Lithium Discontinuation and Reintroduction
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Keywords:
Discontinuation
Hypomania
Bipolar II disorder
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Objective: A recent study reported an 8% increase in bipolar diagnoses in public and community mental health services in New South Wales from 2003 to 2014, an increase interpreted by the authors as reflecting increasing diagnostic boundaries of bipolar disorder, and bipolar II in particular. If valid, we would expect an increase in hospital admissions for hypomania as well as for mania and so analysed a relevant dataset to test that hypothesis. Methods: Data were examined for 27,255 individuals hospitalised in NSW psychiatric hospitals over a 14-year period (2000–2014) for ICD-10 diagnosed mania or hypomania and with analyses examining rates of hospitalisation/per year for both mania and for hypomania. Results: While overall admissions for mania and hypomania increased over the study period by 16.4%, admissions for mania increased by 31.0% and admissions for hypomania actually decreased by 32.1%. Conclusion: The increased rate in admissions of those with a bipolar disorder appears to reflect a trend over more than four decades. The hypothesis that any increase in the diagnostic boundaries of bipolar II disorder would be associated with an increase in hospitalisation rates was rejected, with the converse trend being identified.
Hypomania
Bipolar II disorder
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A case of mania subsequent to the addition of lithium in unsuccessful treatment by antidepressants is presented. It is suggested that lithium might potentiate some properties of antidepressants which affect their capacity to induce mania.
Affect
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Bipolar disorder (BD) is a mood disorder where moods can fluctuate from depression to elevated moods referred to as mania. BD is currently divided into three types. All three types involve clear changes in mood, energy, and activity levels. BD-I is the most severe disorder and symptoms of mania can be so severe that they can require psychiatric hospitalization. BD-II has the same symptoms as BD-I; however, it was described as hypomania because they are less severe than in pure mania. Cyclothymia, also known as a cyclothymic disorder, is a minor mood disorder characterized by fluctuating low-level depressive symptoms and periods of mild mania, similar to BD-II. Mood stabilizers and second-generation antipsychotics are first-line for treating and maintaining a stable mood. This study related to a case report on slurred speech and tremors induced by antipsychotics in a patient suffering from BD.
Hypomania
Depression
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Episode duration, recurrence rates, and time spent in manic and depressive phases of bipolar disorder (BD) is not well defined for subtypes of the disorder.We reviewed the course, timing, and duration of episodes of mania and depression among 1130 clinically treated DSM-IV-TR BD patients of various types, and compared duration and rates as well as total proportion of time in depressive versus manic episodes during 16.7 average years at risk.As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P). Recurrence rates (episodes/year) and proportion of time in depression and their ratios to mania were highest in BD-II and BD-Mx subjects, with more manias/year in psychotic and BD-I subjects. In most BD-subtypes, except with psychotic features, there was more time in depressive than manic morbidity, owing mainly to longer depressive than manic episodes. The proportion of time in depression was highest among those who followed a predominant DMI course, whereas total time in mania was greatest in BD with psychotic features and BD-I. and with an MDI course.Subtypes of BD patients differed little in episode-duration, which was consistently much longer for depression. The findings underscore the limited control of bipolar depression with available treatments.
Depression
Bipolar I disorder
Polarity (international relations)
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PURPOSE: Bipolar mania is characterized by marked impairment in social, occupational, or other important areas of functioning. One should expect to see an equally severe burden in informal caregivers. The literature was reviewed in order to provide a foundation upon which to build nursing interventions. CONCLUSIONS: Several characteristics of bipolar mania—patient aggressiveness, lack of insight, and financial problems—were identified as severe burdens to caregivers. Professionals might not have a total view of the extent of the burden in caregivers. This review could not link the patients' mania or hypomania to factors that were described in other literature on caregiver burden related to bipolar disorder, regardless of the type of episode. PRACTICE IMPLICATIONS: There is a need for further research in this area to make more explicit the burden on caregivers during times of mania or hypomania.
