Chapter 8 Bipolar illness

• Introduction 280
  
• Historical perspective 282
  
• Mania/manic episode 284
  
• Hypomania/hypomanic episode 286
  
• Bipolar spectrum disorder 287
  
• Bipolar (affective) disorder 1: classification 288
  
• Bipolar (affective) disorder 2 290
  
• Bipolar affective disorder 3: management principles 292
  
• Other issues affecting management decisions 294
  
• Hospital admission 296
  
• Treatment of acute manic episodes 298
  
• Treatment of depressive episodes 300
  
• Prophylaxis 302
  
• Psychotherapeutic interventions 304
  
• Cyclothymia 306
  
• Lithium 308
  
• Lithium: adverse effects 310
  
• Valproate/valproic acid 312
  
• Carbamazepine 314
  
• Lamotrigine 316
  

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2 Characterized by cheerful, optimistic personality style, tendency to become easily irritated, extroverted and sociable, and requiring little sleep (less than 6 hours/night).

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2 Yatham LN (2002) The role of novel antipsychotics in bipolar disorders. Journal of Clinical Psychiatry, 63(Suppl. 3), 10–14.

3 Mukherjee S, Sackeim HA and Schnur DB (1994) Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience. AJP, 151, 169–76.

4 McElroy SL and Keck PE Jr (2000) Pharmacologic agents for the treatment of acute bipolarmania. Biol Psychiatry, 48, 539–57.[CrossRef][Web of Science][Medline]

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3 Nemeroff CB, Evans DL, Gyulai L et al. (2001) Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. AJP, 158, 906–12.

4 Calabrese JR, Vieta E and Shelton MD (2003) Latest maintenance data on lamotrigine in bipolar disorder. Eur Neuropsychopharmacol, 13(Suppl. 2), S57–66.

5 Bauer M, Berghofer A, Bschor T et al. (2002) Supraphysiological doses of L-thyroxine in the maintenance treatment of prophylaxis-resistant affective disorders. Neuropsychopharmacology, 27, 620–8.[Web of Science][Medline]

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1 The use of lithium salts in the treatment of ‘psychotic excitement’ is usually credited to John Cade in 1949 (Medical Journal of Australia 2, 349–52). However, this was a ‘rediscovery’ of the application of lithium to the treatment of ‘insanity’ first described by W.A. Hammond in 1871 (The treatment of insanity in A treatise on diseases of the nervous system, New York: Appleton, 325–84). The use of a specific agent for a specific disorder heralded the start of the modern era of psychopharmacology.

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3 Burgess S, Geddes J, Hawton K et al. (2002) Lithium for maintenance treatment of mood disorders. The Cochrane Library, 1 Oxford: Update Software.

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2 Jefferson JW (ed.) (1987) Lithium encyclopedia for clinical practice, 2nd edn. Washington, DC, American Psychiatric Association Press.

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4 Weinstein MR (1980) In FN Johnson, ed., Handbook of lithium therapy, pp. 421–9. Lancaster MTP Press.

5 Cohen LS, Friedman JM, Jefferson JW et al. (1994) A reevaluation of risk of in utero exposure to lithium. JAMA, 271, 146–50.[Abstract/Full Text]