7 results
New Anticonvulsant Medication Uses in Bipolar Disorder
- Po W. Wang, Terence A. Ketter, Olga V. Becker, Cecylia Nowakowska
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- Journal:
- CNS Spectrums / Volume 8 / Issue 12 / December 2003
- Published online by Cambridge University Press:
- 07 November 2014, pp. 930-947
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Therapy of bipolar disorders is a rapidly evolving field. Lithium has efficacy in classic bipolar disorders whereas divalproex sodium and carbamazepine may have broader spectrum efficacy that includes non-classic bipolar disorder. In the last 10 years, a series of anticonvulsants have been approved for marketing in the United States. Gabapentin has indirect γ-aminobuytric acid-ergic actions, is generally well tolerated, and appears to have anxiolytic, analgesic, and hypnotic effects. Lamotrigine has antiglutamatergic actions and is generally well tolerated (aside from rash in 1 in 10, and serious rash in 1 in 1,000 patients). Lamotrigine is indicated for maintance treatment in bipolar disorder. Emerging evidence suggests lamotrigine may have utility in bipolar disorder patients with depression and treatment-refractory rapid cycling, as well as analgesic effects. Topiramate and zonisamide may allow both weight loss, while topiramate may have specific efficacy in bulimia, binge eating disorder, and alcohol dependence. Two small studies found oxcarbazepine had similar efficacy to lithium and haloperidol in acute mania. Phenytoin, an older anticonvulsant, may have adjunctive acute mania efficacy. Levetiracetam, a newer anticonvulsant, may be worth exploring and has minimal drug-drug interactions. None of these newer agents has been shown effective in a large placebo controlled trial for acute mania. Although the clinical profiles of these newer anticonvulsants do not appear to overlap markedly with divalproex and carbamazepine (except perhaps for oxcarbazepine), these novel agents may still offer important new options in relieving a variety of specific target symptoms in patients with bipolar disorder.
Magnetic resonance spectroscopic measurement of cerebral gamma-aminobutyric acid concentrations in patients with bipolar disorders
- Po W. Wang, Napapon Sailasuta, Rebecca A. Chandler, Terence A. Ketter
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- Journal:
- Acta Neuropsychiatrica / Volume 18 / Issue 2 / April 2006
- Published online by Cambridge University Press:
- 24 June 2014, pp. 120-126
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Background:
Animal models of depression and psychopharmacological mechanisms of action suggest the importance of the gamma-amino butyric acid (GABA) system in the pathophysiology of mood disorders. Mood stabilizers have overlapping effects on GABAergic neurotransmission, and antidepressant use has been associated with alterations in GABAB receptor function. Magnetic resonance spectroscopy (MRS) provides an opportunity to noninvasively assess cerebral GABA concentrations in anterior paralimbic circuits that have been implicated in mood disorders.
Methods:In bipolar disorder patients and healthy control subjects, we used MRS with a modified GABA-edited point resolved spectroscopy sequence (TE 68 ms, TR 1500 ms, 512 averages, total scan time 26 min) to assess GABA in an 18-cm3 occipital voxel. In addition, in another cohort of bipolar disorder patients and healthy control subjects, we similarly assessed GABA in a 12.5-cm3 medial prefrontal/anterior cingulate (MPF/AC) voxel. The concentration of GABA was referenced to creatine (Cr) from unedited spectra.
Results:In bipolar patients and controls, we consistently detected 3.0 p.p.m. GABA peaks in occipital lobe and MPF/AC. In 16 bipolar (nine bipolar I and seven bipolar II) disorder patients, compared with six healthy control subjects, mean occipital GABA/Cr concentration was 61% higher. In addition, in 15 bipolar (five bipolar I, nine bipolar II, and one bipolar not otherwise specified) disorder patients, compared with six healthy control subjects, mean MPF/AC GABA/Cr concentration tended to be 41% higher.
Conclusions:Patients with bipolar disorders may have increased cerebral GABA concentrations. Although this was more evident in the occipital lobe, MPC/AC GABA disturbance may be of greater potential interest in view the more established role of MPF/AC in affective processing. Additional studies are warranted to assess changes in GABAergic neurotransmission and the influences of diagnosis, mood state, and medication status in bipolar disorder patients.
