Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms (CAMBRIDGE STUDIES IN INTERNATIONAL AND COMPARATIVE LAW NEW SERIES)

This is an excellent book on Mixed States and Rapid Cycling of Bipolar Disorder. I consists mainly of scientific studies and gives a very balanced view of the current thinking. Other books on the disorder don't mention these peculiar forms of the illness and this book fills that gap. I suffer from Mixed States and Rapid Cycling forms of Bipolar Disorder and found the book very informative because it give information on types not covered by other books. Cover 1 Half-title 3 Title 5 Copyright 6 Contents 7 Contributors 9 Preface 13 1 Bipolar disorders beyond major depression and euphoric mania 15 Introduction: knowledge from the past, goals for the future 15 Mixed states 16 The ancient times 16 From Heinroth to the psychopharmacological revolution 20 The renaissance of mixed states 29 Frequency 34 Phenomenology 34 Onset, course, and outcome 35 Comorbidity 36 Family history 37 Treatment 37 Future perspectives on mixed states 37 Rapid cycling 38 Age at onset 42 Family studies and genetics 42 Biological data 42 Comorbidity 42 Longitudinal prognosis 43 Treatment 43 Bipolar schizoaffective mixed states 43 Atypical depressions 47 Polymorphic psychotic disorders as a possible atypical bipolar disorder 50 Lessons from the past and options for the future 51 REFERENCES 51 2 Emerging concepts of mixed states: a longitudinal perspective 59 Definition of bipolar mixed states 59 Dysphoric mania 61 Toward a broader definition of mixed mania 63 Depressive mixed states 65 Bipolar II and unipolar depressive mixed states 66 Long-term aspects of mixed states 67 Conclusions 71 REFERENCES 72 3 Rapid-cycling bipolar disorder 75 Introduction 75 Family genetics 76 Pathophysiology 77 Epidemiology, phenomenology, and comorbidity 79 Pharmacotherapy 83 Treatment recommendations 83 Lamotrigine 85 Clinical response 89 Lithium 91 Divalproex sodium 93 Olanzapine 93 Quetiapine 94 Combination therapy 94 REFERENCES 97 4 Bipolar I and bipolar II: a dichotomy? 102 Introduction 102 Is there a true dichotomy between bipolar I and bipolar II disorder? 104 Epidemiologic studies 104 Age at onset 104 Clinical course and outcome 105 Pathophysiology 109 Family studies and genetics 109 Neuroimage 110 Neurochemical studies 112 Neurophysiology 112 Treatment 113 Conclusion 115 Acknowledgments 115 REFERENCES 115 5 Recurrent brief depression as an indicator of severe mood disorders 123 Introduction 123 Bipolar spectrum 123 Recurrent brief psychiatric syndromes 125 Methodology 126 Sample 126 Interviews 126 Definitions 127 Bipolar spectrum 127 Depressive spectrum 127 Recurrent brief psychiatric syndromes 127 Combined syndromes 128 Rapid cycling and seasonality 128 Treatment and distress 128 Personality 128 Statistics 129 Results 129 Recurrent brief psychiatric syndromes and their overlap 129 The value of RBD, RBM, and hypomanic symptoms as a predictor of BP-II disorder 130 Combined versus pure mood disorders (Table 5.2) 131 Gender 131 Diagnostic overlap 131 Family history 131 Clinical characteristics 131 Onset and course 135 Associations with other psychiatric disorders 135 Personality 135 Suicide attempts 136 Discussion 136 Prevalence 137 Comorbidity 137 Risk of suicide attempts 137 What is the nature of RBD? 138 Treatment of RBD and CD 139 Conclusion 140 Acknowledgment 140 REFERENCES 141 6 Atypical depression and its relation to bipolar spectrum 145 Introduction: the relationship of atypical depression to bipolar II disorder 145 Recent literature review 146 The author's studies 148 Is AD more common in BP-II versus UP? 148 Is BP-II versus UP difference in AD frequency age-related? 149 Is there a difference in AD frequency in BP-II samples when probing for past hypomania focused on overactivity? 149 Is AD frequency still higher in BP-II versus UP when BP-II had a short hypomania? 149 Is AD a predictor of BP-II? 150 Can AD increase the probability of UP switching into hypomania? 150 Is there any difference in AD frequency in early-onset versus late-onset BP-II? 150 Is there any difference between BP-II AD and UP AD? 150 Is there a link between BP-II and UP AD? 150 What is the relationship between AD and age? 151 Are there differences between AD and non-AD? 151 Is there any difference between early-onset and late-onset AD? 152 What is the relationship between AD and chronic depression? 152 Are females more common in AD versus non-AD? 152 Is AD a moderate-severity depression? 153 Is there a link between depressive mixed state and AD? 153 Is there a link between female gender and AD in depressive mixed state? 