustrates the extent to which these two disorders are genetically related. He speculates that hundreds if not thousands of genes are at the root of each disorder, about half of which may overlap. But, as other researchers have pointed out, the vast majority of these genes are yet to be found.

All around the world "there are large-scale genetic studies trying to look at genes responsible for causing these disorders," says Lichtenstein, who is currently conducting one of them. "We should look for overlap between not only schizophrenia and bipolar disorders (but also for other psychiatric illnesses such as depression)."
source http://www.sciam.com

Lamotrigine for treatment of bipolar depression

2009-01-30T00:46:00.000-08:00

Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials

John R. Geddes, MD FRCPsych

Department of Psychiatry, University of Oxford, UK

Joseph R. Calabrese, MD

Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio, USA

Guy M. Goodwin, DPhil, FMedSci

Department of Psychiatry, University of Oxford, UK

Correspondence: John R. Geddes, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. Email: john.geddes@psych.ox.ac.uk

Declaration of interest

J.R.C. is a member of the psychiatry advisory board for GlaxoSmithKline. J.R.G. is Chief Investigator and G.M.G. is a co-investigator on the independent Medical Research Council-funded trial: Comparative Evaluation of QUEtiapine-Lamotrigine combination v. quetiapine monotherapy (and folic acid v. placebo) in people with bipolar depression (CEQUEL).

Background

There is uncertainty about the efficacy of lamotrigine in bipolar depressive episodes.

Aims

To synthesise the evidence for the efficacy of lamotrigine in bipolar depressive episodes.

Method

Systematic review and meta-analysis of individual patient data from randomised controlled trials comparing lamotrigine with placebo.

Results

Individual data from 1072 participants from five randomised controlled trials were obtained. More individuals treated with lamotrigine than placebo responded to treatment on both the Hamilton Rating Scale for Depression (HRSD) (relative risk (RR)=1.27, 95% CI 1.09–1.47, P=0.002) and Montgomery–Åsberg Depression Rating Scale (MADRS) (RR=1.22, 95% CI 1.06–1.41, P=0.005). There was an interaction (P=0.04) by baseline severity of depression: lamotrigine was superior to placebo in people with HRSD score >24 (RR=1.47, 95% CI 1.16–1.87, P=0.001) but not in people with HRSD score ≤24 (RR=1.07, 95% CI 0.90–1.27, P=0.445).

Conclusions

There is consistent evidence that lamotrigine has a beneficial effect on depressive symptoms in the depressed phase of bipolar disorder. The overall pool effect was modest, although the advantage over placebo was larger in more severely depressed participants.

Source: http://bjp.rcpsych.org/cgi/content/abstract/194/1/4

Use of benzodiazepines in anxiety disorders

2009-01-30T00:44:00.000-08:00

Purpose of review: The aim of this study is to provide a review of articles published between July 2007 and August 2008 on the current use and rationale of benzodiazepines in anxiety disorders.

Recent findings: Recent review articles confirm selective serotonin reuptake inhibitors as first-choice drugs for treating anxiety disorders, alongside newer agents such as pregabalin or serotonin-norepinephrine reuptake inhibitors, and combined with cognitive-behavioural therapy. Benzodiazepines are still widely used by clinicians for these disorders, as shown by recent surveys, even though their anxiolytic effectiveness is questioned. Newer agents are in development and may in the future resolve the therapeutic dilemma.

Summary: Despite current guidelines, benzodiazepines are still considered by many clinicians to remain good treatment options, in both the acute and the chronic phase of the treatment of anxiety disorders, partially because of their rapid onset of action and their efficacy with a favourable side effect profile, and also because of the sometimes only incomplete therapeutic response and the emergence of side effects of alternative medications. Having experienced good initial symptom relief with benzodiazepine treatment, patients may also be reluctant to taper it down. Clinicians should, however, bear in mind the frequent physiological dependence associated with these substances, and suggest both pharmacological and psychological treatment alternatives before opting for a long-term benzodiazepine treatment, which may remain necessary in certain clinical conditions.

my source: http://www.co-psychiatry.com

Brain Function In Schizophrenia May Be Altered By Interaction Between Gene Variants

2009-01-20T07:08:00.000-08:00

A collaborative study led by investigators from Massachusetts General Hospital (MGH) is giving what may be the first look at how interactions between genes underlie a key symptom of schizophrenia, impaired working memory.

Functional imaging studies reveal how a combination of common variants in two genes is associated with reduced activity of important brain structures in schizophrenia patients but not in normal controls. The report has been released online in the Early Edition of the Proceedings of the National Academy of Sciences.

"Schizophrenia is a highly genetic disorder, but we are learning that its genetics are not straightforward. In most cases potential risk genes appear to have very small effects on symptoms, making it difficult to attribute clinical findings to particular genes," says Joshua Roffman, MD, of the MGH Department of Psychiatry, the study's lead author. "To amplify some of these subtle effects, we and others are looking how the genes affect brain function, rather than just behavior."

The team - which included investigators from the University of New Mexico, University of Iowa and University of Minnesota through the MIND Clinical Imaging Consortium - used functional MRI to scan an area of the pre frontal cortex known to be critical to working memory in 79 schizophrenia patients and 75 healthy controls as they completed a memory task. Levels of cortical activity were then analyzed for any association with common variants in two genes: MTHFR, which regulates folate metabolism and has been associated with schizophrenia risk, and COMT, which is involved with dopamine processing during working memory.

Although the schizophrenia-associated variant of MTHFR was found in both patients and controls, when the working memory task become more difficult, weaker cortical function associated with that variant was seen only in the schizophrenia patients, not in controls. While variations in COMT did not influence cortical activation patterns on their own, the combined effects of both genes did make a difference.

The reduction in cortical function seen in patients with the schizophrenia-associated MTHFR variant was even more pronounced in patients who also had a COMT variant previously associated with less efficient working-memory-related brain activity.

"Based on the known effects of these alleles on brain biochemistry, it is likely that our results reflect cumulative impacts of the gene variants on dopamine signaling, particularly in the pre frontal cortex. These findings may help us to identify patients more likely to benefit from new treatments targeting the dopamine and folate systems," Roffman says. "We are hopeful that this approach will catalyze the development of individualized treatment regimens, since it will allow us to examine the effects of treatment-related genes on brain function using a much smaller groups of study participants."

