Bipolar Psychopharmacotherapy Caring for the Patient

by Akiskal, Hagop S.; Tohen, Mauricio

• ISBN13: 9780470747216
• ISBN10: 0470747218
• Edition: 2nd
• Format: Hardcover
• Copyright: 2011-04-25
• Publisher: Wiley

Summary

If a colleague were to ask me, "What would you recommend I read if I want to become a real expert on bipolarity?" I would respond 'Bipolar Psychopharmacotherapy: Caring for the Patient'." Journal of Bipolar Disorders. And the second edition is even better! Bipolar Psychopharmacotherapy covers both pharmacotherapy and the supportive role of psychotherapy, psychoeducation and social approaches to provide a broad integrative philosophy of care for bipolar patients. Extensive coverage is given to special management issues such as the pharmacological care of women with bipolar disorder, children and the elderly, as well as bipolar depression and suicide prevention. The mood swings that characterize bipolar disorder can now be better stabilized in most patients than in the past, but the illness must be carefully managed throughout a person's life. Pharmacotherapy is central to the acute treatment and long-term management and as there are several classes of drugs which are often prescribed concurrently, treatment issues are complex. This essential reference work features critical reviews of the existing literature, plus information on new treatments that have been reported at peer reviewed scientific meetings, often written by the pioneering experts on a particular treatment. The second-generation antipsychotics are now covered in separate chapters to provide in-depth coverage of these agents. There are also new chapters on the pharmacological treatments of mixed states and rapid cycling and novel therapeutic vistas.

Author Biography

Hagop Akiskal is Distinguished Professor of Psychiatry and Director of the International Mood Center, San Diego Veterans Administration Medical Center, San Diego, California, USA.  He was awarded the Jean Delay prize by the World Psychiatric Association in 2002 for research work that better bridges the gap between biological, psychological and social aspects of psychiatry and mental health. He has received the Gold Medal for Pioneer Research (Society of Biological Psychiatry), the German Anna Monika Prize for Depression, the NARSAD Prize for Affective Disorders, the French Jules Baillarger and the Italian Aretaeus Prizes for his research on the bipolar spectrum. He is Editor-in-Chief of the Journal of Affective Disorders.

Mauricio Tohen was appointed to the  Krus endowed chair in Psychiatry at the University of Texas Health Science Centre at San Antonio in 2009.  He is  Chief of the Division of Mood and Anxiety Disorders, Department of Psychiatry,   University of Texas Health Science Centre,  San Antonio, Texas, USA.  He is President  of  the International Society for Bipolar Disorders (2010 – 2012).  His research has focused on the clinical epidemiology and psychopharmacological treatments of bipolar disorder. Professor Tohen has over 200 original publications and over 500 book chapters and scientific abstracts. He has co-edited Mood Disorders Across the Lifespan and Textbook of Psychiatric Epidemiology, and has also edited Comorbidity in Affective Disorders.

Table of Contents

List of Contributors

Preface to the Second Edition

The scope of bipolar disorders

Diagnostic and public health aspects

Psychological and social aspects

Lithium treatment: Focus on long-term prophylaxis

Introduction

Cade's pioneering study

Discovery of the prophylactic action of lithium

Practical issues

Are new and better prophylactic agents about to oust lithium?

Combination treatment

Prophylaxis in recurrent depressive disorder

The effect of lithium on the patients' suicidal behavior

Benefits of prophylactic lithium treatment

Conclusion

Valproate: Clinical pharmacological profile

Historical background

Structure-activity relationships

Pharmacodynamic properties

Pharmacokinetics and metabolic clearance

Serum concentration and efficacy

Efficacy and indications

Efficacy in bipolar disorder

Combination strategy in acute mania

Prophylaxis in bipolar disorder

Treatment of bipolar depression

Valproate in treatment of bipolar disorder in children and adolescents

Use in bipolar illness comorbid with alcoholism

Bipolar disorder comorbid with ADHD

Bipolar disorder comorbid with borderline personality disorder

Adverse effects

Comparative adverse effects

Adverse effects in combination therapy, compared with monotherapy

Adverse effects by bodily system

Summary

Pharmacological profile and clinical utility of lamotrigine in mood disorders

Introduction

Clinical pharmacology of lamotrigine

Lamotrigine and mood disorders

Safety

Clinical applications for lamotrigine in mood disorders

Summary

Carbamazepine and other anticonvulsants

Introduction

Conclusions

Olanzapine in treatment for bipolar disorder

Introduction

Rationale in the clinical trial development of olanzapine

Efficacy in the treatment of acute mania

Efficacy in the treatment of bipolar depression

Efficacy in bipolar maintenance/relapse prevention

Safety and tolerability

Summary

Haloperidol and other first generation antipsychotics in mania

Introduction

Acute tranquillization in mania

Sedation is not required for antipsychotics to improve mania

Chlorpromazine in mania

Haloperidol in mania

Hormone changes and mechanisms of antimanic effects of antipsychotics

Antipsychotics as mood stabilizers

Placebo-controlled studies in mania

Recent comparative trials without placebo

Pharmacoeconomics

Conclusions

Clinical utility of clozapine in bipolar disorder

Introduction

History

Clinical pharmacology of clozapine

Clozapine in bipolar disorders

Effective pharmacotherapy for bipolar disorder?