Hypomania
Caregiver Burden
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The substance use is common among people with a diagnosis of bipolar disorder. In addition, alcoholism and bipolar disorder coexist with a high frequency. This association is higher in men than in women, and this consumption is thefactor that most strongly influences the hospitalization. To analyze the clinical, epidemiological, diagnostic approach and evolution of bipolar disorder andalcoholism. Review of thesubject on recent articles of alcoholism in bipolar disorder. The stages of mania associated with alcohol consumption up to 40% of casesand are more common at this stage that in depressive. This association isgreater than that which occurs between alcoholism and schizophrenia ordepression. Patients with bipolar disorder who have mixed and irritative statesand those with rapid cycling have a prevalence of alcohol consumption and sustanceuse higher than those who do not use substances. It has also been observed thatthe consumption of alcohol, and substance use can change the symptoms of maniaand turn them into a mixed state symptoms. It also states that rapid cycles canbe precipitated by increased alcohol consumption during rotation from mania todepression. The associationof bipolar disorder with addictive behaviors is a factor that worsens theprognosis and comorbid alcohol itself is associated with a poor prognosis. Close monitoring of bipolar patients and especially in those who consumealcohol is very important.
Dual diagnosis
Bipolar I disorder
Alcohol Dependence
Alcohol use disorder
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Abstract Objective: Unipolar mania is not included in the diagnostic and statistical manual of mental disorders-5 (DSM-5) as a separate diagnosis, although it is defined by widely accepted diagnostic criteria. The aim of this study was to investigate the differences between unipolar mania and bipolar disorder in terms of clinical and inflammatory parameters. Methods: The data of 495 hospitalised patients with bipolar disorder diagnoses were analysed retrospectively. Forty met the diagnostic criteria for unipolar mania. Two patients refused to participate in the study. Thirty-eight unipolar mania patients and 42 randomly selected patients with bipolar disorder diagnosis were included in the study. The two groups were compared in terms of sociodemographic, clinical characteristics, serum brain-derived neurotrophic factor, C-reactive protein (CRP), leucocyte and cytokine levels. Results: A total of 40 (8.08%) of 495 patients diagnosed with bipolar disorder met the unipolar mania diagnostic criteria. The number of manic episodes and the number of hospitalisations were statistically higher in the unipolar mania group than in the bipolar disorder group. Among all the manic symptoms, the incidence of symptoms such as euphoria, increased sexual interest, grandiosity and delusions were found to be statistically higher in the unipolar mania group. Interleukin (IL)-6 and CRP levels were significantly higher in the unipolar mania group than in the bipolar disorder group. Conclusion: Unipolar mania differs from bipolar disorder in terms of clinical features and serum IL-6 and CRP levels.
Grandiosity
Bipolar I disorder
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This article reviews the use of lithium from Roman times, when physicians first recommended alkaline springs in the treatment of mania, to the present. Serious interest in lithium began in 1949, with a report of improvement of mania in 10 of 10 patients. Since then, lithium has become increasingly popular both for treating acute mania and as a prophylactic agent. Its use in depression is also described. Finally, lithium's clinical spectrum is discussed, noting that its use extends far beyond the treatment of mania.
Depression
Bipolar illness
Prophylactic treatment
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Previous studies attempting to support unipolar mania as an entity distinct from bipolar disorder, have produced conflicting results. The present study reports on a chart review of 247 patients admitted to the University of Iowa with a history of at least one manic episode; 87 of these had apparently never experienced a depression. A subgroup of 92 patients, who met DSM III diagnostic criteria and had a history of at least two episodes of affective disorder, were also examined. There were few clinically meaningful differences between patients with unipolar mania and bipolar disorder on demographic, symptomatic, or familial variables. An earlier report that unipolar manics were more likely to be male and have a family history of unipolar depression was not confirmed. Unipolar mania is not supported as a separate entity from bipolar disorder.
Depression
Hypomania
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