Protein On 'Speed' Linked To attention deficit hyperactivity disorder(ADHD)

2009-01-20T06:53:00.000-08:00

A genetic change in the dopamine transporter - one of the brain's dopamine-handling proteins - makes it behave as if amphetamine is present and "run backward," Vanderbilt University Medical Center investigators report this week in The Journal of Neuroscience.

The altered function of the transporter gene variant, discovered in two brothers with attention deficit hyperactivity disorder (ADHD), supports a role for dopamine signaling in the disease. ADHD is one of the most common mental health disorders in children and adolescents, affecting up to 5 percent of school-age children in the United States.

"We believe that this is important evidence that ADHD can be caused by a functional deficit in the brain's dopamine signaling pathway," said Randy Blakely, Ph.D., director of the Center for Molecular Neuroscience.

The researchers propose that because the altered transporter runs backward and pushes dopamine out into the space between neurons - like normal transporters do when amphetamine, or 'speed,' is present - it alters dopamine signaling and contributes to the symptoms of ADHD.

"It's like these kids are on amphetamine all the time," said Aurelio Galli, Ph.D., an investigator in the center. Amphetamine causes hyperactivity, paranoia and psychosis in normal subjects.

Variations in brain dopamine signaling have long been suspected to participate in the development ADHD and other neuropsychiatric disorders. Dopamine has roles in brain circuits linked to attention, motor function, reward and cognition, and drugs that target dopamine transporters and receptors are used to treat ADHD, bipolar disorder and schizophrenia.

Because the dopamine transporter is a key member of the dopamine-signaling network, Blakely and colleagues searched for changes in this protein in patients with ADHD. They found a single "letter" change in the transporter gene in two brothers. The particular mutation had been reported once before in a patient with bipolar disorder, which also has connections to dopamine signaling, but the functional impact of the mutation had not been pursued, Blakely said.

In initial studies of the variant transporter in cultured cells, the group found no differences in function compared to the normal transporter - the mutant transporter moved dopamine into the cell and was appropriately regulated by dopamine transporter blockers and cellular signaling pathways.

Turning to a sensitive technology called amperometry that uses a small carbon fiber to "listen in" on how single cells release or transport dopamine, the Galli and Blakely laboratories discovered that the altered transporters were running backward at an exaggerated rate, literally pushing dopamine out of the cell.

"We think this activity would short circuit the normal synaptic transmission process," Blakely said. "Instead of the precise 'pop-pop-pop' of dopamine being released from vesicles (tiny packets of neurotransmitter), there's a cloud of dopamine bleeding out, and the dopamine signaling system is not as sharp as it should be."

To their surprise, the investigators also found that amphetamine blocks the leak of dopamine through variant transporter. Normally, amphetamine does just what the mutation does - it causes the dopamine transporter to run in the reverse direction.

The findings offer a new perspective on a conundrum in the ADHD field - the fact that two of the medications that successfully treat the disease have opposing effects on their molecular target, the dopamine transporter. With the normal dopamine transporter, methylphenidate (Ritalin) blocks the ability of amphetamine (Adderall) to make the transporter run backward, yet both drugs are equally beneficial to patients with ADHD.

But when the transporter runs backward of its own accord - as it does with this rare mutant version - both agents act as blockers and stop the leak of dopamine.

"This observation unifies the action of these drugs and strongly suggests that backward-running transporters may be an important mechanism in ADHD, even for those who do not have this particular mutation," Blakely said.

Researchers studying the dopamine transporter have found that there are multiple ways to cause the transporter to run backward, Galli pointed out, and the team is now screening other genes in the "network of signaling pathways that target the transporter and reverse dopamine flow" as potential contributors to ADHD risk.

The investigators also speculate that backward-running transporters may represent a more general phenomenon, giving rise to multiple types of neuropsychiatric disorders.

"Millions of patients have taken drugs that block transporter proteins, such as those that handle brain nor epinephrine and serotonin, to treat anxiety and depression," Blakely said. "We used to think that the only thing these drugs could do is block uptake - now we wonder if reducing the backward leak of neurotransmitter is a key component of their utility."

About Oral Zyprexa

2009-01-20T06:38:00.000-08:00

Zyprexa is indicated in the United States for the short- and long-term treatment of schizophrenia, acute mixed and manic episodes of bipolar disorder, and maintenance treatment of bipolar disorder. Since Zyprexa was introduced in 1996, it has been prescribed to approximately 24 million people worldwide. Zyprexa is not approved for patients under 18 years of age.

Zyprexa is not approved for the treatment of patients with dementia-related psychosis. Elderly patients with dementia-related psychosis treated with atypical anti psychotic drugs are at an increased risk of death compared with those patients taking a placebo.

In addition, compared to elderly patients with dementia-related psychosis taking a placebo, there was a significantly higher incidence of cerebrovascular adverse events in elderly patients with dementia-related psychosis treated with Zyprexa.

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including Zyprexa.

While relative risk estimates are inconsistent, the association between atypical antipsychotics and increases in glucose levels appears to fall on a continuum and olanzapine appears to have a greater association than some other atypical antipsychotics. Physicians should consider the risks and benefits when prescribing olanzapine to patients with an established diagnosis of diabetes mellitus, or who have borderline increased blood glucose level. Patients taking olanzapine should be monitored regularly for worsening of glucose control. Persons with risk factors for diabetes who are starting on atypical antipsychotics should undergo baseline and periodic fasting blood glucose testing. Patients who develop symptoms of hyperglycemia during treatment should undergo fasting blood glucose testing.

Undesirable alterations in lipids have been observed with olanzapine use. Clinical monitoring, including baseline and follow-up lipid evaluations in patients using olanzapine, is advised. Significant, and sometimes very high, elevations in triglyceride levels have been observed with olanzapine use. Modest mean increases in total cholesterol have also been seen with olanzapine use.

Potential consequences of weight gain should be considered prior to starting olanzapine. Patients receiving olanzapine should receive regular monitoring of weight.

As with all antipsychotic medications, a rare and potentially fatal condition known as NMS has been reported with Zyprexa.

If signs and symptoms appear, immediate discontinuation is recommended.

Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure.

