Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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352 J. Cookson and S. GhalibTohen, M., Goldberg, J. F, Gonzalez-Pinto Arrillaga, A. M., et al. (2003). A 12-week, doubleblindcomparison of olanzapine vs. haloperidol in the treatment of acute mania. Arch. Gen.Psychiatry, 60, 1218–26.Wehr, T. A. and Goodwin, F. K. (1987). Can antidepressants cause mania and worsen the courseof affective illness? Am. J. Psychiatry, 144, 1403–11.White, E., Cheung, P., and Silverstone, T. (1993). Depot antipsychotics in bipolar affectivedisorder. Int. Clin. Psychopharmacol., 8, 119–22.Winnicott, D. W. (1935). In Through Paediatrics to Psychoanalysis, chapter 9. London: HogarthPress.World Health Organization (1993). Tenth Revision of International Classification of Diseases.Geneva: World Health Organization.Yatham, L. N. (2000). Safety and efficacy of risperidone as combination therapy for the manic phaseof bipolar disorder: preliminary findings of randomized, double-blind study (RIS-INT-46).Int. J. Neuropsychopharmacol., 3 (suppl. 1), 142.Yatham, L. N., Liddle, P. F., Shiah, I.-S., et al. (2002). PET study of [18F]6-fluoro-L-dopa uptakein neuroleptic- and mood-stabiliser-naive first-episode nonpsychotic mania: effects of treatmentwith divalproex sodium. Am. J. Psychiatry, 159, 768–74.
16The use of atypical antipsychotic agentsin the treatment of diagnostic subgroupsof bipolar disorder: mixed and purestates, psychotic and non-psychoticRobe rt W. Baker1 1 2, Leslie M. Schuh and Mauricio Tohen1 Lilly Research Laboratories, Indianapolis, IN, USA2 Lilly Research Laboratories, Indianapolis, IN, and Harvard Medical School, Belmont, MA, USAIntroductionThere are many challenges in treating bipolar disorder, including confrontingmarked variability in symptoms between patients, as well as highly differingsymptomatic presentations within an individual patient’s course of illness.Diversity of presentation and course is potentially quite important to prognosisand treatment selection, though the relevance has not been consistently welldefined in empirical research. This chapter reviews controlled findings regardingthe impact of variant bipolar presentations to predicting treatment response withatypical antipsychotic agents.Classic bipolar I disorder consists of euthymic periods punctuated by episodesof mania or major depression. Interindividual variability is manifest in differingseverity, length, and frequency of manic and depressive episodes and the degree ofsymptom relief occurring between acute episodes. There are, of course, manyvariations on the classic pattern, such as the concurrent dysphoric and manicsymptoms of mixed states, subsyndromal presentations, or the markedly frequentepisodes of rapid cycling. Bipolar disorder is also commonly complicated bypsychiatric comorbidity, such as psychosis, as well as substance abuse or physicaldisorders. Not surprisingly, patients with bipolar disorder have increased mortalityfrom suicide, accidents, substance-abuse-related causes, and various medicaldiseases (Baldessarini, 2002).Variant presentations may be more difficult to treat than classic bipolar depressionor mania. First, these presentations often broaden the range of target symptoms# Cambridge University Press, 2005.
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Bipolar DisordersMixed States, Rapi
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ContentsList of contributorsPreface
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ContributorsValadeta Ajdacic PhDPsy
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ixList of contributorsAlexia E. Kou
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PrefaceBipolar disorders have a lon
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2 A. Marneros and F. K. Goodwinold
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4 A. Marneros and F. K. GoodwinFig.
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6 A. Marneros and F. K. GoodwinThe
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32 A. Marneros and F. K. GoodwinBip
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38 A. Marneros and F. K. GoodwinAki
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42 A. Marneros and F. K. GoodwinMar
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44 A. Marneros and F. K. GoodwinPri
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46 G. Perugi and H. S. AkiskalTable
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50 G. Perugi and H. S. AkiskalDepre
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52 G. Perugi and H. S. Akiskalwith
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54 G. Perugi and H. S. Akiskal3020.
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59 Longitudinal perspective of mixe
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3Rapid-cycling bipolar disorder1 2O
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63 Rapid-cycling bipolar disorderPs
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65 Rapid-cycling bipolar disorderOn
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67 Rapid-cycling bipolar disorderBr
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69 Rapid-cycling bipolar disorderin
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71 Rapid-cycling bipolar disorderLa
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73 Rapid-cycling bipolar disorderre
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77 Rapid-cycling bipolar disorderDe
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79 Rapid-cycling bipolar disorderan
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81 Rapid-cycling bipolar disorderTa
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83 Rapid-cycling bipolar disorderRE
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85 Rapid-cycling bipolar disorderJo
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87 Rapid-cycling bipolar disorderde
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89 Bipolar I and bipolar II: a dich
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101 Bipolar I and bipolar II: a dic
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5Recurrent brief depression as an i
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111 Recurrent brief depressionRecur
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113 Recurrent brief depressionbeen
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115 Recurrent brief depressioncorre
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117 Recurrent brief depressionThere
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Chronic 4.8 18.2 9.1 10 NCRapid-cyc
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121 Recurrent brief depressionTable
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123 Recurrent brief depressionPreva
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125 Recurrent brief depressionWe fo
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127 Recurrent brief depressionREFER
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129 Recurrent brief depressionMarne
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6Atypical depression and its relati
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133 Atypical depression and bipolar
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7Agitated depression: spontaneous a
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159 Agitated depression: spontaneou
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8Schizoaffective mixed statesAndrea
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189 Schizoaffective mixed statescon
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191 Schizoaffective mixed stateswas
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193 Schizoaffective mixed statesUni
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195 Schizoaffective mixed statesTab
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197 Schizoaffective mixed statesday
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199 Schizoaffective mixed statesTot
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201 Schizoaffective mixed statesBip
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203 Schizoaffective mixed statesThe
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205 Schizoaffective mixed statesMar
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9Acute and transient psychotic diso
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209 Acute and transient psychotic d
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Table 9.10 (cont.)ATPD(n ¼ 39)Bipo
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Table 9.11 (cont.)Bipolar affective
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Table 9.14b Significant differences
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10Bipolar disorder in children and
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239 Bipolar disorder in children an
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Pellegrini et al. (1986) 16 23 (7-1
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253 Atypical features of bipolarity
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12Comorbidity in mixed states and r
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265 Comorbidity in mixed states and
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13Challenges in the genetics of bip
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279 Challenges in the genetics of b
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Table 13.1 Proportion of first-degr
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Table 13.3 Summary of recent bipola
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13q32 = 3.321q22 = 3.6Liu, C.et al.
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Page 315 and 316: 301 Challenges in the genetics of b
Page 325 and 326: 14Biological aspects of rapid cycli
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Page 337 and 338: 323 Rapid cycling and mixed statesW
Page 339 and 340: 325 The treatment of bipolar mixed
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Page 369 and 370: 355 Use of atypical antipsychotic a
Page 383 and 384: 17Investigational strategies: treat
Page 385 and 386: 371 Investigational strategiesBIPOL
Page 387 and 388: 373 Investigational strategiesinsta
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Page 393 and 394: 379 Investigational strategiescateg
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Page 397 and 398: 383 Investigational strategies2. Th
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Page 401 and 402: 387 Indexclinical course and outcom
Page 403 and 404: 389 Indexdepressive mixed states 51
Page 405 and 406: 391 IndexLange, J. 163learning disa
Page 407 and 408: 393 Indexpsychopharmacological revo
Page 409: 395 Indexmania, acute 334mixed stat
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Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

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