153 Is psychomotor retardation more common in AD versus non-AD? 154 Is there a link between recurrences and AD? 154 What is the relationship between AD and psychotic features? 154 What is the relationship between AD and menopause? 154 The author's last sample study on atypical depression 155 Study methods 155 Interviewer 155 Study setting 155 Patients and interview 155 Statistics 158 Results 158 Conclusions 160 REFERENCES 165 7 Agitated depression: spontaneous and induced 171 Introduction 171 Melancholia agitata 172 Mixed affective states and agitated depression 175 The parallelism between drive, mood, and thought 179 Clinical picture of agitated depression 180 Clinical forms of agitated depression 181 Psychotic agitated depression 181 Agitated depression (non-psychotic) with psychomotor agitation 181 Minor agitated depression 181 Flight of ideas, racing and crowded thoughts 183 Restlessness, inner agitation, and anxiety 185 Role of temperament 187 The nature and definition of agitated depression 188 Diagnostic criteria of agitated depression 190 Patients and method 190 Spontaneous and induced agitated depression 191 Latent agitated depression 193 Treatment 193 Outcome 194 Treatment with olanzapine 194 Agitated depression followed by simple depression 194 Conclusions 196 REFERENCES 196 8 Schizoaffective mixed states 201 Introduction 201 Developments of the definition of schizoaffective disorders 202 Current research in schizoaffective mixed states 206 Schizoaffective mixed states in the Cologne study 206 The Halle Bipolarity Longitudinal Study 208 Results 208 Characteristics of episodes 208 Duration of episodes 210 Frequency of patients having mixed episodes 212 Gender distribution 213 Initial episode and first manifestation of a mixed episode 213 Disability pensions 214 Conclusions 216 REFERENCES 217 9 Acute and transient psychotic disorder: an atypical bipolar disorder? 221 Introduction 221 Definitions of acute and transient psychotic disorders 221 Acute onset 222 Typical syndromes 222 Acute stress 222 The predecessors of the acute and transient psychotic disorders 225 Cycloid psychoses 226 Bouffée délirante 229 Other predecessors 230 What are acute and transient psychotic disorders? 231 Methods of the HASBAP 233 Results 234 ATPD versus bipolar affective mixed states versus bipolar schizoaffective mixed states 234 Polymorphic subgroup of ATPD versus bipolar affective mixed versus bipolar schizoaffective mixed states 235 ATPD versus all mixed states (affective plus schizoaffective) 240 Polymorphic subgroup versus all mixed (affective and schizoaffective) 240 ATPD versus the groups of bipolar affective mixed, bipolar schizoaffective mixed, bipolar affective non-mixed, and non-mixed bipolar schizoaffective disorders 241 Conclusions 246 References 247 10 Bipolar disorder in children and adolescents 251 Introduction 251 Prevalence 251 Clinical diagnoses 252 Longitudinal course 256 Family history 258 Bottom-up studies 258 Top-down studies 258 Treatment 259 Summary 262 Acknowledgment 262 REFERENCES 262 11 Atypical features of bipolarity in old age 266 Introduction 266 Atypical features 266 Age of onset and clinical course 267 Neurologic comorbidity 269 Cognitive impairment 270 Nosologic confusion 271 Proposed subtypes 271 Atypical treatment issues 273 References 274 12 Comorbidity in mixed states and rapid-cycling forms of bipolar disorders 277 Relevance of comorbidity 277 Medical conditions and neuropsychiatric disorders 278 Substance-abuse disorders 280 Anxiety disorders 281 Personality disorders 282 Other psychiatric disorders 283 The general effect of comorbidity 284 Conclusions 284 References 285 13 Challenges in the genetics of bipolar disorder 291 Epidemiology of mood disorders 291 Genetic epidemiology of mood disorders in adults 292 Family studies 292 Review of empirical evidence 293 Factors associated with familial transmission of mood disorders 297 Relationship to the proband 297 Age of onset 298 Sex of proband 298 Twin studies of mood disorders 299 Adoption studies of the mood disorders 300 Genetic epidemiology of mood disorders in youth 301 Family studies 301 Twin studies 302 Age 303 Genetic marker studies of mood disorders 303 Association studies of mood disorders 303 Review of empirical evidence 304 Linkage studies of mood disorders 305 Review of empirical evidence 306 Challenges to the identification of genes for mood disorders 310 Psychiatric disorder phenotypes 310 Lack of direct correspondence between the genotype and phenotype 310 Gene–environment interaction 311 Future directions 312 References 314 14 Biological aspects of rapid cycling and mixed states 325 Introduction 325 Implications of catecholamines on mixed states and rapid cycling 326 Implications of hormonal aberrations on mixed states and rapid cycling 328 The impact of transmembranous ion fluxes on rapid cycling and mixed states 329 How do antiepileptic drugs used in treating mixed states and rapid cycling potentially interfere with intracellular calcium signalling? 