Personality Changes Later in Life: Diagnostic and Treatment Considerations

Topics: Bipolar Disorder | Borderline Personality Disorder | Disinhibition | Frontotemporal dementia | Hypomania | Mania | MOCA | Neuropsychological testing | Personality Disorders | Self-injury | Stimulants | Suicide

CGPR: What is the course of personality disorders as people age? Dr. Tampi: Personality usually doesn’t change much. People with borderline personality disorder (BPD), for example, don’t usually experience significant changes once they reach middle age. Experiences over a person’s lifespan may teach them skills that blunt their sharp edges, but

Lithium Exposure In Utero—How Bad Is It Really?

Topics: Bipolar Disorder | birth defects | Lithium | perinatal | postpartum mood | Pregnancy | women

REVIEW OF: Fornaro M et al, Am J Psychiatry 2020;177(1):76–92 STUDY TYPE: Literature review Most of us are wary of prescribing lithium to pregnant patients, but is prenatal lithium exposure as risky as we think? A meta-analysis of 13 case-control, cohort, and interventional studies (n = 1,349,563 pregnancies) compared congenital anomalies among

Assessing Bipolar Disorder in Children and Adolescents

Topics: Assessment | Bipolar Disorder | DMDD | Nomogram | Posterior Probability

CCPR: Can you talk about usual practice in assessing children and adolescents for bipolar disorder? Dr. Van Meter: Despite decades of good research demonstrating that young people are affected by bipolar disorder, it’s often a diagnosis of last resort. For example, somebody might be diagnosed initially with major depressive disorder and treated with

The Bipolar Heart [60 Sec Psych]

Topics: Bipolar Disorder | Cardiovascular | Heart health | Podcast

Introducing 60 Second Psych, a series of super short episodes presenting bottom line assessments of useful studies in psychiatry. An international task force issues a warning about the risk of cardiovascular disease in bipolar disorder. A review of: Goldstein BI, Baune BT, Bond DJ, et al. Call to Action Regarding the Vascular-Bipolar Link: A Report

Equetro: New Name, Old Drug

Topics: Bipolar Disorder

Okay, we’ll lay our cards on the table right away. Rarely has TCR been as annoyed by the launch of a new medication as we are by the launch of Equetro. The last time the pharmaceutical industry embarrassed itself this much was when Eli Lilly launched “Sarafem,” calling it a “new” medication for PMDD when it was simply Prozac with a new name an

Antidepressants in Bipolar Disorder: The Controversy Continues

Topics: Antidepressants | Bipolar Disorder

There is a battle underway in the genteel circles of academic psychiatry. The disputed question is: Are antidepressants (ADs) good or bad for patients with bipolar disorder? The major figureheads in this drama are respected psychiatrists on opposite coasts. In the pro-AD corner, weighing in with an endowed chair and full professorship at UCLA, we hav

Lab Monitoring with Mood Stabilizers: Let’s Get Real

Topics: Bipolar Disorder

“Be careful, doctor. Don’t order lab tests that you don’t really need. You’re asking for trouble.” No, that’s not TCR talking. That’s none other than George Lundberg, M.D., former editor of JAMA. He made that statement in an editorial webcast in January 2005 on Medscape, where Dr. Lundberg is Editor-in-Chief (http://www.medscape. com/vi

Ivan Goldberg, M.D., on Treating Bipolar Depression

Topics: Bipolar Disorder

TCR: Dr. Goldberg, I know you’ve spent a lot of time thinking about and treating bipolar disorder over the years, beginning when you were a researcher at NIMH, then on the faculty of Columbia University, and most recently in your private practice and your managing of Depression Central. I was hoping we could begin by discussing some of the tricky aspe

A Sad and Strange Chapter

Topics: Bipolar Disorder

There have been many misguided treatments for bipolar disorder and other major mental illnesses throughout the history of psychiatry, but perhaps none has been as misguided--and as damaging--as the one practiced by Henry Aloysius Cotton, M.D. Once a student of Adolf Meyer, Emil Kraepelin, and Alois Alzheimer, he headed the New Jersey State Hospital in T

Atypicals for Bipolar: And Then There Were Five

Topics: Bipolar Disorder

We knew it was about to happen. We just didn’t know it would happen all at once. Between July and September of 2004, Seroquel, Geodon, and Abilify sequentially won approval for the treatment of manic episodes in bipolar disorder. Which means that now all of the newer atypical antipsychotics have been admitted to the bipolar club, which until December

Trileptal: Everyone’s Using It!

