Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

Fountoulakis, Konstantinos Ν.; Vieta, Eduard; Siamouli, Melina; Valentí, Marc; Magiria, Stamatia; Oral, Timuçin; Fresno, David H.; Giannakopoulos, Pantéleimon; Kaprinis, George

doi:10.1186/1744-859x-6-27

Cited by 63 publications

(47 citation statements)

References 157 publications

(96 reference statements)

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“…The STAI was selected primarily because it is one of the most commonly used instruments for assessing anxiety. There are criticisms of the Spielberger scale (e.g., Caci, Baylé, Dossios, Robert, & Boyer, 2003) but it has been found to be as effective a measure as a number of other anxiety scales (Fountoulakis et al, 2007), and also retains the advantages of validity, reliability, and a history of extensive use in psychological and health research. One possibility is that anxiety and depression are separate constructs but with overlap, particularly at later stages (Eizenman et al, 2003;Mogg & Bradley, 2005).…”

Section: Discussionmentioning

confidence: 99%

Adapting effects of emotional expression in anxiety: Evidence for an enhanced Late Positive Potential

Richards

Holmes

Pell

et al. 2013

Social Neuroscience

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An adaptation paradigm was used to investigate the influence of a previously experienced visual context on the interpretation of ambiguous emotional expressions. Affective classification of fear-neutral ambiguous expressions was performed following repeated exposure to either fearful or neutral faces. There was a shift in the behavioral classification of morphs toward "fear" following adaptation to neutral compared to adaptation to fear with a nonsignificant trend toward the high-anxiety group compared to the low being more influenced by the context. The event-related potential (ERP) data revealed a more pronounced late positive potential (LPP), beginning at ~400 ms poststimulus onset, in the high but not the low-anxiety group following adaptation to neutral compared to fear. In addition, as the size of the behavioral adaptation increased, there was a linear increase in the magnitude of the late-LPP. However, context-sensitivity effects are not restricted to trait anxiety, with similar effects observed with state anxiety and depression. These data support the proposal that negative moods are associated with increased sensitivity to visual contextual influences from top-down elaborative modulations, as reflected in an enhanced LPP deflection.

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Section: Discussionmentioning

confidence: 99%

Adapting effects of emotional expression in anxiety: Evidence for an enhanced Late Positive Potential

Richards

Holmes

Pell

et al. 2013

Social Neuroscience

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“…VPA (sodium salt; Sigma-Aldrich) in saline once daily for 30 days, as previously described [12,14,22,73]. Three hours after the last VPA injection, the plasma VPA concentration equals 31 ± 6 (mean ± SD) lg/ml [22], slightly below the therapeutic range (45-150 lg/ml) for bipolar disorder [35]. A control group received the same volume of saline (vehicle) under parallel conditions.…”

Section: Animals and Dietsmentioning

confidence: 99%

Chronic Administration of Valproic Acid Reduces Brain NMDA Signaling via Arachidonic Acid in Unanesthetized Rats

et al. 2008

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Evidence that brain glutamatergic activity is pathologically elevated in bipolar disorder suggests that mood stabilizers are therapeutic in the disease in part by downregulating glutamatergic activity. Such activity can involve the second messenger, arachidonic acid (AA, 20:4n - 6). We tested this hypothesis with regard to valproic acid (VPA), when stimulating glutamatergic N-methyl-D: -aspartate (NMDA) receptors in rat brain and measuring AA and related responses. An acute subconvulsant dose of NMDA (25 mg/kg i.p.) or saline was administered to unanesthetized rats that had been treated i.p. daily with VPA (200 mg/kg) or vehicle for 30 days. Quantitative autoradiography following intravenous [1-(14)C]AA infusion was used to image regional brain AA incorporation coefficients k*, markers of AA signaling. In chronic vehicle-pretreated rats, NMDA compared with saline significantly increased k* in 41 of 82 examined brain regions, many of which have high NMDA receptor densities, and also increased brain concentrations of the AA metabolites, prostaglandin E(2) (PGE(2)) and thromboxane B(2) (TXB(2)). VPA pretreatment reduced baseline concentrations of PGE(2) and TXB(2), and blocked the NMDA induced increases in k* and in eicosanoid concentrations. These results, taken with evidence that carbamazepine and lithium also block k* responses to NMDA in rat brain, suggest that mood stabilizers act in bipolar disorder in part by downregulating glutamatergic signaling involving AA.

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“…[4,5] Despite consistent data about the impact and prevalence of anxiety symptoms and disorders in BD, current treatment guidelines present a paucity of information on the management of these conditions. [6][7][8] This may reflect the fact that most of the available controlled studies have focused only on distinct mood phases of BD.…”

mentioning

confidence: 99%

Epidemiology and Management of Anxiety in Patients with Bipolar Disorder

2009

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Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.

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Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

Abstract: Background: Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.

Cited by 63 publications

References 157 publications

Adapting effects of emotional expression in anxiety: Evidence for an enhanced Late Positive Potential

Adapting effects of emotional expression in anxiety: Evidence for an enhanced Late Positive Potential

Chronic Administration of Valproic Acid Reduces Brain NMDA Signaling via Arachidonic Acid in Unanesthetized Rats

Epidemiology and Management of Anxiety in Patients with Bipolar Disorder

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