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McGraw Systems to Present at Caminar Mental Health Symposium

Written by Administrator on Friday, 12 May 2017.

On May 18, 2017 Caminar will host their annual educational symposium focused on new research in mental health and its impact on early diagnosis and treatment.

Panelists

  • Ben McGraw, President and CEO, McGraw Systems - Using bStable for active symptom monitoring to prevent crisis situations
  • Steven Adelsheim, M.D., Clinical Professor of Psychiatry and Behavioral Sciences, Stanford University - Adolescent mental health early intervention programs
  • Libby Craig, Crisis Text Line - Using data and tech to increase support for people in crisis
  • Rebecca Bernert, Ph.D., Director, Suicide Prevention Research Laboratory, Stanford Mood Disorders Center - New findings in suicide prevention and treatment
  • Kathleen Kara Fitzpatrick, Ph.D., Clinical Assistant Professor, Stanford University School of Medicine - Interventions for eating disorders in adolescents and young adults
  • Eric Kuhn, Ph.D., Research Clinical Psychologist, National Center for PTSD, VA Palo Alto - How tech is helping people manage mental health conditions, such as PTSD

Effective Personalized Strategies for Treating Bipolar Disorder

on Saturday, 17 August 2013. Posted in General

Bipolar disorder causes havoc in patients’ lives. Even in the best of circumstances, successful treatment is challenging

Effective Personalized Strategies for Treating Bipolar Disorder

By Stephen V. Sobel, MD

Bipolar disorder causes havoc in patients’ lives. Even in the best of circumstances, successful treatment is challenging. Treatment targets constantly shift; patients are frequently nonadherent; and comorbidity is the rule, not the exception. Diagnosis of bipolar disorder is often difficult. Comorbidities need to be identified and addressed if treatment is to be effective.

The importance of an accurate diagnosis

With apologies to Charles Dickens, bipolar disorder is often experienced as the “best of times and the worst of times.” This polarity often causes bipolar disorder to be undiagnosed, overdiagnosed, or misdiagnosed. Bipolar disorder is associated with a significantly elevated risk of suicide. Moreover, bipolar patients often use highly lethal means for suicide.1 Contributing factors include early age at disease onset, the high number of depressive episodes, comorbid alcohol abuse, a history of antidepressant-induced mania, and traits of hostility and impulsivity.

Bipolar I disorder, with episodes of full-blown mania, is usually easier to diagnose than bipolar II disorder, with episodes of subtler hypomania. Recognizing that the primary mood state may be irritability rather than euphoria increases the likelihood of diagnosis as does the recognition that symptoms often last fewer than the 4 days required for diagnosis by DSM-IV.2 Focusing more on overactivity than mood change further improves diagnostic accuracy, and the use of structured questionnaires is helpful.

Given the greater frequency of depression than manic episodes in bipolar disorder, what clues indicate bipolar disorder rather than unipolar depression? The Table lists factors that may help identify unipolar depression.

A moving target needs moving treatment

Effective personalized treatment recognizes bipolar disorder as a biopsychosocial disorder, but mood-stabilizing medications are the backbone of treatment. These medications fall into 3 categories: lithium, antikindling/antiepileptic agents, and second-generation antipsychotics. The mechanisms of actions by which these medications work are numer-ous and include increasing levels of serotonin, γ-aminobutyric acid, and brain-derived neurotrophic factor (BDNF) and decreasing glutamate levels; modifying dopamine pathways; stabilizing neuronal membranes; decreasing sodium channels; decreasing depolarization; decreasing apoptosis; and increasing neural cell growth/arborization.

Double-blind placebo-controlled studies of the medications—lithium, divalproex, carbamazepine, and atypical antipsychotics—used to treat symptoms of acute mania have demonstrated a response rate of approximately 50% to these drugs. Response was defined as a 50% decrease in symptoms using the Young Mania Rating Scale (YMRS) with onset of response within a few days.

An increasingly intriguing aspect of treatment with lithium and atypical antipsychotics involves their effect on BDNF. In a study of 10 manic patients treated with lithium for 28 days, most (87%) showed an increase in BDNF level (ie, from 406 pg/mL to 511 pg/mL). 

