Posted by jrbecker on October 3, 2003, at 16:06:40
Bipolar II
the American Psychiatric Assn is finally getting it right. an excerpt from McMan's Depression and Bipolar Weekly.
for those of you not familiar with McMan's it's a website that has a terrific bi-weekly newsletter on all issues (research, treatment, politics, laws, personal stories) of affective disorders. If you haven't signed up for it already, you definitely should. It's probably the most informed and consolidated source of mood disorder news anywhere on the web. To sign up for the newsletter, or just to peruse the many articles and links at the site, visit:
see below for an interesting excerpt on revising the bipolar II diagnosis (finally)....
Sweet and SourWhile working on the American Psychiatric Association’s latest DSM version of bipolar (IV-TR), Trisha Suppes MD, PhD of the University of Texas Medical Center in Dallas carefully read its criteria for hypomania, and had an epiphany. "I said, wait," she told a UCLA grand rounds lecture in April and webcast the same day, "where are all those patients of mine who are hypomanic and say they don’t feel good?"
Hypomania can be thought of as mania lite, which the DSM defines as "a distinct period of persistently elevated, expansive or irritable mood." The impression is that of life of the party behavior combined with salesperson of the month productivity. But Dr Suppes had in mind a different type of patient, say one who experiences road rage and can’t sleep. Why was there no mention of that in hypomania? she wondered. A subsequent literature search yielded virtually no data.
The DSM alludes to mixed states where full-blown mania and major depression collide in a raging sound and fury, but nowhere does it account for more subtle manifestations, often the type of states many bipolar patients may spend a good deal of their lives in. The treatment implications can be enormous. Dr Suppes referred to a secondary analysis by Swann of a Bowden et al study of patients with acute mania on lithium or Depakote which found that even two or three depressed symptoms in mania were a predictor of outcome.
Clinicians commonly refer to these under-the-DSM radar mixed states as dysphoric hypomania or agitated depression, often using the terms interchangeably. Dr Suppes defines the former as "an energized depression," which she and her colleagues made the object of in a prospective study of 919 outpatients from the Stanley Bipolar Treatment Network. Of 17,648 patient visits, 6993 involved depressive symptoms, 1,294 hypomania, and 9,361 were euthymic (symptom-free). Of the hypomania visits, 60 percent (783) met her criteria for dysphoric hypomania. Females accounted for 58.3 percent of those with the condition.
Neither the pioneering TIMA Bipolar Algorithms nor the APA’s Revised Practice Guideline (with Dr Suppes a major contributor to both) offer specific recommendations for treating dysphoric hypomania, such is our lack of knowledge. TIMA makes a distinction between "euthymic mania/hypomania" and "dysphoric mania/hypomania" in stage one only of its mania algorithm, recommending Depakote or Zyprexa but not lithium for the latter. The APA merely suggests that Depakote may be preferred over lithium for mixed states.
Clearly the day will come when psychiatrists will probe for depressive symptoms or mere suggestions of symptoms in mania or hypomania, knowing this will guide them in the prescriptions they write, thus adding an element of science to the largely hit or miss practice that governs much of meds treatment today. But that day isn’t here yet. Don’t despair. Dr Suppes and others are on the case.
Bipolar II
At the same grand rounds lecture, Dr Suppes also discussed bipolar II, that much neglected kin of bipolar I, the object of only about 20 review papers. Neither the TIMA Algorthm nor the APA Treatment Guideline discuss bipolar II, as there is precious little research to go on. By conservative estimates, bipolar II accounts for 0.5 percent of the US population. Other calculations put it at up to one percent. "That’s a lot of people," she concluded, "not to know anything about."
poster:jrbecker
thread:265284
URL: http://www.dr-bob.org/babble/social/20031002/msgs/265284.html