Also, as with all antipsychotic treatment, prescribing should be consistent with the need to minimize Tardive Dyskinesia (TD). The risk of developing TD and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic increase. The syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn.

The most common treatment-emergent adverse event associated with Zyprexa in placebo-controlled, short-term schizophrenia and bipolar mania trials was somnolence. Other common events were dizziness, weight gain, personality disorder (COSTART term for nonaggressive objectionable behavior), constipation, akathisia, postural hypotension, dry mouth, asthenia, dyspepsia, increased appetite and tremor.

Clinical Studies for Bipolar Disorder

2009-01-19T02:53:00.000-08:00

What About Clinical Studies for Bipolar Disorder?

Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of “real-world” clinical studies. They are called “real-world” studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, “real-world” study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see Clinical Trials , visit the National Library of Medicine’s clinical trials database, or contact NIMH.

How Can Individuals and Families Get Help for Bipolar Disorder

2009-01-19T02:51:00.000-08:00

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:

* University—or medical school—affiliated programs
* Hospital departments of psychiatry
* Private psychiatric offices and clinics
* Health maintenance organizations (HMOs)
* Offices of family physicians, internists, and pediatricians
* Public community mental health centers

People with bipolar disorder may need help to get help.

* Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
* A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
* Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
* A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
* Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
* In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
* Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
* Family members of someone with bipolar disorder often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
* Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations.

Do Other Illnesses Co-occur with Bipolar Disorder?

2009-01-19T02:49:00.000-08:00

Alcohol and drug abuse are very common among people with bipolar disorder.
Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.

Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.

Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.

How Is Bipolar Disorder Treated?

2009-01-19T02:27:00.000-08:00

Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.

Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.
Medications

Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as “mood stabilizers” usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years).

Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

* Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
* Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
* Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
* Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
* Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. Therefore, young female patients taking valproate should be monitored carefully by a physician.
* Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.

* Atypical anti psychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants. Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval. Olanzapine may also help relieve psychotic depression.
* Aripiprazole (Abilify) is another atypical anti psychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder. Olanzapine may also help relieve psychotic depression.
* If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
* Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
* Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
* To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland function. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.
Medication Side Effects

Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist’s guidance.
Psychosocial Treatments

As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or “talk” therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient’s progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psycho education, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

* Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
* Psycho education involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psycho education also may be helpful for family members.
* Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms.
* Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
* As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments

* In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidally, electro convulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
* Herbal or natural supplements, such as St. John’s wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John’s wort can reduce the effectiveness of certain medications. In addition, like prescription antidepressants, St. John’s wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.
* Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

What Causes Bipolar Disorder?

2009-01-19T02:25:00.000-08:00

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic “building blocks” of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person’s chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.
It appears likely that many different genes act together, and in combination with other factors of the person or the person’s environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.
New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures.
These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

Bipolar Disorder at Children and Adolescents

2009-01-19T02:22:00.000-08:00

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Is the Course of Bipolar Disorder?

2009-01-19T02:11:00.000-08:00

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder.

When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see “How Is Bipolar Disorder Treated?”).

Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.

But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Suicide

2009-01-19T02:09:00.000-08:00

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

* talking about feeling suicidal or wanting to die
* feeling hopeless, that nothing will ever change or get better
* feeling helpless, that nothing one does makes any difference
* feeling like a burden to family and friends
* abusing alcohol or drugs
* putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
* writing a suicide note
* putting oneself in harm’s way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is:

* call a doctor, emergency room, or 911 right away to get immediate help
* make sure you, or the suicidal person, are not left alone
* make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder.

Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

Symptoms of Bipolar Disorder

2009-01-19T02:07:00.000-08:00

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

* Increased energy, activity, and restlessness
* Excessively “high,” overly good, euphoric mood
* Extreme irritability
* Racing thoughts and talking very fast, jumping from one idea to another
* Destructibility, can’t concentrate well
* Little sleep needed
* Unrealistic beliefs in one’s abilities and powers
* Poor judgment
* Spending sprees
* A lasting period of behavior that is different from usual
* Increased sexual drive
* Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
* Provocative, intrusive, or aggressive behavior
* Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:

* Lasting sad, anxious, or empty mood
* Feelings of hopelessness or pessimism
* Feelings of guilt, worthlessness, or helplessness
* Loss of interest or pleasure in activities once enjoyed, including sex
* Decreased energy, a feeling of fatigue or of being “slowed down”
* Difficulty concentrating, remembering, making decisions
* Restlessness or irritability
* Sleeping too much, or can’t sleep
* Change in appetite and/or unintended weight loss or gain
* Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
* Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypo mania. Hypo mania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypo mania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypo mania (mild to moderate mania), and then severe mania. In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships.

Such problems in fact may be signs of an underlying mood disorder.

Bipolar Disorder

2009-01-19T02:04:00.000-08:00

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function.

Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide.

But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

“Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.”

“I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do.”

Kay Redfield Jamison

Antidepressants in Bipolar Disorder

2008-12-23T05:24:00.000-08:00

The Controversies:

The bottom line overall here: antidepressants may carry much more risk for people with bipolar disorder than is generally recognized. That antidepressants can cause "switching", bringing on a manic or hypo manic phase, is generally accepted, although how often this occurs is still hotly debated (somewhere between 4% and 40% of the time?).

However, antidepressants may pose bigger risks in the long term. Substantial evidence suggests that antidepressants can induce "rapid cycling". Indeed, it is a standard recommendation for the treatment of rapid cycling to gradually withdraw any antidepressant. In addition, more subtle "destabilizing" effects are possible. Antidepressants may make it more difficult to get a good outcome from an otherwise ineffective mood stabilizer treatment. There is even a concern that antidepressants may permanently alter the course of a person's bipolar illness, through a phenomenon called "kindling".

Therefore, considerable caution should be used before starting an antidepressant in a patient with bipolar disorder. Because data suggest that antidepressants may not be effective at all in this condition, one can wonder why they should be used at all, given the accepted risks (switching, rapid cycling), let alone the more difficult-to-prove concerns about kindling.

Finally, some patients clearly do better if they stay on an antidepressant.

However, new evidence raises further questions about just how many patients meet this description.

In my view, nearly every patient with bipolar disorder deserves at least a significant trial, if not several, of a treatment approach without an antidepressant to see if this might work as well as when the antidepressant is included -- or, quite possibly, better.