Factors that suggest bipolar depression rather than unipolar depression

In a typical 3-week study of acute mania, approximately half of the benefit was seen by day 4. A 3-week, double-blind, inpatient study of olanzapine and risperidone in 274 patients with acute mania found that of 117 patients who had a less than 50% decrease in the YMRS score at 1 week, only 39% responded and 19% had symptom remission at end point. Of 40 patients with a less than 25% decrease in the YMRS score at 1 week, only 25% responded and only 5% had symptom remission at 3 weeks. Of 157 patients who had at least a 50% decrease in the YMRS score at week 1, 84% responded and 64% had symptom remission at 3 weeks.4 Clinically, a medication change should be considered for patients who do not demonstrate substantial benefit by week 1.

A meta-analysis comprising 16,000 patients who had acute mania found that the most effective agents were haloperidol, risperidone, and olanzapine. The least effective were gabapentin, lamotrigine, and topiramate.5

A combination of medications—typically lithium or an antiepileptic with an atypical antipsychotic—is often necessary to successfully treat acute mania. A meta-analysis found the response rate increased from 42% to 62% when an antipsychotic was added.6

Bipolar depression has proved to be more resistant to medication treatment than mania. The same medications are used, with lamotrigine for maintenance treatment. The FDA has approved Seroquel, Seroquel XR, and Symbyax (the combination of olanzapine and fluoxetine), for the acute treatment of bipolar depression. Studies of acute bipolar depression have typically lasted 8 weeks. Approximately half of the benefit oc-curs by week 2, with statistical separation from placebo between weeks 1 and 3.7-9

The best treatment is prevention

Patients who have bipolar disorder almost always require lifelong maintenance treatment, frequently with 2 medications: one to prevent the upside (ie, hypomania/mania), and another to prevent the downside (ie, depression).

Findings from a registration trial showed that lamotrigine more effectively prevented depressions than lithium but lithium prevented mania/hypomania more effectively than lamotrigine.10

Another study added placebo or lamotrigine to lithium treatment for 124 patients. The median time to relapse/recurrence was 3.5 months for those taking lithium monotherapy but 10 months for those who received combination treatment.11

The effectiveness of a combination maintenance regimen was also seen in a study of 628 patients with bipolar I disorder treated for 2 years: 65% of those taking lithium or divalproex alone experienced a recurrence compared with 21% who received quetiapine added to lithium or divalproex.12 However, combination treatment may result in more adverse effects and increased risk of drug-drug interactions.

The best mood stabilizer

The best mood stabilizer for a patient is the one he or she will take. No matter how effective a medication is, it will not relieve symptoms if it is not being taken. The key to effective personalized treatment of bipolar disorder is a good patient-physician connection in which the patient is part of the treatment decision-making process.

Psychotherapy is an integral part of the effective treatment of bipolar disorder, not just an augmentation strategy. Psychotherapies that are helpful include cognitive-behavioral therapy and social rhythm therapy.13 Psychotherapy can focus on several areas, such as education, comorbidities, medication adherence, and interpersonal relationships. In addition, therapy can challenge the automatic, distorted, and dysfunctional thoughts and help the patient maintain social rhythms (eg, consistent sleep). The involvement of family members in treatment enhances success.

Patients may stop taking their medications because the adverse effects become intolerable; they may miss what they perceive as their more satisfying and productive hypomania; and they might believe that a period without symptoms means that they are cured and no longer need medications. One study of 3640 patients with bipolar disorder who made 48,000 physician visits found that 24% of patients were nonadherent (defined as missing at least 25% of doses) 20% of the time. Factors associated with nonadherence included rapid cycling, suicide attempts, earlier onset of illness, anxiety, and alcohol abuse.14

Patients who have bipolar II disorder spend far more time depressed than hypomanic. Lithium appears to be less effective than antikindling agents for rapid cycling as well as for mixed bipolar disorder states.15

Maintenance treatment is necessary for patients with acute mania or acute depression; therefore, choose medications that are more tolerable to the patient to facilitate long-term adherence. Recognize that medications may need to be adjusted or changed—in the acute phase of illness, rapid efficacy is often the priority, while medication adherence is the priority during the maintenance phase.

