Bipolar Disorder E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1807

Veröffentlichungsjahr: 2011

Beschreibung

Bipolar Disorder Bipolar disorder is the most complex psychiatric disorder with different types of mood episodes, subtypes, varied course, and significant comorbidity. Not surprisingly, this complexity poses unique challenges to clinicians for optimal management of those with bipolar disorder. There has been an explosion of research into the causes and treatment of this condition over the past two decades. It is a daunting task for a practising clinician to make sense of this research and to remain up to date with progress in the understanding of the neurobiology and treatment of bipolar disorder. This book synthesizes and translates the vast array of research knowledge into information that is both relevant and meaningful for a clinician. The book provides a comprehensive, yet focused, reference work on bipolar disorder for both trainees and practising psychiatrists. The two editors are leaders in the field who have published extensively on bipolar disorder. They have assembled a team of experts from around the world: in many instances, chapters are co-authored by people from different continents, bringing a truly international perspective to this important topic. The book covers the basic science of the pathology underlying bipolar disorder but addresses the clinical aspects of the disease throughout. The book comprises four sections: * Descriptive Aspects-issues ranging from how the concept of bipolar disorder has evolved over the years to new information about neurocognitive impairment, creativity and economic productivity, and to discussion of the deliberations of the DSM-V committee on changes in diagnostic categories and criteria. * Biological Aspects-the contribution of genes to this disorder, changes in circadian rhythms, what we know about brain changes and the role of oxidative stress. * Management-all the latest information about pharmacological and other somatic treatments plus psychological therapies for the optimal management of this condition. * Special Populations-detailed descriptions of bipolar disorder in women, children and the elderly. If you want to provide state-of-the-art care to your bipolar patients, be sure to consult this authoritative reference.

Leseprobe

Contents

Preface

List of Contributors

CHAPTER 1 From Mania to Bipolar Disorder

From Pinel to Kraepelin

Manic-depressive illness

The reception of manic-depressive illness – the academic response

The reception of manic-depressive illness: a typical asylum

The emergence of bipolar disorder

References

CHAPTER 2 Clinical Features and Subtypes of Bipolar Disorder

Introduction: the phenomenology of cyclicity and polarity

Clinical features of affective episodes

Mania

Depression

Mixed states of bipolar disorder

Diagnostic subgroups of bipolar disorder

Cyclothymia

Conclusion

References

CHAPTER 3 The Long-Term Course and Clinical Management of Bipolar I and Bipolar II Disorders

Introduction

Methods of the NIMH CDS

Characteristics of the long-term course of bipolar illness

Conclusions about the long-term course of bipolar illness

Implications for the long-term clinical management of BP-I and BP-II disorders

References

CHAPTER 4 Comorbidity in Bipolar Disorder: A Focus on Addiction and Anxiety Disorders

Introduction

Alcohol abuse and dependence

Comorbid alcoholism and bipolar course of illness

Treatment implications for dual diagnosis bipolar disorder and alcoholism

Nicotine dependence

Bipolar disorder course of illness and nicotine dependence

Treatment considerations in bipolar disorder with nicotine dependence

Anxiety disorders

Epidemiological and clinical data

Comorbid ADs and clinical presentation of bipolar disorder

Treatment implications of anxious comorbidity

Conclusion

References

CHAPTER 5 DSM-V Perspectives on Classification of Bipolar Disorder

An overall view of the DSM-V process

Ongoing work on bipolar disorder for DSM-V

Criteria for recommending a change in DSM-IV

Bipolar disorder

Bipolar spectrum

Mixed episodes

Rapid cycling bipolar disorder

Bipolar depression

Schizoaffective disorder

Paediatric bipolar disorder

Behavioural dimensions

References

CHAPTER 6 Update on the Epidemiology of Bipolar Disorder

Introduction

Background on epidemiology

Epidemiology of bipolar disorder in adults

Epidemiology of bipolar disorder in youth

Age of onset and treatment rates in both adults and youth with bipolar disorder

Risk factors

Family history/genetics

Summary

References

CHAPTER 7 Suicide and Bipolar Disorder

Introduction

Suicide and attempted suicide in major mood disorders

Suicide risk and protective factors in bipolar disorders

References

CHAPTER 8 Neurocognition in Bipolar Disorder

Introduction

Brief overview of neuropsychological assessment

Nature of cognitive impairment in bipolar disorder

Cognitive deficits associated with mood symptoms

Cognitive deficits in euthymic patients

Cognitive deficits in subsets of patients

Effects of medication

Neuroimaging bipolar disorder cognition

Aetiology of cognitive impairment

Genetic vulnerability

Progressive cognitive decline

Clinical significance of cognitive impairments

Cognition and functional outcome

Neuropsychological assessment in bipolar disorder

Treatment strategies for cognitive deficits

Conclusions

References

CHAPTER 9 The Genius-Insanity Debate: Focus on Bipolarity, Temperament, Creativity and Leadership

History

Methodologic issues

Is psychosis relevant to creative genius?