Algorithm of Bipolar Disorder Treatment

2008-12-15T05:43:00.000-08:00

The first step in the treatment of this population of patients is the detection and deletion drugs possible factors contributing to the formation and maintenance of effective volatility with rising phase formation. Given that all antidepressants, especially three cyclic can cause inversion phase, an attempt to repeal must be the first step in the conduct of patients with Bipolar Disorder. Even with the prevalence of depressive symptoms, preference should be given mood stabilizer therapy. The question of the appointment of antidepressants in the depressive phase should be decided based on the analysis of the inevitability of such a move based on an assessment of factors such as suicidal risk, duration and severity of depressive phases, the degree of violations brought by social adaptation of the patient, his family situation, the presence or absence of support from part of loved ones and so on psychosocial support can provide substantial assistance in treating depressive phase and reduce the intensity of recidivation.

Some psychosocial techniques designed specifically for BAR, can reduce interpersonal conflicts grade potential trigger mechanisms for the development phase and / or mitigate the circadian rhythmic.

When choosing mood stabilizer preference will be given anticonvulsive, given their greater efficiency in comparison with lithium carbonate in the Bipolar Disorder. When the ineffectiveness of the first designated mood stabilizer must decide on the future of therapeutic tactics - namely, change or conduct mood stabilizer FC, followed by the appointment mood stabilizer therapy. Perhaps, with heavy course of the disease effective deployed in phases, euthymic short period or a path over Bipolar Disorder appropriate early treatment. Carrying out maintenance Bipolar Disorder may in patients with previous efficiency stopped course Bipolar Disorder and inefficiency combined schemes mood stabilizer drugs.
With a combination of inefficiency have mood stabilizer therapy eutireoidnyh patients may introduce in the scheme of thyroid hormone (L-thyroxin or thyroid). It is first used replacement dosage L-thyroxin. In their inefficiency dose gradually increased under the control of blood tests for T4, prior to achieving greater than normal hormone content of no more than 150% (The Expert Consensus Guideline Series, 1996).
In resistant cases may also attempt to use calcium channel blockers, whose effectiveness when BAR displayed in a number of studies (AJ Giannini et al., 1984; SL Dubovsky et al., 1986; CC Hoschl et al., 1989; ES Garza-Trevino, et al ., 1992; GP Panteleeva et al, 1995; SA Walton, et al., 1996).
Therapy of Bipolar Symptoms is a complex task that requires careful systematic monitoring of the patient. Although the clinical need often determines the impossibility of postponing the intensification of therapy more than 4 months, you must do everything possible to maintain wait-and-see tactic, given the known effects of the timing of establishing any mood stabilizer therapy. Only such a tactic is an opportunity to get a real idea about the effectiveness of a dosage mood stabilizer until the maximum dose of portable, providing optimum efficiency. Increased doses mood stabilizer can help reduce faze formating process, as well as relief of manic or depressive symptoms during relapse. Such tactics, along with «therapy cover», in some cases to avoid the appointment of classical neyroleptikov in times of many antidepressants or during periods of depression and thus reduce the risk of provoking enhance cycling. Using benzodiazepinovyh tranquilizers, which are available in injectable forms, permits, in most cases, control psychomotor excitement with mania or expressed dismay with depression in a hospital. New opportunities for kupirovaniya anxiety with depression (W. Macfadden et al., 2004a) and kupirovaniya manic symptoms opens use atipichnyh antipsihotikov.
Unfortunately, in practice, especially in the hospital environment, an approach to therapy is carried out infrequently. This is partly due to the established time frame, officially designated hospital (on average - 2 months). Of course, kupiruyuschee effect mood stabilizer develops more slowly in comparison with traditional neyroleptikami and antidepressants, which determines the choice of a doctor in favor of the latter. At the same time, a heavy depression, especially with suitsidalnymi trends, to avoid the appointment of antidepressants is not possible. In these cases, used the tactic of treatment of bipolar depression, and after kupirovaniya symptoms again return to the methods to break BTS. However, the treatment of acute episode is carried out without lifting the previous normotimicheskoy therapy.
In the case of inefficiency selected in the first phase mood stabilizer therapy over a period of time equal to 3 cycles or within 6 months, we recommend a change of the drug. In the case of a partial effect, depending on the clinical need to be encouraged to continue the observation period, or joining the second mood stabilizer.
Antirecurrent therapy in the treatment of Bipolar Disorder in most cases persisted even when the course of the disease no longer meets the criteria. For patients with 1-3 episodes per year major efforts should be aimed at achieving a long-term remission with a view to maximizing improve their quality of life.

Atypic antipsychotic

2008-12-15T05:02:00.000-08:00

In cases of resistance to therapy with mood stabilizer-anti convulsive use ET helps break the current BT and the subsequent more effective use of drugs mood stabilizer series. According to S.I. Mosolov, SY Moshchevitina (1990), 40% of patients with resistance to the use of ET therapy mood stabilizer achieves stopped effect, followed by fixation eutimich period of lithium salts. Another 30% of patients after the course ET an increase efficiency mood stabilizer therapy, expressed in reducing the frequency and severity effective and effective-delusional episodes. It should be noted that most patients with stopped effect of ET to be resistant to preventive therapy of lithium carbonate. It can be assumed that the lithium salt because delayed mood stabilizer effect of failing to show up at his frequent changes in phases, and that is why they are ineffective in the continuous flow BAR. Terminating effect of ET is more likely in patients with no evidence of organically inferior soil, with lesser duration of illness and the period of actual path of disease, as well as with a distinct remission scenes, the predominance of expression and greater depressive phases, compared with manic.

Electroconvulsive therapy (ET)

2008-12-15T04:41:00.000-08:00

In cases of resistance to therapy mood stabilizer-anti convulsive use Electroconvulsive therapy helps break the current Electroconvulsive therapy and the subsequent more effective use of drugs mood stabilizer series.
According to S.I. Mosolov, SY Moshchevitina (1990), 40% of patients with resistance to the use of Electro convulsive therapy of mood stabilizer achieves stop effect, followed by fixation euthimic period of lithium salts. Another 30% of patients after the course of Electroconvulsive therapy can increase efficiency of mood stabilizer therapy, expressed in reducing the frequency and severity effective an defective-delusional episodes. It should be noted that most patients with cutoff effect of ET to be resistant to preventive therapy of lithium carbonate. It can be assumed that the lithium salt because abandon with mood stabilizer effect of failing to show up at his frequent changes in phases, and that is why they are ineffective in the continuous flow BAR.