Other factors to consider when choosing the best medication for a particular patient include:

• A history of treatment response

• A family history of response

• Adverse effects of a particular drug

• Drug interactions

• Pregnancy

• Breast-feeding

Antidepressants

The use of antidepressants in bipolar disorder is controversial because they may induce rapid cycling, especially in patients with episodes of rapid cycling.16 In a study by Altshuler and colleagues,17 patients who had breakthrough depression despite treatment with a mood stabilizer were treated with antidepressants for at least 60 days. Patients who had symptom remission for 6 weeks were followed up for 1 year: 36% of patients who continued antidepressants for longer than 6 months relapsed versus 70% who discontinued antidepressants before 6 months.

A randomized discontinuation study with antidepressants found no statistically significant symptomatic benefit in the long-term treatment of bipolar disorder.18 Trends toward mild benefits, however, were found in patients who continued antidepressants. This study also found, similar to studies of tricyclic antidepressants, that rapid-cycling patients had worsened outcomes with continuation of modern antidepressants, including SSRIs and SNRIs.

An NIMH study of 159 patients who had breakthrough depression despite receiving a mood stabilizer were treated with sertraline (mean dosage, 192 mg/d), bupropion (mean dosage, 286 mg/d), or venlafaxine (mean dosage, 195 mg/d) for 10 weeks with a 1-year follow-up.19 At the end of 1 year, only 16% of the patients had continued remission while more than 55% had switched to mania/hypomania. The worst results were seen with venlafaxine and the best with bupropion.

In a study by Sachs and colleagues,20 patients who had breakthrough depression despite being treated with mood stabilizers were randomized to paroxetine (mean dosage, 30 mg/d), bupropion (mean dosage, 300 mg/d), or placebo. No significant differences on any effectiveness or safety outcome, including remission rates or affective switch frequency, were found.

Overall, these studies indicate that the role of antidepressants is limited and that, in fact, a trial of a mood stabilizer cannot be considered to have failed unless the failure occurs in the absence of an antidepressant. A meta-analysis of 18 studies with 4105 patients found that combination treatment including a mood stabilizer and an antidepressant was not statistically superior to monotherapy.21

When symptoms persist

Establish the context of each appointment by focusing on changes in occupational, social, family, and health status. Evaluate medication regimens, with a focus on effectiveness for carefully chosen target symptoms and adherence to treatment, as well as medication tolerability and patient attitudes. Be alert to the emergence of early symptoms of mood change, and adjust medications if necessary. Remember that treatment modalities often need to change over time.

Mood stabilizers should be optimized with combination therapy for sustained remission. Antidepressants may worsen the disease course, and a true trial of a mood stabilizer can-not occur within the setting of antidepressants. If symptoms persist, ask: Is the patient taking anything that is making symptoms worse, eg, drugs, alcohol, or antidepressants? Is the patient taking the medications? Is treatment adequate? Is another condition (including subclinical hypothyroidism) interfering with treatment? Is psychotherapy being ignored?

God's Psychiatrist

on Monday, 08 July 2013.

Funny portrayal of a psychiatrist analyzing some events in the Old Testament

God's Psychiatrist

By H. Steven Moffic, MD

Chapter 1. A Psychiatrist in Biblical Times

In Genesis, it is described that man, and then presumably woman in a first example of matchmaking, is created in the image of God. Imagine a modern day psychiatrist time traveling back to observe this creation. If you don’t believe in such a God, but are a parent, think of a child created, at least half genetically speaking, in your image.

As holy as it may seem to be created in the image of a God, would a psychiatrist think that this was mentally healthy? What happens to the children of parents who want their children to fulfill their own dreams? Could it be too much of a narcissistic wish and expectation to be created in anyone’s image? Wouldn’t this make normal separation and individuation more difficult, the psychiatrist wondered?