Case studies

Risperidone and paliperidone in the treatment of bipolar disorder

Introduction

Oral risperidone in bipolar mania

Paliperidone extended release (ER) in bipolar mania

Risperidone long-acting injectable (LAI) in the maintenance treatment of bipolar disorder

Elements of special interest

Summary and conclusions

Quetiapine in bipolar disorder

Introduction

Pharmacology

Quetiapine in the treatment of acute mania

Quetiapine in the treatment of acute bipolar depression

Quetiapine in the maintenance treatment of bipolar disorder

Safety and tolerability of quetiapine

Summary

Ziprasidone in the treatment of bipolar disorder

Introduction

Ziprasidone and its proposed mechanism of action

Ziprasidone in treatment guidelines

Overview of ziprasidone efficacy from clinical trial data

Acute manic/mixed episodes

Acute depressive episodes

Long term maintenance treatment of bipolar disorder

Practical guidance on the use of ziprasidone in bipolar disorder

Safety and tolerability

Treatment of special populations

Summary and conclusions

Aripiprazole in bipolar disorder

Aripiprazole and its mode of action

Aripiprazole in treatment guidelines

Aripiprazole efficacy from clinical trial data

Aripiprazole safety and tolerability

Treatment of special populations

Pharmacogenetics of aripiprazole

Asenapine in bipolar disorder

Introduction

Pharmacology

Human pharmacokinetics

Asenapine: Efficacy in bipolar mania and mixed states

Asenapine: Efficacy and tolerability during extension treatment

Summary and conclusion

Complex combination therapy for long-term stability in bipolar disorder

Introduction

Rationale for complex combination therapy in bipolar illness

Principles of building an effective therapeutic regimen

Conclusions

The role of antidepressants in bipolar disorder

Introduction

Tricyclic antidepressants

MAO inhibitors

SSRIs

SNRIs: Venlafaxine, mirtazapine, duloxetine

Bupropion

Clinical and research implications

Bipolarity in women: Therapeutic issues

Introduction

Epidemiology and gender distribution of the bipolar spectrum

Gender differences in phenomenology

Gender differences in course and outcome

Gender differences in comorbidity

Bipolar disorder and the reproductive cycle

Treatment of bipolar disorder in females

Summary

Pediatric bipolar disorder: The promise of psychopharmacotherapy

Introduction

Lithium

Anticonvulsants

Antipsychotics

Conclusion

Treatment of bipolar disorder in old age

Treatment of bipolar disorder in old age

Management of bipolar disorder in the elderly

Treatment of bipolar depression in older adults

The future

Diagnosis and treatment of mixed states

What is a mixed state?

General considerations for treatment strategies in mixed states

Treating mania in mixed states

Treating depression in mixed states

Nonpharmacological treatments

An Integrated model for treating mixed states

Conclusions

Rapid cycling of bipolar patients

Introduction

Epidemiological data

Spontaneous and induced rapid cycling

Temperament and rapid cycling

Course

Clinical picture of rapid cycling

Neurobiology of rapid cycling bipolar disorder: The role of dopamine D2 receptors, sensitization

Treatment

Discussion

Novel therapeutic approaches for treating bipolar disorder

Introduction

The dynorphin opioid neuropeptide system

The purinergic system

The melatonergic system

The glutamatergic system

The tachykinin neuropeptides system

The glucocorticoid system

The arachidonic acid (AA) cascade

The endocannabinoid system

Oxidative stress and bioenergetics

The intracellular signaling pathways

Final remarks

The pivotal role of psycho-education in the long-term treatment of bipolar disorder

Introduction

On the need for psycho-education

The five ingredients of psycho-education

Substance misuse avoidance

Early warning signs - detection

Lifestyle regularity (and miscellanea)

Psycho-education with the family

Long-term follow-up

The future

Funding sources and acknowledgments

The role of treatment setting in the pharmacotherapy of bipolar disorder

Implementation of drug treatment according to phase and severity of illness

Pretreatment evaluation and monitoring of pharmacotherapy

Drug response and treatment setting

From efficacy to efficiency of pharmacotherapy in bipolar illness

Pharmacological prevention of suicide in bipolar patients

Introduction

Mood disorders and suicidal behavior

Risk of suicidal behavior in bipolar disorders

Suicide prevention in bipolar disorders

Overview of principles of caring for bipolar patients

Introduction

The major players in bipolar disorder

Principles of caring

Special considerations for hypomanic and cyclothymic patients

Conclusion

References

Index.

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