330 Other mechanisms of mood stabilizers possibly related to rapid cycling and mixed states 332 Conclusions 333 References 333 15 The treatment of bipolar mixed states 338 Mixture of elements (mood, activity, thinking) 338 Severe stage of mania 338 Dysphoric mania 339 Depression as characterological response to mania 340 Manic defense in depression 340 Transition state during a cycle: MDI/DMI 341 Mixed states in predominantly depressed bipolar patients (BP-II, Dm) 342 Modified by substance misuse 344 Modified by organic brain disease 345 Ultrarapid cycling 346 With mood-incongruent psychotic features 347 Schizoaffective mixed states 347 Clinical trials in mania and mixed states 347 Treatment responses in different models of mixed states 349 Antipsychotics in mania 350 Cortisol levels during response to antipsychotics 350 Antipsychotics, depression in mania, and switch into depression 351 "Manic defense," transitions, and treatment of mania 351 Antipsychotics in prophylaxis of bipolar disorder 352 Lamotrigine 353 Treatment of mixed states with antidepressants 353 Antidepressants in bipolar mixed states 353 Resistance to treatment in mixed states 355 Combining lithium and antidepressants in prophylaxis of mixed mania 356 Suicide risk 357 Conclusions 357 References 358 16 The use of atypical antipsychotic agents in the treatment of diagnostic subgroups of bipolar disorder: mixed and pure states, psychotic and non-psychotic 367 Introduction 367 Controlled studies of atypical antipsychotic medications in bipolar disorder 368 Method 369 Clozapine 370 Risperidone 370 Olanzapine 372 Quetiapine 377 Ziprasidone 378 Aripiprazole 379 Use of atypical antipsychotic medications in mania: psychotic and non-psychotic patients 379 References 380 17 Investigational strategies: treatment of rapid cycling, mixed episodes, and atypical bipolar mood disorder 383 Difficulties in conducting clinical trials for atypical bipolar disorder 383 Difficulties in conducting clinical trials for mixed episodes 386 Difficulties in conducting clinical trials for rapid cycling 387 What are the lessons from clinical trials for rapid cycling? 389 Rapid cycling: clinical trial design issues 393 Conclusion 396 Definitions 396 Current rapid cycling 396 History of rapid cycling 396 Secondary rapid cycling 396 Primary rapid cycling 397 Defining a phase shift 397 Acknowledgment 397 References 397 Index 400 Cover......Page 1 Half-title......Page 3 Title......Page 5 Copyright......Page 6 Contents......Page 7 Contributors......Page 9 Preface......Page 13 Introduction: knowledge from the past, goals for the future......Page 15 The ancient times......Page 16 From Heinroth to the psychopharmacological revolution......Page 20 The renaissance of mixed states......Page 29 Phenomenology......Page 34 Onset, course, and outcome......Page 35 Comorbidity......Page 36 Future perspectives on mixed states......Page 37 Rapid cycling......Page 38 Comorbidity......Page 42 Bipolar schizoaffective mixed states......Page 43 Atypical depressions......Page 47 Polymorphic psychotic disorders as a possible atypical bipolar disorder......Page 50 REFERENCES......Page 51 Definition of bipolar mixed states......Page 59 Dysphoric mania......Page 61 Toward a broader definition of mixed mania......Page 63 Depressive mixed states......Page 65 Bipolar II and unipolar depressive mixed states......Page 66 Long-term aspects of mixed states......Page 67 Conclusions......Page 71 REFERENCES......Page 72 Introduction......Page 75 Family genetics......Page 76 Pathophysiology......Page 77 Epidemiology, phenomenology, and comorbidity......Page 79 Treatment recommendations......Page 83 Lamotrigine......Page 85 Clinical response......Page 89 Lithium......Page 91 Olanzapine......Page 93 Combination therapy......Page 94 REFERENCES......Page 97 Introduction......Page 102 Age at onset......Page 104 Clinical course and outcome......Page 105 Family studies and genetics......Page 109 Neuroimage......Page 110 Neurophysiology......Page 112 Treatment......Page 113 REFERENCES......Page 115 Bipolar spectrum......Page 123 Recurrent brief psychiatric syndromes......Page 125 Interviews......Page 126 Recurrent brief psychiatric syndromes......Page 127 