Affective temperaments and achievement

Toward a synthesis

Implications for clinical practice

References

CHAPTER 10 Economics of Bipolar Disorder

Introduction

Economic cost of bipolar disorder

Economic evaluations of interventions for bipolar disorder

Conclusions

References

CHAPTER 11 An Introduction to the Neurobiology of Bipolar Illness Onset, Recurrence and Progression

Introduction

Clinical evidence for bipolar illness progression

Potential neurobiological mechanisms for illness progression

Overview of the neurobiology of bipolar disorder

Clinical implications for illness progression

Neurobiology informing clinical therapeutics

An evolving neurobiology of bipolar disorder

References

CHAPTER 12 Genetics of Bipolar Disorder

Introduction

Genetic epidemiology of bipolar disorders

Linkage studies of bipolar disorders

Candidate gene studies of bipolar disorder

Genome-wide association studies

Conclusions and future directions

References

CHAPTER 13 Structural Brain Imaging in Bipolar Disorder

Prefrontal cortex

Ventricles

Limbic structures

Subcortical structures

Corpus callosum

Cerebellum and vermis

Conclusions

Acknowledgements

References

CHAPTER 14 Functional Magnetic Resonance Imaging, Diffusion Tensor Imaging, and Magnetic Resonance Spectroscopy in Bipolar Disorder

Introduction

Magnetic resonance spectroscopy in bipolar disorder

Diffusion tensor imaging in bipolar disorder

Functional magnetic resonance imaging in bipolar disorder

Acknowledgements

References

CHAPTER 15 Functional Brain Imaging Studies in Bipolar Disorder: Focus on Cerebral Metabolism and Blood Flow

Introduction

Overall organization

Cerebral blood flow and metabolism across affective states

Conclusions

References

CHAPTER 16 Neurotransmitter Systems in Bipolar Disorder

The role of monoamines and acetylcholine in the pathophysiology of bipolar disorder

Amino acids and the pathophysiology of bipolar disorder

Neuroendocrine systems and neuropeptides

Conclusions

References

CHAPTER 17 Molecular Biology of Bipolar Disorder

Introduction

Signal transduction pathways

References

CHAPTER 18 Mitochondrial Dysfunction and Oxidative Stress

Introduction

Cellular vulnerability in bipolar disorder

Phosphorous magnetic resonance spectroscopy in bipolar disorder

Role of mitochondrial DNA deletion in bipolar disorder

Gene expression analysis

Genetics

Animal models

Consequence of mitochondrial dysfunction

Calcium signalling

Progressive cell loss

Oxidative stress and mitochondrial dysfunction: a vicious cycle propelled by dopaminergic hyperactivity?

Oxidative stress markers in bipolar disorder

Treatment studies

Effects of known treatment on oxidative systems

Glutathione precursors

Conclusion

References

CHAPTER 19 Neuroendocrinology of Bipolar Illness

HPA regulation

Basal HPA activity in bipolar disorder

Dexamethasone suppression test (DST)

