Neurological, Psychiatric, and Developmental Disorders Meeting the Challenge in the Developing World (2001) / Chapter Skim
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8 Bipolar Disorder
8 Bipolar Disorder
Pages 257-282
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From page 257... ...
and severe depression.~7] Elevated mood can be accompanied by delusions, hallucinations, insomnia, and extreme excitement, aIld depressive states by persistent low mood or sadness that is accompanied by both physical and psychological symptoms of at least 2 weeks duration and an associated impact on social functioning.
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From page 258... ...
Social and Economic Costs In light of the findings of the 1996 Global Burden of Disease study and more recent estimates of the same measurements of disability-adjusted life years (DALYs) , neuropsychiatric conditions have been recognized as a significant social and economic burden (see Chapter 2~.~16,17]
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From page 259... ...
and no past major depressive disorders (B) The manic episode is not better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
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From page 260... ...
F.32 Depressive Episode In typical depressive episodes of all three varieties described below (mild, moderate, and severe) , the individual usually suffers from depressed mood, loss of interest arid enjoyment, and reduced energy leading to increased fatiguability and diminished activity.
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From page 261... ...
However, when comparisons are made both within and between countries the evidence points to some variation in both the incidence and prevalence of the symptoms of bipolar affective disorder.~27-33] In the United States, the Epidemiologic Catchment Area Study used DSM-Ill criteria.~27]
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From page 262... ...
Bazzoui found that 44 percent of patients admitted with affective disorder in Iraq suffered from bipolar disorder.~39] Though only a fifth of people suffering from affective disorders in Sweden suffer from bipolar disorder, one in three such patients in Jerusalem suffers from the disorder.~40]
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From page 263... ...
Data from a recent French study suggest that early- and late-onset bipolar disorders differ in clinical expression and familial risk, and may therefore foreshadow findings of different subforms ofthe disorders within genetic research.~49] It is known that there is a 1.5 percent lifetime risk for the children of an affected person, 6 percent for brothers, 4.1 percent for mothers, and 6.4 percent for fathers.~24]
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From page 264... ...
Adolescents who are early into their illness are often prone to highly elevated mood states and grandiose delusions resulting in poor adherence to treatment.tl 1,53] Similar findings on the course of bipolar disorder in children have been reported in lndia.~25,51]
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From page 265... ...
Recommendation 8-1. Research to determine the applicability of current diagnostic methods in the local settings of developing countries should be conducted to better understand the epidemiology of bipolar disorder in developing countries and to ensure the effectiveness of efforts to identify and treat the disease within various health care settings.
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From page 266... ...
First, those who are experiencing the manic phase of the disorder do not usually seek treatment because this period is characterized by highly elevated mood states. Often it is only when patients present with high levels of agitation or aggression that treatment will be pursued.
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From page 267... ...
, making sense of what has happened Adapting to post-episode symptoms and social-occupational deficits, financial stress, accepting a regular medication regime, uncomfortable discussions about medication and illness, denial about the realities of the disorder Prevent recurrences, alleviate residual affective symptoms, continue to encourage medication compliance Fears about the future. accepting the illness and the vulnerability to future episodes, coping with ongoing deficits in social-occupational functioning issues surrounding long-term medication adherence SOURCE: [66]
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From page 268... ...
It is used for the treatment of mania and for the prophylaxis of bipolar and unipolar affective disorders.~7981 ~ Retrospective studies ranging from 4 months to 3 years indicate that the relapse rate for bipolar patients treated with placebo is 80 percent, while the relapse rate for those treated with lithium is as low as 35 percent.~78,82] Lithium has been shown to decrease the severity as well as the frequency of episodes.tl 1,83,84]
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From page 269... ...
Patients with dysphoric mania, mixed states, no family history of bipolar disorder, mania following brain injury, or a history of rapid cycling may be more likely to respond initially to carbamazepine than to lithium. However, there is some evidence that the effects of carbamazepine decrease 3 years or so into treatment.~96]
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From page 270... ...
Most of these mood stabilizers are relatively expensive as compared with lithium, carbamazepine, and valproate. Additionally, despite concerns about the described side effects of lithium, a recent review of existing research regarding the use of lithium for the treatment of acute mania in bipolar disorder concluded that it should remain the first-line treatment.[ 1 03]
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From page 271... ...
Additionally, treatment programs that make mobile facilities for blood monitoring more readily available to more remote populations should be developed to enable appropriate courses of treatment that avoid the toxic and sometimes lethal side effects of mood stabilizers. Recommendation 8-4.
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Recommendation 8-7. Randomized controlled trials of the efficacy and feasibility of affordable community-based management programs for those with bipolar disorder (within the context of the extended health care system)
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From page 273... ...
et al. Shifts in the diagnostic frequencies of schizophrenia and affective disorders from 1972 through 1998 A combined analysis from four North American psychiatric hospitals.
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Journal of Affective Disorders 59~2~:107-117, 2000.
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From page 275... ...
Susser. Course of acute affective disorders in a developing country setting.
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From page 276... ...
Linkage of bipolar affective disorder to chromosome 18 markers in a new pedigree series. American Journal of Human Genetics 6i : 1397-1404, 1997.
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From page 277... ...
Frey. The course of unipolar and bipolar affective disorders In: M Schou and E
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From page 278... ...
Carbamazepine prophylaxis refractory affective disorders: A focus on long-term follow-up. Journal of Clinical Psychopharmacology Oct.; 10~5~:318-327, 1990.
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From page 279... ...
Zieba. Development and application of cognitive therapy in affective disorders.
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From page 280... ...
Adjunctive psychotherapy for bipolar disorder: Effects of changing treatment modality. Journal of Abnormal Psychology 108~4~:579-587, 1999.
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From page 282... ...
... .~-:~MaJor risk factor.s;~:~r depress~'on~appe~ar-.s~'m~lar:::'n..
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