Bipolar Disorder: An Evidence-Based Guide to Manic Depression
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This book examines in detail the diagnostic approach to manic depressive (bipolar) illness, with special reference to the borderline zones with unipolar depression and schizoaffective disorder. Among other diagnostic issues considered are mixed episodes (often misdiagnosed by psychiatrists), rapid cycling, and the confusion with personality disorders. Within the context of diagnosis and understanding of the dynamics of bipolar disorder, temperament, character, and personality are all extensively discussed. Neurocognitive deficit and disability are covered, as are elements of evolutionary biology and behavior. With regard to treatment, the major focus is on evidence-based therapy, with reference to the results of randomized controlled trials and meta-analyses; in addition, contemporary guidelines and future trends are examined. Careful consideration is also given to the psychosocial treatment approach and issues relating to societal and economic costs and burdens.
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of divalproex was observed. Fewer patients in the divalproex arm dropped out (48 % vs. 61 % vs. 64 %). Dropouts because of lack of efficacy were fewer in the two treatment arms in comparison to placebo (30 % vs. 33 % vs. 51 %), while dropouts because of adverse events were more frequent with lithium (6 % vs. 11 % vs. 3 %). The most frequent adverse events for divalproex were asthenia, constipation, dizziness, nausea, twitching and vomiting (Bowden et al. 1994). A post hoc analysis of the previous
should be mentioned however that hypothyroidism, which is a frequent adverse effect of lithium, might be associated with mood destabilization in vulnerable patients (Kupka et al. 2003). 16.2.6 Treatment of Special Conditions 22.214.171.124 Treatment of Comorbid Conditions Comorbidity is a significant issue in bipolar patients and often needs specific therapeutic intervention. Simply adding medication might not be the correct strategy, at least not always. 126.96.36.199.1 Treatment of Comorbid Substance
Aizpuru F, Gonzalez-Pinto A (2010) Long-term efficacy of a psychological intervention program for patients with refractory bipolar disorder: a pilot study. Psychiatry Res 176:161–165PubMedCrossRef Gonzalez-Isasi A, Echeburua E, Liminana JM, Gonzalez-Pinto A (2012) Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial. Eur Psychiatry 29:134–141PubMedCrossRef Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Moller HJ,
Young 1993). Among psychiatric inpatients aged 55 year or older, the prevalence of BD is approximately 10 % while for outpatients it is estimated to be lower and equal to 6.1 % (Depp and Jeste 2004). In long-term care institutions, the reported prevalence ranges from 3 to 9.7 % (Koenig and Blazer 1992; Tariot et al. 1993). Concerning hypomania the percentage is as low as 1.6 % but it comes from only one study (Cravello et al. 2011). It is important to know the prevalence of acute mania in the