Dexamethasone/CRH test

DEX/vasopressin test

CRH receptor studies

Corticoid receptors

Thyroid hormones

Thyroid status in patients with affective disorders

Rapid cycling bipolar disorder

Conclusions and future directions

References

CHAPTER 20 Circadian Rhythms and Sleep in Bipolar Disorder

Introduction and overview

Circadian rhythms and sleep

Sleep, circadian function and affect

Sleep, circadian function and mood symptoms in BD

Mechanisms underpinning biological rhythm involvement in BD

Psychosocial interventions targeting biological rhythms in BD

Summary and conclusions

References

CHAPTER 21 Treatment Adherence in Bipolar Disorder

Introduction

Adherence

Therapeutic relationships

Developing a shared understanding and agreeing treatment goals

Three questions to aid effective prescribing

Monitoring and enhancing adherence

Future directions – using a necessities-concerns framework

References

CHAPTER 22 Acute Mania

Introduction

Lithium

Valproic acid

Carbamazepine

First-generation (typical) antipsychotics

Second-generation (atypical) antipsychotics

Electroconvulsive therapy

New potential antimanic agents

Agents without demonstrated antimanic efficacy

Clinical recommendations

Summary

References

CHAPTER 23 Pharmacological Treatment of Bipolar Depression

Introduction

Treatments for the management of bipolar I depression

Pharmacological treatment of bipolar II depression

Conclusions

Financial disclosures

References

CHAPTER 24 Practical Pharmacological Maintenance Treatment of Bipolar Disorder

Introduction

Goals of long-term treatment

Adherence to and participation in treatment

Nature of evidence: relationship to the goals of treatment

Transition to maintenance treatment

Maintenance treatment: evidence from controlled trials

Treatments for severe illness without evidence from randomized clinical trials

Treatment targets other than affective episodes

Using major treatments

Summary: practical maintenance pharmacological treatment

References

CHAPTER 25 Rapid Cycling Bipolar Disorder: Phenomenology and Treatment

Controversies regarding the definition of rapid cycling

Phenomenology

Antidepressants and rapid cycling

Treatment of rapid cycling

Lithium and divalproex

Carbamazepine

Lamotrigine

Thyroid hormone

Calcium channel blockers

Second-generation antipsychotics

Is there a role for antidepressants?

Electroconvulsive therapy

Other novel treatments

Chronobiological treatments

Psychotherapy

Summary and conclusions

References

CHAPTER 26 Management of Bipolar II Disorder

Introduction

An overall management model

Medication

Education

Psychological interventions

Well-being plans

Summary

Acknowledgement

References

CHAPTER 27 Management of Comorbidity in Bipolar Disorder

Introduction

Faces of comorbidity in bipolar disorder

Management issues

Diagnostic considerations

The role of systematic screening

General treatment considerations

Treatment phases

Pharmacotherapy

Issues related to specific medications

Conclusion

References

CHAPTER 28 Bipolar Disorder and Safety Monitoring for Clinicians: A Review of the Evidence and the Implications

Introduction

Metabolism and bipolar disorder

Monitoring requirements for bipolar patients

Topical debates for years to come

Can safety monitoring for CVD risk factors improve?

Can wellness programmes in bipolar illness decrease CVD risk?

Implications for future monitoring and clinical research

Summary

Declaration of interest

Disclosure

References

CHAPTER 29 Somatic Treatments for Bipolar Disorder: ECT, VNS and TMS

Introduction to the technologies

Electroconvulsive therapy (ECT)

Vagus nerve stimulation (VNS)

Transcranial magnetic stimulation (TMS)

Overall conclusions about brain stimulation methods for BD

Acknowledgement

Conflicts

References

CHAPTER 30 Novel Therapeutic Strategies for Bipolar Disorder

Introduction

Intracellular pathways and targets worthy of further study in BPD

Conclusion

Acknowledgements

References

CHAPTER 31 Psychoeducation as a Core Element of Psychological Approaches for Bipolar Disorders

Psychoeducation in bipolar disorders: state of the art

What is psychoeducation?

Growth of evidence-based psychoeducational approaches

Ingredients of psychoeducation

Practical considerations when implementing a psychoeducation group

Conclusions

References

CHAPTER 32 Cognitive-Behavioural Therapy for Bipolar Disorder

Overview of key CBT manuals for bipolar disorder

Theoretical underpinnings for a model of CBT for bipolar disorder

Review of CBT trials

Summary of CBT trials with ‘treatmentas-usual’ controls

References

CHAPTER 33 Interpersonal and Social Rhythm Therapy for Bipolar Disorder

Introduction

Overview of interpersonal and social rhythm therapy

Treatment strategies

IPSRT for adolescents

Research findings

Conclusion

Acknowledgement

References

CHAPTER 34 Family Therapy Approaches to Bipolar Disorder

Introduction

Theoretical background

Family-focused treatment

Communication enhancement training

Problem solving

Multifamily group approaches

Cognitive-behavioural family models

Conclusions

Directions for future research

References

CHAPTER 35 Collaborative Care for Bipolar Disorder

Integrated care for bipolar disorder: current evidence

Bridging the divide: treatment models to integrate patient care

A collaborative care model for bipolar disorder

Conclusion

References

CHAPTER 36 Bipolar Disorder in Women

Introduction

The reproductive life cycle in women with bipolar disorder

The postpartum in women with bipolar disorder

Menopause and menopausal transition

Conclusions

References

CHAPTER 37 Phenomenology and Treatment of Bipolar I Disorder in Children: A Critical Review