Topics: Bipolar Disorder

Suddenly, we all have a colleague who is prescribing Trileptal (oxcarbazepine) for bipolar disorder, and who is claiming to have fabulous success. Rarely has a medication generated so much enthusiasm on so little data. The reason is that Trileptal is blessed with extraordinary intuitive appeal. Approved by the FDA for epilepsy in 2000, it is such a c

Dr. Claudia Baldassano on Interviewing Tips in Bipolar Disorder

Topics: Bipolar Disorder | Practice Tools and Tips

TCR: Dr. Baldassano, as the Director of the Bipolar Outpatient Clinic of U Penn, how many patients with bipolar disorder do you typically evaluate in a given week? Dr. Baldassano: About 80 patients a week, and that would include consultations, patients referred directly to me, and patients that I see in supervision with U Penn residents. TCR: Are mo

Bipolar Confusion: Diagnosis Hints

Topics: Bipolar Disorder

Suddenly, it seems that everybody and their cousin is asking us if they have bipolar disorder. A few years ago, bipolar disorder was the ignored orphan diagnosis in psychiatry. However, now that various patented molecules have been proven effective, industry money is flying into efforts to publicize the diagnosis, and it's clearly working. We are get

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

Antipsychotic Maintenance: How Long is Enough?

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Deprescribing | Depression | Depressive Disorder | Mania | Metabolic syndrome | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Risperidone | Side Effects | Tardive dyskinesia

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

Thyroid Augmentation in Bipolar Disorder

Topics: Anxiety | Bipolar Disorder | Depression | Laboratory Testing in Psychiatry | Mania | Pharmacology | Side Effects

TCPR: When do you use thyroid augmentation in bipolar disorder?Dr. Kelly: It may be useful for treatment-resistant bipolar depression, and I emphasize treatment-resistant because that is where the empiric support lies. Now, the evidence is not rock-solid, but when it comes to treatment-resistant bipolar depression we don’t have much else to draw on ex

Lumateperone in Bipolar Depression

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Lumateperone | Second Generation Antipsychotics (SGAs)

REVIEW OF: Calabrese JR et al, Am J Psychiatry 2021. Epub ahead of print STUDY TYPE: Randomized, placebo-controlled trial In 2019, lumateperone (Caplyta) became the 13th atypical antipsychotic with FDA approval in schizophrenia. Compared to other atypicals, it is relatively well tolerated, with low rates of akathisia and metabolic side effects. On

A Novel Treatment for Methamphetamine Use Disorder

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Lumateperone | Second Generation Antipsychotics (SGAs)

REVIEW OF: Trivedi MH et al, N Engl J Med 2021;384(2):140–153 STUDY TYPE: Randomized, double-blind, placebo-controlled trial with sequential parallel comparison design Methamphetamine use disorder is an increasing cause of overdose deaths in the US. Pharmacologic options are scarce, but pilot studies suggest that bupropion and naltrexone may be

Quetiapine in Bipolar With OCD

Topics: Antipsychotics | Bipolar Disorder | Co-occurring disorders | Obsessive Compulsive Disorder | OCD | Quetiapine

REVIEW OF: Sahraian A et al, CNS Spectr 2021;1–5 TYPE OF STUDY: Randomized, double-blind, placebo-controlled clinical trial SSRIs are first-line meds for obsessive-compulsive disorder (OCD), but they may pose risks of mania and rapid cycling when the patient also has bipolar disorder (BD). These conditions overlap more often than expected by chance,

How to Diagnose Bipolar Disorder

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Diagnosis | DSM | Hypomania | Mania | Mixed Features | Mood

TCPR: When I ask a depressed patient if they’ve ever had manic symptoms, I often run into a problem. They say, “Of course I feel more confident, energetic, and happy ... when I’m not depressed.”Dr. Parker: As it can be hard to tease apart true hypomania from normal happiness, we’ve developed a rating scale to assist, the Sydney Bipolar Screene