Picker effect of ET is more likely in patients with no evidence of organically inferior soil, with lesser duration of illness and the period of actual path of disease, as well as with a distinct remission scenes, the predominance of expression and greater depressive phases, compared with manic.

Mood Stabilizer defenition

2008-12-09T03:31:00.000-08:00

The term "mood stabilizer" is used rather loosely sometimes.

Some experts have included in their definition the ability to prevent recurrence as well as treat current symptoms. This makes a lot of sense: why not start with the medications that have evidence for keeping you well, in addition to getting you well?

But the studies it takes to get such evidence are extremely costly to set up, and thus there are few such reports, only for the really well funded medications, basically mood stabilizer drugs are: olanzapine and lamotrigine (and lithium, because it was included in a lamotrigine study).

A recent review pointed out, using combinations of medications to sum their strengths is now the norm, not the exception, in the treatment of bipolar disorder.

This way of thinking leads to another definition sometimes used: "mood stabilizers" are a group of medications which can treat both mania and depression; or at minimum, they treat one of the two and rarely cause the other pole to become worse in the process. Thus they can be used together to make up combinations for a particular patient's symptoms and history.

This review tried to use precise rules for "evidence" for four aspects of treatment, including the ability to:

1. Treat a person who is currently having manic or hypomanic symptoms (“acute mania”);

2. Treat a person who is currently having depressive symptoms (“acute depression”);

3. Prevent recurrence into mania or hypomania;

4. Prevent recurrence into depression;

5. Cure Bipolar Disorder Symptoms

Pharmacotherapy for Bipolar Dysorder Symptoms, part II

2008-12-09T02:36:00.000-08:00

Mood Stabilizers

When treating patients with FC mood stabilizers be aware that lithium, unlike anticonvulsive insufficiently effective in these cases (JR Calabrese et al., 1995, 2000, etc.). The choice of drugs is carried out, especially taking into account the peculiarities of the disease, namely the prevailing polarity of phases: lithium carbonate and sodium valproat drugs are the first choice when the maniacal symptoms dominated the course of the disease, and carbamazepine and lamotrigine - with the dominant depressive symptoms. With FC remains a priority for carbamazeptine, valproatom and lamotrigine.

Step with anticonvulsive continuous and FC during phase behavior endogenous psychosis as a whole is developing faster than lithium carbonate SN Mosolov and others, 1994): from stable carbamazepine effect with the subsequent formation of remission can be noted in the first 3 months of treatment, but the sodium valproata earlier - after 1-2 months. Such efficiency, which is bluff continual flow in the early course of preventive therapy significantly correlated with favorable outcome of therapy in the next year. At the same time to judge the effectiveness of prophylactic lithium carbonate can be no earlier than 6 months of therapy.
Preparations slightly differ not only on speed but on the nature of reduction of the circular. If lytic version reductions observed more frequently in the application of lithium salts, is critical - anticvonvulsative. And a critical type in more than 2 times more often than with lithium carbonate is found in the application valproata sodium.

In the case of partial effect of lithium carbonate for more typical harmonic reduction of symptoms with a gradual transition to subefective register. In applying anticonvulsive often occurs disharmonic reduction in the opposite uneven development of individual components clinical picture, in violation of the integrity of circular triad and the emergence at the forefront of rudimentary raving, senesto-ipohondric or asthenic symptoms. Lithium carbonate therapy may lead to temporary intensification of symptoms (frequent relapses), followed over the years, their gradual reduction. In applying carbamazepine to 3-4-weeks may be be observed a peculiar depletion of the initial efficiency with increased past a circular symptoms (often manic pole), which requires an increase in dosage, which ensures the gradual extinction of aggravation. Perhaps this phenomenon can be attributed to the phenomen of enzymatic metabolism autoinduction carbamazepine(JW Faigle et al., 1975) and decrease its concentration in blood plasma, although convincing pharmacocinetic dates on the relationship between the content of the drug in blood plasma and its therapeutic efficacy is not currently available.

In terms of the evidentiary requirements of modern medicine, with the Fc examined only one normothymic - lamotrigin. Its effectiveness was shown in a randomized double-blind placebo-controlled study including 182 patients (JR Calabrese et al., 2000). The study showed that the average time before the attrition of patients from the study for any reason, including the need for additional therapy, group of patients receiving lamotrigin was 14 weeks, and placebo group - 8 weeks (p = 0036 in terms of «survival» in the study ). Moreover, the percentage of patients who have achieved clinical stability throughout the course of therapy was significantly higher (p = 0,03) in group lamotridzhina (41%) compared with placebo (26%). The number of patients who need additional therapy for the bipolar dysorder symptoms was lower among recipients lamotrigin compared with the placebo group (p = 0007), and the time before the next phase in the treatment of depressive with lamotriginem was higher compared to placebo (DR Goldsmith et al. , 2003).
The effect of monotherapy with lamotrigine was higher in the Bipolar Disorder symptoms-II compared to its effect in the Bipolar Disorder symptoms-I. Among the first mean time to attrition from the study group lamotrigine was more than twice as high (p <0,05), compared with a placebo, and the percentage of patients with clinically stable condition throughout the treatment period (46 to 18%; p <0 , 05). For patients with Bipolar Disorder Symptoms-I distinguish these figures in the group receiving lamotrigine and placebo were less pronounced and did not reach statistical significance.
Thus, lamotrigine has expressed mood stabilizers act with the most malignant form of current bipolar disorder symptoms with rapid change in phases, especially when Bipolar Disorder Symptoms-II, which is probably linked to its greater efficiency in the prevention depressive phases, compared with manic.

Control of depressive episodes in the FC is a pressing clinical challenge, given that their frequency may be 2-3 times exceed the frequency of manic phases.

Pharmacotherapy for Bipolar Dysorder Symptoms

2008-12-05T06:42:00.000-08:00

Objectives and Strategy pharmacotherapy

The goal of therapy is the FC cliff path currents, the achievement and maintenance of ethimic period. When treating patients with Bipolar Disorder Symptoms over FC respected the general principles of preventive therapy bipolar disorder. Drug of first choice is mood stabilizer.

