Special Issue "Management of Bipolar Disorder"

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Psychiatry".

Deadline for manuscript submissions: closed (1 July 2021).

Special Issue Editors

Prof. Martin Schäfer
E-Mail Website
Guest Editor
Department of Psychiatry, Psychotherapy, Psychosomatics and Addiction Medicine, KEM I Evang. Kliniken Essen – Mitte, 45136 Essen, Germany
Interests: Psychopharmacology; Bipolar disorder; depression; Psychoimunology; Psychosomatics; Schizophrenia (treatment); Addiction (treatment)
Prof. Heinz Grunze
E-Mail Website
Guest Editor
Klinikum am Weissenhof, 74189 Weinsberg, Germany
Interests: Bipolar disorder; Treatment-resistant depression; Addiction; Psychopharmacology, ECT

Special Issue Information

Dear Colleagues,

About 2% of people worldwide suffer from bipolar disorder, and up to 5% from bipolar spectrum disorders. Symptoms often begin in later childhood or adolescence but remain undetected or misdiagnosed for 10 years or longer. During this time, patients have to deal with symptoms and mood changes while they are starting their career and trying to build up a family. They often do not receive specific treatment or psychosocial support, and some patients remain misdiagnosed and/or untreated for life. Later on, cognitive impairment and other subsyndromal chronic symptoms might affect patients’ daily life and have to be differentiated from other causes of cognitive disturbances.

The aim of this Special Issue is to invite researchers to submit scientific and clinical work on relevant clinical aspects of bipolar disorder over the lifespan. Especially, studies focused on the handling of symptoms in daily life, specific aspects of diagnosis and treatment in younger and older patients, as well as gender aspects and long-term changes such as cognitive disturbances or subsyndromal symptoms are welcome. Articles dealing with issues related to working with bipolar disorder, family aspects, role of support groups, and issues emerging when special groups such as physicians, psychiatrists, or psychologists suffer from bipolar disorders will be included in this Special Issue.

Prof. Martin Schäfer
Prof. Heinz Grunze
Guest Editors

Manuscript Submission Information

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Keywords

  • Bipolar disorder in daily life
  • Diagnosis and diagnostic problems
  • Co-morbidity
  • Long term treatment
  • Subsyndromal symptoms
  • Cognitive disturbances and chronicity of symptoms
  • Working with bipolar disorders
  • Family
  • Concepts of support groups
  • Bipolar disorder in older life
  • Health workers with bipolar disorders

Published Papers (6 papers)

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Research

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Article
Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States
Medicina 2021, 57(6), 624; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060624 - 15 Jun 2021
Viewed by 451
Abstract
Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced [...] Read more.
Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)
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Article
Affective Temperaments, Panic Disorder and Their Bipolar Connections
Medicina 2021, 57(3), 289; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030289 - 19 Mar 2021
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Abstract
Background and Objectives: The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic disorder (PD) and affective temperaments. Accordingly, we aimed to study the [...] Read more.
Background and Objectives: The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic disorder (PD) and affective temperaments. Accordingly, we aimed to study the distribution of affective temperaments (depressive (DE); cyclothymic (CT); irritable (IRR); hyperthymic (HT) and anxious (ANX)) among outpatients with PD. Materials and Methods: Affective temperaments of 118 PD outpatients (80 females and 38 males) with or without agoraphobia but without any other psychiatric disorder at the time of inclusion were evaluated using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and compared with the affective temperament scores of control subjects. All patients were followed up for at least 1.5 years in order to detect the onset of any major affective disorders, substance use disorders and suicide attempts. Results: Among females, the dominant ANX and DE temperaments were four and three times as common as in a large normative Hungarian sample (for both cases p < 0.01). Among male PD patients, only the dominant DE temperament was slightly overrepresented in a non-significant manner. Females with PD obtained significantly higher scores on ANX, DE and CT subscales of the TEMPS-A, whereas males with PD showed significantly higher scores on ANX, DE and HT temperament subscales compared with the members of a large normative Hungarian sample and also with a gender- and age-matched control group. During the follow-up, newly developed unipolar major depression and bipolar spectrum (bipolar I or II and cyclothymic) disorders appeared in 64% and 22% of subjects, respectively. Conclusions: Our preliminary findings suggest that a specific, ANX-DE-CT affective temperament profile is characteristic primarily for female patients, and an ANX-DE-HT affective temperament profile is characteristic for male patients with PD, respectively. These findings are in line with expectations because PD is an anxiety disorder par excellence on the one hand, whereas, on the other hand, it is quite frequently comorbid with mood (including bipolar) disorders. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)

Review

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Review
The Challenges of Children with Bipolar Disorder
Medicina 2021, 57(6), 601; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060601 - 11 Jun 2021
Viewed by 473
Abstract
Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the [...] Read more.
Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)
Review
Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment
Medicina 2021, 57(6), 587; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060587 - 08 Jun 2021
Viewed by 551
Abstract
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called [...] Read more.
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)
Review
Efficacy of Carbamazepine and Its Derivatives in the Treatment of Bipolar Disorder
Medicina 2021, 57(5), 433; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050433 - 30 Apr 2021
Viewed by 490
Abstract
Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy [...] Read more.
Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug–drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)

Other

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Case Report
Lithium Medication in Pregnancy and Breastfeeding—A Case Series
Medicina 2021, 57(6), 634; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060634 - 18 Jun 2021
Viewed by 381
Abstract
Lithium salts are the first-line prophylaxis treatment for bipolar disorder in most guidelines. The majority of bipolar women are treated with mood stabilizers at the time they wish to get pregnant. One reason for this is the rising average age at first childbirth, [...] Read more.
Lithium salts are the first-line prophylaxis treatment for bipolar disorder in most guidelines. The majority of bipolar women are treated with mood stabilizers at the time they wish to get pregnant. One reason for this is the rising average age at first childbirth, at least in the high-income countries, which increases in general the likelihood of a medication with psychotropic drugs. Previously, lithium exposition during pregnancy was thought to strongly increase the risk of severe cardiac malformation. However, recent studies only point to a low teratogenic risk, so nowadays an increasing number of women are getting pregnant with ongoing lithium treatment. Regarding lithium medication during breastfeeding, there is evidence that lithium transfers to the breastmilk and can also be detected in the infants’ serum. The influence on the infant is still a largely understudied topic. Regular monitoring of the infants’ renal clearance, thyroid function, and lithium levels is warranted when breastfeeding under lithium exposure. In this case series, we present three case reports of bipolar mothers who were treated with lithium during pregnancy and breastfeeding to add to the scarce literature on this important topic. In short, we strengthen the importance of therapeutic drug monitoring due to fluctuating plasma levels during pregnancy and after birth, and we can report the birth and development of three healthy infants despite lithium medication during pregnancy and breastfeeding. Full article
(This article belongs to the Special Issue Management of Bipolar Disorder)
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