Indeed, the psychological challenges and problems for Adam and Eve emerge quickly in the Garden of Eden. The psychiatrist observing this scenario wondered about offering a walk, as Freud did about a century ago with Mahler, to discuss the temptation and symbolic meaning of the Serpent and the Tree of Knowledge. But the psychiatrist wondered if this was an impossible paradox to resolve. Without knowledge, how does one understand the risks of obtaining knowledge?

So Eve goes ahead, and she and Adam are banished from the Garden in shame. If our psychiatrist could have met them in this wider world, perhaps they could have processed their shame and the current status of their relationship before they had children. Instead, the result is 2 sons, Cain and Abel, who portray the first sibling conflict and competition, so severe that Cain murders Abel.

After this tragedy, history seems to progress adversely until Noah. Noah is said to be the best of his time. In the Ark that he builds, his family, animals, and himself survive drastic environmental and climate changes. If a psychiatrist were also on the Ark, there would have been ample time to discuss how Noah felt about the responsibility of saving the world, and how he might prepare himself for a different future. As it turns out, he becomes drunk afterward. Noah might have needed detox and Alcoholic Anonymous; his family might have sought support from Al-Anon. However, just like the lives of so many modern day celebrities, their lives and the story goes on without completing treatment.

The next major figure is Abraham. No one claims to know, not even himself, why he is chosen to start a new religion. Later on in his life, sibling rivalry emerges again, but now between stepbrothers. After Abraham has his son Ishmael by the handmaiden, Hagar, Abraham and his wife Sarah have their own son, Isaac. Can’t you just predict the need for some challenging family therapy? Instead, Sarah, with the apparent approval and support of God, orders Ishmael to be banished. Abraham acquiesces, and God, to seemingly even things out a bit, says that Ishmael will start his own Kingdom, which many have taken to become the Arab people.

Abraham is later asked to sacrifice Isaac. Any psychiatrist might say that at times of exasperation, a parent might think of sacrificing their child. But this time it includes the actual preparation, without the apparent knowledge, of Sarah. Isaac is spared at the last minute, but to a psychiatrist, it might seem that he suffered PTSD. Sarah may have died soon afterward from the shock of grief.

Without treatment, as family problems are wont to do, the sibling conflicts continue in Isaac’s sons, Esau and Jacob, and then again in Jacob’s sons. Esau also goes off in exile, perhaps to start what will become the Roman people.

This story should be enough to call forth a psychiatrist, shouldn’t it? Finally, do we see the prototype of God’s psychiatrist in Jacob’s son, Joseph? Though Jacob’s favoritism, culminating in his giving Joseph the coat of many colors, seems to produce excessive narcissism, Joseph overcomes the trauma of being sold by his brothers and given jail time in Egypt, to use his prophetic interpretation of dreams. He attributes this skill to God, succeeding beyond anyone’s wildest dreams in a new culture, in which he prepares successfully for climate change, forgives his brothers, and is united with his father. After this family forgiveness, the cycle is broken and there is just “normal” sibling rivalry depicted in the Old Testament.

With the psychological path cleared in one way, but challenging in another, Moses arrives. A psychiatrist in the court might wonder if his stuttering was a consequence of an unusual child rearing, both in the Egyptian court, where he is adopted, and with the surreptitious involvement of his own family. Maybe he was dealing with buried anger, too. Moses, despite being so humble, has several outbursts of anger, which cost his entry into the Promised Land. Would anger management and/or a prn calming medication have helped him? If he were calmer, perhaps he would have recommended group psychotherapy for those disgruntled among his people, and maybe then sought psychoanalysis for himself. Following the death of Moses, the Old Testament ends.