In doing so, however, should take into account some features of these therapies most patients illness with Bipolar Disorder Symptoms .

Bipolar Disorder often provoked during the introduction or exclusion of factors that could destabilize effective scope or provoke a cycle (see above).

In the case of manic symptoms following the lifting of antidepressants in patients with BD with the FC over possible resumption of the scheme therapy used in reduction acute condition, followed by a gradual lifting after a remission.

Availability reduction disorder itself can be regarded as one of the possible reasons for the formation of secondary fast cycling (FC) currents, especially when it comes to obsessive-compulsive or panic disorder, bulimia, attention deficit syndrome or migraine.

If the commonly used drugs for the treatment of co morbid disorders are potentially dangerous in terms of enhancing cycling are encouraged, first of all, the appointment mood stabilizer or intensification of existing mood stabilizer therapy.

We show that some of mood stabilizer in varying degrees effective in co morbid disorders. In the case of their inefficiency should apply alternative therapy is not causing acceleration cycling.
Drugs that could cause enhanced phase formation, may be appointed only in third place with the ineffectiveness of other activities, such as when severe obsessive-compulsive disorder, sensitive only to the action of selective serotonin inhibitors reverse the seizure.

This should be their minimum dosage, allowing for psychotherapy

The differential diagnosis of Bipolar disorder symptoms

2008-11-26T00:43:00.000-08:00

Many of the bipolar disorder symptoms, spectrum of disorders can occur with other diseases, including disturbing disorder, psychotic disorders, personality disorders, etc.

Cyclothymia, first was described by K. Kahlbaum (1882), in its clinical manifestations in many ways similar to the path and the BTS over the bipolar disorder symptoms. According to modern view, it is defined as chronic affective disorder, characterized by blurring pronounced fluctuations in mood from hypomania to depression, never reaches the detailed criteria for BIPOLAR DISORDER SYMPTOMS-I and BIPOLAR DISORDER SYMPTOMS-II. There is a tendency to underestimate the disease because if developing depression and subjectively assessed as discomfort, illness or disease, hypomania usually perceived as desirable periods Well-Being.

For those patients is observed experiencing chronic cycle of disease during the many periods hypo maniacally or depressive symptoms, which never quite pronounced in order to meet the diagnostic criteria hypomania or depression. The minimum period of affective disorders needed for diagnosis in accordance with the criteria for DSM-IV, defines two years.

Up to date, there are no clear criteria to distinguish cyclothymiacs and hypomania. Most also can not distinguish between cyclothymiacs and normal condition. At the same time, even subsidy normal forms of bipolar disorder symptoms bear the risk disadaptation, forming comorbids disorders, drug addiction, alcoholism, drug addiction, which are the cause of seeking care at the remote stages of the main disease.

As you know, hypomaniacal condition, typical for BIPOLAR DISORDER SYMPTOMS-II, is not an accompanied by social dysadaptation patient and very rarely are the cause of a doctor. In doing so, patients subjectively evaluate such conditions as the feeling of full health, good tone, a normal working and do not talk about them as a painful period. For retrospective detection hypo maniacally states require targeted qualified ascertain anamnestic data in the inspection of the patient to seek medical assistance in connection with the current depressed state. In the absence of such a thorough diagnostic approach hipomaniya can be detected by chance during a planned inspection of many years after the start of the disease.

Its clinical manifestations of hipomaniya different from deployed manic states, only less expressivity symptoms. In accordance with current diagnostic guidelines for diagnosis requires that the duration of symptoms is at least 4 days, if that would not offer significant violations of the daily activities of the patient and does not lead to hospitalization. However, in practice, such cases are often seen as hipertimiya and did not get into the field of psychiatry.

Despite the fact that according to diagnostic criteria hipomaniya never matter of social dysadaptation, its timely diagnosis is crucial, as well as developing later in the BIPOLAR DISORDER SYMPTOMS high depressive episodes led to a significant decline in functioning, disability and higher suicidal risk. Late detection of hypo maniacally states led to a mistaken diagnosis of recurrent depression and inadequate treatment with antidepressants, which leads to weighting current BIPOLAR DISORDER SYMPTOMS and of itself, can cause the formation of FC(fast cycling).

Current diagnostic systems DSM-IV and ICD-10 are trying to divide schizophrenia and BIPOLAR DISORDER SYMPTOMS in categorical terms, bringing to the fore the presence or absence of symptoms to diagnosis. In fact, among the many patients with schizophrenia symptoms of depression and mania, but patients with BIPOLAR DISORDER SYMPTOMS are show shnaiderovschy symptoms of first rank such as delirium and hallucinations with depression. Some compromise on the issue of separation of BIPOLAR DISORDER SYMPTOMS and schizophrenia was the introduction of modern system of classification of disease schizophrenia disorder as a separate diagnostic category. According to ICD-10 main differential diagnostic feature schizophrenia disorder and a bipolar disorder symptoms with affective scenes in the structure which has noncompetitive passion psychotic symptoms, is the content of nonsense that should not meet the criteria listed for schizophrenia, as well as, with BIPOLAR DISORDER SYMPTOMS ravings should not is absolutely incredible content or culture inadequate, and hallucinations should not be commenting nature.

Availability comorobids troubling disorder or alcohol abuse may mask the presence of affective phases. Also in the FC during the BIPOLAR DISORDER SYMPTOMS without the development of heavy affective phases can be mistaken diagnosis of personality disorders, for example, emotionally labile or hysterical type. In all these cases require thorough diagnosis to identify circular affective phases.

Clinical recommendations for therapy fast-cycling current bipolar disorder (draft)

2008-11-24T23:48:00.000-08:00

Path or, in the terminology of American researchers fast-cycling course (FC) is one of the most disadvantaged, disadopt difficult curable options and current BDS. In recent years, increasingly seen patients with BDS over, that is amenable to more than 4 episodes per year.

Since the E. Kraepelin, and so far intensively studied the factors contributing to the formation of BDS and the clinical picture of this version of the current BDS. In recent decades, focuses on the development of therapeutic techniques designed to break BDS and the formation of euthymic period for those patients who actively pursued and acquired at the present stage of particular importance to study and introduction of new effective drugs from this population of patients.