Introduction

The ‘bipolar controversy’

Clinical phenomenology

Comorbidities

Course

Offspring studies

Assessment

Treatment

Conclusion

References

CHAPTER 38 Bipolar Disorder in the Elderly

Introduction

Epidemiology

Clinical presentation

Course of illness

Comorbidity

Cognitive function

Treatment effects

Adherence to treatment

Attitudes and beliefs/satisfaction with treatment

Clinical recommendations

Conclusions and areas for future research

References

Index

Color plate

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Library of Congress Cataloging-in-Publication DataBipolar disorder : clinical and neurobiological foundations / editors, Lakshmi N. Yatham and Mario Maj.p. cm.Includes bibliographical references and index.ISBN 978-0-470-72198-8 (cloth)1. Manic-depressive illness. I. Yatham, Lakshmi N. II. Maj, Mario, 1953–[DNLM: 1. Bipolar Disorder. WM 207 B6161 2010]RC516.B5223 2010616.89’5—dc222010005586ISBN: 9780470721988A catalogue record for this book is available from the British Library.

Set in 9.25/12pt, Palatino by Thomson Digital, Noida, India

Preface

Bipolar disorder is a relatively recent concept, which emerged in the middle of the 20th century. However, bipolar disorder is not a new disease. Indeed, Aretaeus of Cappadocia, in his descriptions, captured the essence of the nature and course of mood changes of mania and depression almost 2000 years ago.

The objective of this book is to describe the clinical and neurobiological foundations of the modern concept of bipolar disorder as defined by the American Psychiatric Association’s Diagnostic Manual of Mental Disorders and the International Classification of Diseases. In order to capture both the American and the international perspectives, the editors deliberately chose authors from different continents for most chapters.

The book is divided into four sections. The first section covers the descriptive aspects of the disorder. This section begins with an historical overview of the evolution of the concept of bipolar disorder. While Dr. Healy admits that bipolar disorder is a distinct clinical entity, he argues that the boundaries of the modern concept of bipolar disorder have been shaped primarily by the interests of the industry over the past 15 years. The next two chapters review clinical features, course and outcome in the context of new data and suggest that depressive symptoms dominate the course of bipolar disorder and that the disorder is chronic for a significant proportion of patients. Comorbidity is the rule rather than an exception for bipolar patients and this chapter illustrates some of the common comorbidities patients with bipolar disorder experience. Dr. Fawcett then outlines the DSM-V process and some of the issues that the DSM-V will address with regard to classification of bipolar disorder in the next chapter. The remaining chapters in this section emphasize that bipolar disorder is common, associated with cognitive impairment in a significant proportion of patients, that suicide risk is high, and that the disorder is associated with significant economic burden. This section also contains a fascinating review of the genius–insanity debate.

The biological aspects section begins with an overview of the neurobiology of bipolar disorder by Robert Post. Subsequent chapters address in greater detail some of the following questions: what is the current status with regard to the search for bipolar susceptibility genes? What brain regions and brain chemicals are altered in bipolar patients? Are changes in neurotransmitters and neurohormones still relevant or are changes in post-receptor signalling pathways more critical to the neurobiology of bipolar disorder? Is bipolar disorder associated with oxidative stress, mitochondrial dysfunction or alterations in biological rhythms?

Treatment adherence is a major challenge in the management of bipolar disorder. Thus, the section on management begins with an overview of reasons for non-adherence and strategies to improve adherence. This is followed by a series of chapters that describe the current status of the pharmacological management of various phases and subtypes of bipolar disorder. This section also contains chapters that review the role of novel treatments, somatic treatments, and safety monitoring, as well as the role of psychological treatments as adjuncts to pharmacotherapy.

The final section on special populations provides clinicians with the latest information and guidance on the management of bipolar disorders in women, children and the elderly.

We hope that this book will become a useful resource for psychiatrists and other health care professionals to improve their understanding and management of bipolar disorder.