Personality......Page 128 Recurrent brief psychiatric syndromes and their overlap......Page 129 The value of RBD, RBM, and hypomanic symptoms as a predictor of BP-II disorder......Page 130 Clinical characteristics......Page 131 Personality......Page 135 Discussion......Page 136 Risk of suicide attempts......Page 137 What is the nature of RBD?......Page 138 Treatment of RBD and CD......Page 139 Acknowledgment......Page 140 REFERENCES......Page 141 Introduction: the relationship of atypical depression to bipolar II disorder......Page 145 Recent literature review......Page 146 Is AD more common in BP-II versus UP?......Page 148 Is AD frequency still higher in BP-II versus UP when BP-II had a short hypomania?......Page 149 Is there a link between BP-II and UP AD?......Page 150 Are there differences between AD and non-AD?......Page 151 Are females more common in AD versus non-AD?......Page 152 Is there a link between female gender and AD in depressive mixed state?......Page 153 What is the relationship between AD and menopause?......Page 154 Patients and interview......Page 155 Results......Page 158 Conclusions......Page 160 REFERENCES......Page 165 Introduction......Page 171 Melancholia agitata......Page 172 Mixed affective states and agitated depression......Page 175 The parallelism between drive, mood, and thought......Page 179 Clinical picture of agitated depression......Page 180 Minor agitated depression......Page 181 Flight of ideas, racing and crowded thoughts......Page 183 Restlessness, inner agitation, and anxiety......Page 185 Role of temperament......Page 187 The nature and definition of agitated depression......Page 188 Patients and method......Page 190 Spontaneous and induced agitated depression......Page 191 Treatment......Page 193 Agitated depression followed by simple depression......Page 194 REFERENCES......Page 196 Introduction......Page 201 Developments of the definition of schizoaffective disorders......Page 202 Schizoaffective mixed states in the Cologne study......Page 206 Characteristics of episodes......Page 208 Duration of episodes......Page 210 Frequency of patients having mixed episodes......Page 212 Initial episode and first manifestation of a mixed episode......Page 213 Disability pensions......Page 214 Conclusions......Page 216 REFERENCES......Page 217 Definitions of acute and transient psychotic disorders......Page 221 Acute stress......Page 222 The predecessors of the acute and transient psychotic disorders......Page 225 Cycloid psychoses......Page 226 Bouffée délirante......Page 229 Other predecessors......Page 230 What are acute and transient psychotic disorders?......Page 231 Methods of the HASBAP......Page 233 ATPD versus bipolar affective mixed states versus bipolar schizoaffective mixed states......Page 234 Polymorphic subgroup of ATPD versus bipolar affective mixed versus bipolar schizoaffective mixed states......Page 235 Polymorphic subgroup versus all mixed (affective and schizoaffective)......Page 240 ATPD versus the groups of bipolar affective mixed, bipolar schizoaffective mixed, bipolar affective non-mixed, and non-mixed bipolar schizoaffective disorders......Page 241 Conclusions......Page 246 References......Page 247 Prevalence......Page 251 Clinical diagnoses......Page 252 Longitudinal course......Page 256 Top-down studies......Page 258 Treatment......Page 259 REFERENCES......Page 262 Atypical features......Page 266 Age of onset and clinical course......Page 267 Neurologic comorbidity......Page 269 Cognitive impairment......Page 270 Proposed subtypes......Page 271 Atypical treatment issues......Page 273 References......Page 274 Relevance of comorbidity......Page 277 Medical conditions and neuropsychiatric disorders......Page 278 Substance-abuse disorders......Page 280 Anxiety disorders......Page 281 Personality disorders......Page 282 Other psychiatric disorders......Page 283 Conclusions......Page 284 References......Page 285 Epidemiology of mood disorders......Page 291 Family studies......Page 292 Review of empirical evidence......Page 293 Relationship to the proband......Page 297 Sex of proband......Page 298 Twin studies of mood disorders......Page 299 Adoption studies of the mood disorders......Page 300 Family studies......Page 301 Twin studies......Page 302 Association studies of mood disorders......Page 303 Review of empirical evidence......Page 304 Linkage studies of mood disorders......Page 305 Review of empirical evidence......Page 306 Lack of direct correspondence between the genotype and phenotype......Page 310 Gene–environment interaction......Page 311 Future directions......Page 312 References......Page 314 