1 Part of Clinical recommendations

Diagnostic criteria and classification

The classification of ICD-10 definitions FC with BDS none. According to current expectations, and in accordance with the criteria for DSM-IV, FC, BDS determined during the development of at least four affective phases (high depressive episode, mania, hypomania mixed episode) over the past year. These affective episodes may be separated by either a period of remission duration of at least two months, or they may end inversion passion and development phase of the opposite poles.
In doing so, each depressive episode must have a duration of at least two weeks, each manic or mixed episode - at least one week every hypo maniacally episode - at least four days.

Epidemiology

BDS prevalence in the population, according to various epidemiological studies, ranging from 0.5 to 2% (average nearly 1%) (H.G. Hwu 1989; H.U. Wittchen, 1992; RMA Hirschfeld , 2002 etc.), BDS occurs during the approximately 1 out of 4 patients BDS , and according to recent epidemiological studies, even more - up to 40 % and differ from unfavorable prognosis and resistance to therapy (L. Tondo, 1998; MS Bauer, 1999; R. Kupka, 2003).
During the widespread use of antidepressants three-cycling many authors (DL Dunner, 1977; JH Greist, 1990, etc.) the continued growth of FC current BDS. Thus, according to J. Angst (1980), following the introduction into clinical practice, by using antidepressants and EST number of illness with bipolar disorder symptoms, increased in 4 times, with 16% of it's sample transferred more than 20 episodes. L.L. Altshuler (1995) showed that approximately a quarter of patients BDS surveyed by the American National Institute of Mental Health increased phase formation or BDS may be linked to excessive use of antidepressants. These figures are confirmed by other studies (TA Wehr, FK Goodwin, 1987; I. Goldberg, et al., 2001).

According to the R.M. Post (2004), based on the results of clinical survey of 674 patients with BDS, FC were observed in 42% of patients, ultrafast (more than 4 episodes per month) - at 26.8%, ultradian (more than 4 episodes of inversion phase of a week) - from 19.7 %.

Clinical signs and over

From the perspective of modern clinical opinion, it is advisable to provide two versions of the current BDS with FC - primary and secondary (GS Sachs, 2004), despite the fact that the DSM-IV is not enshrined the separation.
Primary BDS during a continuous shift of phases of different poles for at least four months. This should be excluded any factors inducing the development of mania or reinforcing cycle (receiving antidepressants or other drugs, common medical illnesses). Primary FC during the often difficult therapy and the use of drugs that enhance the cycle may worsen over the disease.
Secondary FC during shaped by factors that may play a trigger role in increasing phase formation.
In most such cases, BDS diagnosed as primary affective disease, and during the FC is a secondary due to medical or other health factors. Secondary FC during the often provoked the introduction or exclusion of factors that could destabilize affective scope or provoke a cycle. Some patients BDS with the FC Over shortly after the lifting of antidepressants observed the development of manic symptoms.
Most people BAR availability periods FC flow over the disease there are also times without them. For such patients, even in periods when a sufficient basis for the diagnosis of FC not, in comparison with patients who have never had FC, a significantly greater number of episodes, shorter periods times higher suicide trends (RJ Baldessarini et al., 2000 ; W. Coryell et al., 2003). The data allows us to consider periods of FC for a clinical marker of adverse individual projection.
FC over BAR, continuing for years, the exception rather than the rule.
As reasons for the malignant course of the disease can be: serve alcohol and other forms of abuse addiction, multiple sclerosis, brain injury, delayed mental development, hypo thyroidin, migraines, etc., as well as the factors that have a trigger in the development of affective instability.

These include, for example, include:

• sleep disturbance;
• EEG-pathology;
• abolition of nicotine;
• rapid lifting of lithium;
• use or removal of antidepressants;
• receiving certain medications;
• steroids (anabolic steroids); sympathomimetic (stimulants, caffeine, anticoagulant, bronhodilatory, anorectal medecine);
• reproductive hormones / blockers (Gonadotropin, oral contraceptives, testosterone, dehydroepiandrosterone, clomiphene, tamoxifen);
• muscle relaxant;
• triazobenzenediazepim;
• thyroxin;
• barbiturates;
• stressful factors (conflict / trauma, grief / success, the loss of support systems, circadian violations, seasonality, moving from east to west shift work, etc.).

With FC is observed low activity, especially in the application of lithium salts, poor capacity and clinical identity. The majority of these patients detected one or more comorobids disorders, including alcohol and other substance abuse. They have a very low level of social and labor adaptation, most of his life such patients spend in hospitals.
For patients with FC characteristic delay of disease with depressive phase, cyclic premorbids lines on the preponderance of women compared with men.
More frequent formation of FC flow from oligophrenic perso. With thyroid disease (RD Alarcon, 1985; RM Cowdry, 1983, etc.) and the discovery of their violations of EEG in including latent paroxysmal activity (AB Levy , 1988), can think of the possible contribution to the development dimension organically inferior soil, as confirmed by data MA Zvyagelskogo (1988).

Among the disadvantages of options FC is also ultrafast cycles (development of 4 or more affective phases within 1 month), ultradian cycle (more than 4 episodes of inversion phase during the week) and even ultra-ultrafast cycles with the change of passion throughout the day. (KG Kramlinger, RM Post, 1996), which is almost impossible to distinguish from persistent person extremely unstable mixed affective state. These and similar to the clinical picture «Alternating option» affective mixed state (OO Sosyukalo, 1988) and «mixed mania» (JM Himmelhoch, 1986) are fairly typical of phenomenological manifestations of phase with a continuous flow show unfavorable prognosis of the disease and very difficult to therapy.

The course of depression

2008-11-19T04:49:00.000-08:00

Depressive phase represented opposite manic phase triad of symptoms:

-depressed mood (hypothymia)

-slow-thinking (bradypsychia)

-braked-locomotive

In general, BAR depressive more evident than manic states. During the depressive phase of allocating four phases.

Patients lost appetite, food seems tasteless ( «as grass»), the patients lose weight, sometimes significantly (15 kg). For women, for a period of depression disappeared menstruation (amenorrhea).