Lakshmi N. YathamMario Maj

List of Contributors

Hagop S. AkiskalUniversity of California at San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161-9116, USA

Kareen K. AkiskalInternational Mood Center, La Jolla, CA 92093-0603, USA

Ana AndreazzaDepartment of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1, Canada

Mark S. BauerCenter for Organization, Leadership, and Management Research (152M), Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA

Michael BauerDepartment of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany

Lesley BerkORYGEN Research Centre and Department Clinical & Biomedical Sciences, University of Melbourne, Victoria, Australia

Michael BerkBarwon Health and the Geelong Clinic, University of Melbourne, Kitchener House, Ryrie Street, Geelong, Victoria 3220, Australia

Wade H. BerrettiniUniversity of Pennsylvania School of Medicine, Room 2206, 125 South 31st Street, Philadelphia, PA 19104, USA

Zubin BhagwagarDepartment of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Bristol Myers Squibb, USA

Paolo BrambillaInter-University Center for Behavioural Neurosciences, Department of Pathology and Experimental & Clinical Medicine, Section of Psychiatry, University of Udine, Udine, Italy

John O. Brooks IIISemel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, B8-233b NPI, Los Angeles, CA 90024-1759, USA

Chris J. BusheLilly UK, Lilly House, Priestley Road, Basingstoke, RG24 9NL, UK

Gabrielle A. CarlsonDepartment of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony Brook, NY 11794-8790, USA

Francesc ColomBipolar Disorders Program, Clinical Institute of Neuroscience, IDIBAPS-CIBERSAM, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain

Tiffany CookeEmory University, Rollins School of Public Health, 1518 Clifton Road Northeast Atlanta, GA 30329, USA

Timothy DinanDepartment of Psychiatry, Cork University Hospital, Wilton, Cork, Ireland

Jan FawcettDepartment of Psychiatry, University of New Mexico School of Medicine, National Institute of Albuquerque, Albuquerque, NM 87131, USA

Ellen FrankDepartment of Psychiatry and Department of Psychology, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA

Benicio N. FreyDepartment of Psychiatry and Behavioural Neurosciences, McMaster University and Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada

Mark A. FryeDepartment of Psychiatry and Psychology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA

Mark GeorgeBrain Stimulation Laboratory, MUSC IOP, Radiology and Neurosciences Medical University of South Carolina, 67 President Street, Room 502 North, PO Box 250861, Charleston, SC 29425, USA

Joseph F. GoldbergMount Sinai School of Medicine, New York, NY, USA

David E. GoodrichVA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, 2215 Fuller Road, Ann Arbor, MI 48105, USA

Fred K. GoodwinDepartment of Psychiatry and Behavioral Sciences, Center on Neuroscience, Medical Progress, and Society, George Washington University Medical Center, Washington, DC 20037, USA

Allison HarveyPsychology Department, Sleep and Psychological Disorders Lab, University of California, 3210 Tolman Hall, Berkeley, CA 94720-1650, USA

John M. HawkinsLindner Center of HOPE; Associate Professor, Department of Psychiatry, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA

David HealyHargest Unit, North Wales Department of Psychological Medicine, Cardiff University, Ysbyty Gwynedd, Bangor, LL57 2PW, UK

Lewis L. JuddDepartment of Psychiatry, University of California at San Diego (UCSD), 9500 Gilman Drive, MC: 0603, La Jolla, CA 92093-0603, USA

Flávio KapczinskiISBD Hospital de Clinicas, UFRGS Brizil Porto Alegre, RS, Brazil

Tadafumi KatoLaboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Hirosawa 2-1, Wako, Saitama, 350-0198, Japan

Marcia Kauer-Sant’AnnaMolecular Psychiatry Laboratory, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil

Paul E. Keck, Jr.Lindner Center of HOPE and Department of Psychiatry, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA

Lars Vedel KessingDepartment of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark

Terence A. KetterDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2124, Stanford CA 94305, USA

Amy M. KilbourneVA Ann Arbor Serious Mental Illness Treatment Research and Evaluation Center, 2215 Fuller Road, Ann Arbor, MI 48105, USA

John H. KrystalDepartment of Psychiatry, Yale University School of Medicine, Yale-New Haven Hospital, 300 George Street, Suite 901, New Haven, CT, 06511, USA

David J. KupferDepartment of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA

D.Z. LiebermanGeorge Washington University Medical Center, 2150 Pennsylvania Avn., NW, Department of Psychiatry and Behavioral Sciences, 8th Floor, Washington, DC 20037, USA

Falk W. LohoffUniversity of Pennsylvania School of Medicine, Department of Psychiatry Center for Neurobiology and Behavior Translation Research Laboratories., 125 South 31st Street, Room 2213, Philadelphia, PA 19104, USA