Introduction......Page 325 Implications of catecholamines on mixed states and rapid cycling......Page 326 Implications of hormonal aberrations on mixed states and rapid cycling......Page 328 The impact of transmembranous ion fluxes on rapid cycling and mixed states......Page 329 How do antiepileptic drugs used in treating mixed states and rapid cycling potentially interfere with intracellular calcium signalling?......Page 330 Other mechanisms of mood stabilizers possibly related to rapid cycling and mixed states......Page 332 References......Page 333 Severe stage of mania......Page 338 Dysphoric mania......Page 339 Manic defense in depression......Page 340 Transition state during a cycle: MDI/DMI......Page 341 Mixed states in predominantly depressed bipolar patients (BP-II, Dm)......Page 342 Modified by substance misuse......Page 344 Modified by organic brain disease......Page 345 Ultrarapid cycling......Page 346 Clinical trials in mania and mixed states......Page 347 Treatment responses in different models of mixed states......Page 349 Cortisol levels during response to antipsychotics......Page 350 "Manic defense," transitions, and treatment of mania......Page 351 Antipsychotics in prophylaxis of bipolar disorder......Page 352 Antidepressants in bipolar mixed states......Page 353 Resistance to treatment in mixed states......Page 355 Combining lithium and antidepressants in prophylaxis of mixed mania......Page 356 Conclusions......Page 357 References......Page 358 Introduction......Page 367 Controlled studies of atypical antipsychotic medications in bipolar disorder......Page 368 Method......Page 369 Risperidone......Page 370 Olanzapine......Page 372 Quetiapine......Page 377 Ziprasidone......Page 378 Use of atypical antipsychotic medications in mania: psychotic and non-psychotic patients......Page 379 References......Page 380 Difficulties in conducting clinical trials for atypical bipolar disorder......Page 383 Difficulties in conducting clinical trials for mixed episodes......Page 386 Difficulties in conducting clinical trials for rapid cycling......Page 387 What are the lessons from clinical trials for rapid cycling?......Page 389 Rapid cycling: clinical trial design issues......Page 393 Secondary rapid cycling......Page 396 References......Page 397 Index......Page 400 Biopolar Disorders Beyond Major Depression And Euphoric Mania / Andreas Marneros And Frederick K. Goodwin -- Emerging Concepts Of Mixed States: A Longitudinal Perspective / Giulio Perugi And Hagop S. Akiskal -- Rapid-cycling Bipolar Disorder / Omar Elhaj And Joseph R. Calabrese -- Bipolar I And Bipolar Ii: A Dichotomy? / Eduard Vieta, M. Reinares, And M.l. Bourgeois -- Recurrent Brief Depression As An Indicator Of Severe Mood Disorders / Jules Angst [and Others] -- Atypical Dpression And Its Relation To Bipolar Spectrum / Franco Benazzi -- Agitated Depression: Spontaneous And Induced / Athanasios Koukopopoulos [and Others] -- Schizoaffective Mixed States / Andreas Marneros [and Others] -- Acute And Transient Psychotic Disorder: An Atypical Bipolar Disorder? / Andreas Marneros [and Others] -- Bipolar Disorder In Children And Adolescents / Boris Birmaher And David Axelson -- Atypical Features Of Bipolarity In Old Age / Kenneth I. Shulman -- Comorbidity In Mixed States And Rapid-cycling Forms Of Bipolar Disorders / Peter Brieger -- Challenges In The Genetics Of Bipolar Disorder / Kathleen Merikangas And Kelly Yu -- Biological Aspects Of Rapid-cycling And Mixed States / Heinz Grunze And Jörg Walden -- The Treatment Of Bipolar Mixed States / John Cookson And Saad Ghalib -- The Use Of Atypical Antipsychotic Agents In The Treatment Of Diagnostic Subgroups Of Bipolar Disorder: Mixed And Pure States, Psychotic And Non-psychotic / Robert W. Baker, Leslie M. Schuh, And Mauricio Tohen -- Investigational Strategies: Treatment Of Rapid Cycling, Mixed Episodes, And Atypical Bipolar Mood Disorder / Gary Sachs And Mandy Graves. Edited By Andreas Marneros And Frederick K. Goodwin. Includes Bibliographical References And Index. Bipolar disorder manifests itself in a variety of forms. It can coexist with other psychiatric conditions, and treatment efficacy can depend on the type of bipolar state. This book covers the full range of atypical, rapid cycling and transient forms of bipolar disorder, from atypical and agitated depression to schizoaffective mixed states. The most recent ICD category is covered, and the authors also look at the biology and genetics of bipolar disorder, along with issues relating to age (children and the elderly), comorbidity, choice of drug treatment and investigational strategies.