Chapter 2. Psychiatry in the Common Era


Let’s go on to the Rabbis who replaced Jewish priests in the diaspora outside of Israel after the beginning of the Common Era. They seemed to grasp some therapeutic principles that would help sustain the Jewish people and keep them together over the next 2 millennia, despite pogroms, exiles, and most recently, the Holocaust. They came to interpret the Old Testament in different ways and on many levels, including the Talmud, Midrash, Kabalah, weekly Torah study around the world, and pastoral counseling. In the early Middle Ages, one particular Rabbi—Maimonides—who was a general physician and philosopher all in one, conveyed basic concepts of mental well-being, supportive psychotherapy, and even the basis of our most popular and evidence-based therapy, cognitive-behavioral psychotherapy.1

Nevertheless, there was still no formal field of psychiatry, that is, until a Jewish physician emerged about a century ago to complement the work of Kraepelin. Sigmund Freud, after a childhood as an honor student in Jewish religious schools, went on to take the new field of psychiatry to a different level with his psychoanalytic theories.

Like Joseph, Freud arrived at his conclusions after analyzing his own dreams. The difference is that Freud analyzed the conflictual issues in his dreams, and Joseph analyzed their prophetic meanings. In the ensuing therapeutic process, different levels of interpretation paralleled the Rabbis’ interpretation of the teachings in the Torah.

Was Freud God’s psychiatrist at long last? Not likely. Actually, Freud’s views may reflect why a psychiatrist was not around from the beginning of humanity in Biblical times. Freud, though publicly valuing his Jewish cultural background and involved with B’nai B’rith meetings in Vienna, was famous (or infamous) for claiming that religion was an illusion, an opium for the masses, and that belief in God was a matter of the transference of feelings toward one’s parents.

Freud also seems to underestimate anti-Semitism, which labeled psychoanalysis as that “Jewish science,” only leaving his home at the last minute when his daughter’s life was threatened. Since Jewish theology values action over thoughts and beliefs, Freud’s actions—to find new ways to heal people—couldn’t be more Jewish. What did it mean, then, that Freud died on Yom Kippur, the Day of Atonement, in 1939? And if he was thinking of his death in the physician-assisted morphine mental state, did he reassess his feelings about God?

What about that other famous psychiatrist from Vienna, who studied some with Freud? That was Viktor Frankl. In one of life’s ironies, he lived for a time in close proximity to Hitler. What if he, or another psychiatrist, had at one point been able to treat Hitler during his troubled childhood? As it turned out, however, Dr Frankl2 was about to go to America, only to have an existential crisis:

Should I foster my brainchild, logotherapy . . . or should I concentrate on my duties as a real child of my parents and stay by them?2

He returned home to find the letters of the Ten Commandments stating to honor thy father and mother. He let his Visa lapse. Sent not long after to Auschwitz, he became a sort of concentration camp psychiatrist, struggling to give meaning to the struggle to survive. That meaning was to see his wife again and to lecture about the psychological lessens learned. Only the latter came to pass. After the war, he resettled in Vienna and remarried a Christian woman. He soon published the perennial best seller, Man’s Search for Meaning, and established Logotherapy, a “therapy of meaning.”

Although I was trained in Freudian psychotherapy in the early 1970s, by the end of my clinical career, I came to follow the path of Freud to Frankl by focusing on the meaning of life for the decreasing amount of time I had with each patient.3

Did Dr Frankl end up believing in a God? He never would say.

In our time, it seems that the number of psychiatrists who believe in a God are increasing, parallel with the decreasing influence of Freud’s ideas. Jewish psychiatrists, although still prominent in the newer areas of group psychotherapy, cognitive therapy, understanding brainwashing, and even Freud’s predicted psychopharmacology, are nevertheless decreasing in their relative numbers.

Perhaps the notable example of a Jewish psychiatrist who clearly and overtly believes in God is Dr Abraham Joshua Twerski, who is also a Rabbi and scion of a Hasidic dynasty, and specializes in substance abuse. For a comparable Christian psychiatrist, we can cite the late Dr E. Mansell Pattison, who was also a minister.

Chapter 3. The Moral of the Story

What, then, is the moral of this tale, as Hannah, my grandchild of 2 Rabbis, would ask? Just in time, a valued teacher and colleague asked, “Isn’t God a Psychiatrist”? If God is a psychiatrist and we psychiatrists were also created in God’s image, and if we psychiatrists have come currently to view religion and psychiatry as more overlapping than conflictual, then together we can work to help and maybe even improve human nature. Amen.