In a shallow depression marked characteristic of the BAR daily fluctuations of mood:

-feeling worse in the morning (wake up early with a sense of anguish and anxiety

-inactive, indifferent)

- by the evening several enhanced mood, activity.

With age in the clinical picture of depression increasingly took the anxiety (no motivational disturbing premonition that «something should happen», «internal strife»).

1 Initial stage of depression manifested blurred weakening of the overall mental tone, lower mood, mental and physical performance. It is the emergence of moderate sleep disorders in the form of hardship and suspend its superficiality. For all stages of the current depressive phase characterized by improving the general well-being and mood in the evening.

2 Phase is characterized by increasing depression has a clear decline in sentiment with the emergence of disturbing component, a sharp decline in physical and mental efficiency, motor braked. This slow, laconic, quiet. Sleep disturbance resulting in insomnia. It is a marked decrease in appetite.

3 Stage pronounced depression - all symptoms reach maximum development. Characterized by severe psychotic affects anguish and anxiety, painfully experienced by patients. This sharp deceleration, quiet or whispered, monosyllabic answers to the questions, after a long delay. Patients long can sit or lie in one position.

Suicidal attempts, and the most dangerous in the early stage and to withdraw from it when the background of sharp hypothymia expressed no motor braked.

Hallucinations and illusions rare, but they may be (mostly hearing), often in the form of votes, reporting hopelessness of the state of meaningless existence, recommending suicide.

4 Reactive stage is characterized by gradual reduction of all symptoms persisted for some time neurasthenia, but sometimes, on the contrary, there is some hyperthymia, volubility, high motor activity.

The course of manic phase of depression

2008-11-19T04:47:00.000-08:00

Maniacal phase represented major triad of symptoms increased mood (hyperthymia), motor excitation, ideational-mental (tahypsyche). During the manic phase of allocating five stages.

1 Hypo manic stage is characterized by elevated mood, a sense of spiritual recovery, physical and mental vivacity. This exuberant, fast falls the number of semantic association with the increase of motor association (on the similarities and harmony in space and time). It is moderately expressed motor excitation. The attention distraction has increased. Is hypermnesia. Moderately reduced the duration of sleep.

2 Stage pronounced mania characterized by further increasing expressions of fundamental symptoms phase. Patients constantly joke, laugh, against the backdrop of what may be momentary flash of anger. Speech expressed excitement reaches degree jumps ideas. Expressed motor excitation, expressed distraction lead to the inability to maintain a coherent conversation with a patient. Against the backdrop of a reassessment of his own personality appear delusional ideas of grandeur. At work, patients build brighter prospects, are investing money in a dead-projects, projects insane design. The duration of sleep drops to 3-4 hours a day.

3 Stage manic frenzy is the maximum expressivity major symptoms. Sharply motor excitation is messy nature, these seemingly incoherent (in the analysis unable to identify the mechanical associative connection between the components of speech), consists of excerpts of phrases, individual words or syllables.

4 Stage movement is characterized by complacency reduction motor excitation against the backdrop of continuing high spirits and voice excitation. The intensity of the last two symptoms are also gradually declining.

5 Reactive stage is characterized by the return of all of the symptoms of mania to the norm and even a slight decline compared with a norm of mood, asthenia. Some of the scenes being expressed mania stage and manic frenzy of patients can.

Depression and alternatives

2008-11-19T04:45:00.000-08:00

Bipolar Disorder Symptoms

There are different types of bipolar disorder symptoms of depression. It's cyclical depression in which the alternating manic and depressive episodes, it is called bipolar depression. In monopolar depression is very frequent, the only state without a manic depressive episodes. It is just dismal condition, it may be easy, moderate and severe. This depression is characterized by problems with appetite and weight, sleeping problems, chronic fatigue, the decline of power, problems with concentration, the feeling of its own futility, suicidal mood and even suicide attempts. Reactive (psychogenic) depression may occur when a particular event such as death of loved one or loss of employment, but it's not a real depression. Mental depression means "bad mood" and range from mild to moderate depression. Thus, there is a seasonal disorder, which often occurs among people of northern countries.

Many reasons affect depression including diet, excessive consumption of sugar, sugar substitutes, coffee, alcohol and "junk food" ( hamburgers, pizza, etc.), all of which create an abnormal mental state.

Depression can be a very serious disease. In severe forms of depression modern medicine can be a gift from above, especially if these people are inclined to commit suicide and still can not lead a normal life. There need psychotropic drugs and I never will not deny this. But now a lot of abuse of medication. While this herb is wonderfully can help in other cases.

Bipolar disorder symptoms

2008-11-19T04:43:00.000-08:00

Bipolar disorder symptoms (manic-depressive illness) mental state, reflected affective state-manic (hypomania) and depressive as well as mixed states in which the patient symptoms of depression and mania at the same time (for example, strung with melancholy, anxiety, or euphoria with braked - the so-called unproductive mania), a rapidly changing symptoms (hypo) mania and (sub) depression.

For the first time as an independent mental disorder affective bipolar disorder was described in 1854 almost simultaneously by two french researchers J. P. Falret (called «circular psychosis») and J. G. Baillarger (called «insanity in two forms»).

However, it is E. Krepelin identified manic-depressive psychosis as a separate unit in 1986. Krepelin introduced for this disorder name manic-depressive psychosis, which is a long time, it was generally accepted, but are now considered outdated and scientifically incorrect, as this disorder is not always accompanied by psychosis, and not always with him, there are two types of phases (and mania, and depression). Moreover, the term «manic-depressive psychosis» is offensive and stigmatizations patients. Currently, for the mental disorder made more scientific and politically correct name «affective bipolar disorder», abbreviated as BAR. So far in psychiatry different countries and different schools in one state has no uniform definition and understanding of the borders of the disorder.

Etiology Bipolar disorder symptoms

Etiology affective bipolar disorder so far not clear. Basic theories that try to explain the development of the disease, two parts: the hereditary and autointoxication (breach of endocrine balance, disruption of water-electrolyte exchange).

The clinical picture Bipolar disorder symptoms

From the first affektive bipolar disorder accounts for more at a young age - 20-30 years. The number of phases, each of the patient, unpredictable - disorder may limit one phase (mania, and depression hypomania ) for a lifetime, can occur only manic, only hypomania or depressved phases or a change of right or wrong interleaving.