18 - Clinical models for managing Bipolar II disorder: model 2
- Edited by Gordon Parker, University of New South Wales, Sydney
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- Bipolar II Disorder
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- 05 May 2012
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- 12 April 2012, pp 192-213
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Contributors
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- By Darryl Bassett, Michael Berk, David J. Bond, Emre Bora, Tessa Cleradin, Nuria Cruz, Kathryn Fletcher, Sophia Frangou, Mark A. Frye, S. Nassir Ghaemi, David Gilfillan, Michael Gitlin, Joseph F. Goldberg, Guy M. Goodwin, George Hadjipavlou, Terence A. Ketter, Vijaya Manicavasagar, David Miklowitz, Andrew A. Nierenberg, Margo Orum, Christos Pantelis, Joel Paris, Gordon Parker, James Phelps, Robert M. Post, Anne-Marie Rees, Edward Shorter, Michael E. Thase, Eduard Vieta, Po W. Wang, Lakshmi N. Yatham, Allan H. Young
- Edited by Gordon Parker, University of New South Wales, Sydney
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- Bipolar II Disorder
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- 05 May 2012
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- 12 April 2012, pp ix-x
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8 - Molecular imaging of bipolar illness
- from Section II - Mood Disorders
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- By John O. Brooks III, Department of Psychiatry David Geffen School of Medicine University of California, Los Angeles Los Angeles, CA, USA, Po W. Wang, Department of Psychiatry Mount Sinai School of Medicine New York, NY, USA and Medical Department Brookhaven National Laboratory Upton, NY, USA, Terence A. Ketter, Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford, CA, USA
- Edited by Martha E. Shenton, Bruce I. Turetsky, University of Pennsylvania
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- Understanding Neuropsychiatric Disorders
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- 10 January 2011
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- 09 December 2010, pp 125-138
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Summary
There are a number of potential neurochemical alterations in the dorsolateral prefrontal circuit that are related to the clinical expression of bipolar disorder. This chapter focuses on translational studies that integrate neurochemical and neuroanatomical information to better understand the pathophysiology of bipolar disorders. There are three major frontal-subcortical circuits that constitute the corticolimbic network: dorsolateral prefrontal, lateral orbitofrontal, and anterior cingulate. Several techniques have been developed that allow for non-invasive assessment of neurochemistry. Ligand-specific positron emission tomography (PET) and single photon emission computed tomography (SPECT) permit regional measurement of monoamines and other neurochemicals, which are thought to be crucial to affective processes. There have been numerous findings of peripheral serotonergic dysfunction in bipolar disorder, including decreased serotonergic reuptake in platelets. The neurochemistry of corticolimbic circuits presents additional challenges for clarifying the neurochemical basis of dysregulation that has been observed in functional neuroimaging studies.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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16 - Management commentary
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- By Terence A. Ketter, Bipolar Disorders Clinic, Stanford, University School of Medicine, Stanford, USA, Po W. Wang, Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford, University School of Medicine, California, USA
- Edited by Gordon Parker, University of New South Wales, Sydney
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- Bipolar II Disorder
- Published online:
- 13 August 2009
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- 29 January 2008, pp 217-231
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Summary
Introduction
As noted by Parker, management of Bipolar II Disorder is challenging for several reasons, including the scarcity of controlled data to inform evidence-based care. Such limited data mean that clinicians commonly extrapolate information regarding BP I and/or (unipolar) major depressive disorder, and view BP II as an intermediate category. Such an approach has strengths and limitations. One notable limitation is that it may underemphasise the heterogeneity of BP II, a condition with substantial inter-patient variability.
Thus, some patients with BP II may have an illness more like major depressive disorder: relatively infrequent recurrent pure (with minimal mixed features) depressive episodes, rare hypomanias, and – with antidepressants – they experience relief of depression without treatment-emergent affective switch (TEAS) into hypomania or accelerating episodes. Antidepressants may be considered foundational treatments for this presentation. In academic centres with specialty clinics, such patients are more likely referred to major depressive disorder clinics, where clinicians may view antidepressants as the treatment of choice for this type of BP II.
However, other patients with BP II may have an illness more akin to BP I. These patients experience relatively frequent recurrent depressive episodes that include mixed features (in some instances with concurrent depression and hypomania, i.e. dysphoric hypomania), common hypomanias and, in some instances, rapid cycling. Antidepressants give inadequate relief of their depression and can confer TEAS, and/or cycle acceleration. For these patients, mood stabilisers or atypical antipsychotics – not antidepressants – may be considered foundational treatments.