References1. Pies RW. The Judaic Foundations of Cognitive-Behavioral Therapy. Bloomington, Ind; iUniverse; 2010.
2. Scully M. Viktor Frankl at Ninety: An Interview. First Things. April 1995. http://www.firstthings.com/article/2008/08/004-viktor-frankl-at-ninety-an-interview-18. Accessed April 1, 2013.
3. Moffic HS. The meaning of life in a 15-minute med check. Psychiatr Times. May 19, 2011. http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1864201. Accessed April 1, 2013.

- See more at: http://www.psychiatrictimes.com/god’s-psychiatrist-april-fool’s-tale-3-chapters/page/0/2#sthash.cfTiiQbN.dpuf

- See more at: http://www.psychiatrictimes.com/bipolar-disorder/god’s-psychiatrist-april-fool’s-tale-3-chapters#sthash.1Ku3jKyS.dpuf

Awesome Bipolar Disorder Infographic!!

on Friday, 14 June 2013. Posted in General

Created by Deyanara Riddix of Nursingschoolhub.com - thanks!

Awesome Bipolar Disorder Infographic!!

What a great way to summarize bipolar disorder.

Great job Deyanara - all the way from West Bengal, India!

http://www.nursingschoolhub.com

http://www.nursingschoolhub.com/bipolar

 

6 Keys To Building Resilience

on Wednesday, 12 June 2013. Posted in General

Resilience key to dealing with depression or bipolar disorder

6 Keys To Building Resilience

Tactics for building resiliance include:

1. Learn how to regulate your emotions

2. Adopt a positive but realistic outlook

3. Become physically fit

4. Accept challenges

5. Maintain a close and supportive social network

6. Observe and imitate resilient role models

bStable in NAMI North Carolina 2013 Spring Clippings Newsletter

on Saturday, 25 May 2013. Posted in General

McGraw Systems Proud to Support NAMI

bStable in NAMI North Carolina 2013 Spring Clippings Newsletter

Parents With Bipolar Disorder - WAKE UP!

on Saturday, 27 April 2013. Posted in General

IF THERE IS ONE TOPIC AROUND BIPOLAR DISORDER THAT PISSES ME OFF MORE THAN ANYTHING, IT IS THIS!

Parents With Bipolar Disorder - WAKE UP!

PARENTS WHO SHOVE THEIR HEAD IN THE SAND AND NEVER ADMIT THEY ARE SICK AND SPEND THEIR LIFE TALKING ABOUT HOW THEIR CHILD IS SICK INSTEAD OF TAKING RESPONSIBILITY FOR THEIR OWN ILLNESS NEED TO BE PUT AWAY.

LOOK AT THE FACTS IN THIS ARTICLE. BIPOLAR DISORDER HAS A STRONG GENETIC FACTOR. ADD ABUSE ONTOP OF THAT FROM A PARENT THAT WON'T ADMIT THEY HAVE BIPOLAR DISORDER AND PHYSICALLY AND EMOTIONALLY ABUSES A CHILD ON A DAILY BASIS - THAT IS SICK.

 

Psychiatric Times. CHILD AND ADOLESCENT PSYCHIATRY

Offspring of Parents With Bipolar Disorder

By Karen Dineen Wagner, MD, PhD | February 8, 2010

Dr Wagner is the Marie B. Gale Centennial Professor and vice chair of the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston.

It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A

recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue.

These authors compared the lifetime prevalence of bipolar and other psychiatric disorders in children whose parents had–or did not have–BD. The study involved 233 parents with BD and their 388 offspring and a control group of 143 parents without BD and their 251 offspring.

Parents with BD were recruited from outpatient clinics and advertisements for participation in the study. On the basis of diagnostic interviews, 158 parents had bipolar I disorder and 75 had bipolar II disorder. The majority (80%) of the parents interviewed were female. The mean age of parents with BD was 40 years. Sixty-four percent of parents reported that the onset of their mood disorder occurred before they

were 20 years old. Parents with BD were less likely to be married at the time of intake and had a slightly lower socioeconomic status than parents without BD.

The offspring of parents with BD did not have to be symptomatic to participate in the study. The mean age of these children was 12 years; 49% were female; and 88% were white. Fewer than half (42%) were living with both biological parents.

The rate of bipolar spectrum disorder in the offspring of parents with BD was 10.6% versus 0.8% in the offspring of control parents. The rate of bipolar I disorder was 2.1%; bipolar II disorder, 1.3%; and bipolar not otherwise specified (NOS), 7.2%. The rate of BD increased substantially–to 29%–when both parents had BD.

Overall, the offspring of parents with BD were at significantly greater risk (52%) for any Axis I disorder than those in the control group (29%).

The majority (76%) of these offspring experienced childhood-onset bipolar disorder before age 12 years. Bipolar NOS was the most common first episode of illness. Rates of comorbidity in these youths were high: 51% had anxiety disorder, 53% had disruptive behavior disorder, and 39% had attention-deficit/hyperactivity disorder (ADHD).

http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1490412

1

Psychiatric Times. Vol. No. February 8, 2010Psychiatric Times. Vol. No. February 8, 2010

The authors concluded that there is a 14-fold increase in the rate of bipolar spectrum disorder in youths who have a biological parent with BD. If both parents have BD, then the offspring are 3 times more likely to have BD.

The mean age of youths in this study was 12 years. Prevalence rates may therefore be an underestimate because some children with depression may become bipolar in adolescence. It is recommended that clinicians who treat adults with BD inquire about the functioning of their children to provide appropriate early intervention.

Posttraumatic stress disorder and substance abuse

In a family study of BD in youths, Steinbuchel and colleagues2 investigated the relationships among adolescent BD, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Because adults with BD who were severely abused as children are at high risk for SUD, these investigators sought to determine whether there is a similar association in adolescents.

A total of 105 adolescent offspring of parents with BD and a control group of 98 youths without mood disorders participated in this study. The diagnosis of BD was based on structured psychiatric interviews. SUDs included any alcohol(Drug information on alcohol) or drug abuse or dependence.

Rates of PTSD were significantly higher in adolescents with BD than in the control group. Sixteen percent of youths with BD had full or subthreshold PTSD compared with 3% in the control group. These youths had experienced trauma in the form of physical abuse, sexual abuse, witnessing of death, or family violence. Rates of SUDs were higher among youths with BD than in those in the control group (32% vs 4%, respectively). Alcohol was the most frequently used substance (86%) followed by marijuana (71%) and tobacco (29%).

What was the temporal order of these disorders? In half of the cases, BD preceded PTSD. In the other half of cases, PTSD was diagnosed before BD. For those youths in whom SUD developed, the majority had BD followed by PTSD and then SUD.

This study confirms an association between PTSD in adolescents with BD and subsequent development of SUD. Rates of SUD were higher in those youths who met full criteria for PTSD than for those with subthreshold symptoms. The findings reveal that BD increases the risk for PTSD, which in turn increases the risk for SUDs. The investigators suggest that treatment of adolescents with BD may prevent trauma related to the development of PTSD and subsequent SUD. It is recommended that clinicians who treat adolescents with BD evaluate for the presence of PTSD and SUD.

References

1. Birmaher B, Axelson D, Monk K, et al. Lifetime psychiatric disorders in school-aged offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring study. Arch Gen Psychiatry. 2009;66:287-296.

2. Steinbuchel PH, Wilens TE, Adamson JJ, Sgambati S. Posttraumatic stress disorder and substance use disorder in adolescent bipolar disorder. Bipolar Disord. 2009;11:198-204.

 

 

United States Mental Healthcare

on Wednesday, 16 January 2013. Posted in General

Let's discuss mental healthcare in the United States

United States Mental Healthcare

Check out our interview with McGraw System's CEO Ben McGraw and join the discussion on your thoughts on mental healthcare in the United States