In Kyoon LyooSeoul National University, Seoul, South Korea

Rodrigo Machado-VieiraExperimental Therapeutics, Mood and Anxiety Disorders Research Program, NIMH-NIH, Bldg 15K, 15 North Drive, MSC 2670, Bethesda, MD 20892, USA

Karine A. MacritchieInstitute of Mental Health, Department of Psychiatry, University of British Columbia, Suite 403 - 5950 University Blvd., Vancouver, BC V6T 1Z3, Canada

Gin S. MalhiDepartment of Psychiatry, University of Sydney, CADE (Clinical Assessment Diagnostic Evaluation) Clinic, Royal North Shore Hospital, Sydney, Australia

Husseini K. ManjiJohnson & Johnson Pharmaceuticals Group, 1125 Trenton-Harbourton Road, E32000, Titusville, NJ 08560, USA

Paul E. McCroneCentre for the Economics of Mental Health, Section of Community Mental Health Service and Population Research, Department PO24, Institute of Psychiatry, King’s College, De Crespigny Park, London SE5 8AF, UK

Susan L. McElroyLindner Center of HOPE and Department of Psychiatry, University of Cincinnati College of Medicine, 4075 Old Western Row Road Mason, OH 45040, USA

Kathleen R. MerikangasGenetic Epidemiology Research Branch, Porter Neuroscience Research Centre, National Institute of Mental Health, Building 35, Room 1A-201, 35 Convent Drive, MSC 3720, Bethesda, MD 20892-3720, USA

David J. MiklowitzUCLA Semel Institute for Neuroscience and Human Behavor Division of Child and Adolescent Psychiatry, 760 Westwood Plaza, Rm 58-217 David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-1759, USA

Greg MurrayFaculty of Life and Social Sciences, Swinburne University of Technology, PO Box 218 John Street, Hawthorn 3122, Australia

Marina NakicDepartment of Psychiatry, Yale University School of Medicine, Yale-New Haven Hospital, 300 George Street, Suite 901, New Haven, CT, 06511, USA

Charles B. NemeroffDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami FL, USA

Luca PaniIstituto Tecnologie Biomediche, Consiglio Nazionale delle Ricerche, Sede di Cagliari-Pula and PharmaNess Scarl, Edificio 5 - Parco Scientifico e Tecnologico della Sardegna - 09010 Pula (Cagliari), Italy

Sagar V. ParikhDepartment of Psychiatry, University Health Network, University of Toronto, Room 9M-329, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada

Gordon ParkerSchool of Psychiatry, University of New South Wales (UNSW), New South Wales, Australia 2031; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Ranwick, NSW 2031, Australia

Giulio PerugiDepartment of Psychiatry, University of Pisa; Institute of Behavioural Sciences “G. De lisio”, Viale Monzone 3, 54031 Carrara, Italy

Tracy L. PetersGenetic Epidemiology Research Branch, Mood and Anxiety Program, Intramural Research Program, National Institute of Mental Health, National Institute of Health, Porter Neuroscience Research Center, Building 35, Room 1A-201, 35 Convent Drive, Bethesda, MD 20892-3720, USA

Robert M. PostGeorge Washington University Medical School, Bipolar Collaborative Network, 5415 W. Cedar Kabem Suite 201B, Bethesda, MD 20814, USA

D. RazzoukDepartment of Psychiatry, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil

Perry F. RenshawUniversity of Utah, Salt Lake City, UT USA

Zoltán RihmerDepartment of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Kútvölgyi Clinical Centre, Budapest, Hungary

R. Sabes-FigueraCentre for the Economics of Mental Health, Health Service and Population Research Department PO24, Institute of Psychiatry, King’s College, De Crespigny Park, London SE5 8AF, UK

Martha SajatovicUniversity Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH 44106, USA

Ihsan M. SalloumDepartment of Psychiatry, University of Miami Miller School of Medicine, 1120 NW 14th Street, Rm 1450, Miami, FL 33136, USA

Pamela J. SchettlerMood Disorders Research Group, Department of Psychiatry, University of California at San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

Jan ScottUniversity Department of Psychiatry, Newcastle University, Institute of Psychiatry, Institute of Neuroscience, Newcastle-upon-Tyne NE1 4RU, UK

Claudio N. SoaresDepartment of Psychiatry and Behavioural Neurosciences, McMaster University and Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada

Jair C. SoaresDepartment of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA

Meir SteinerDepartment of Psychiatry and Behavioural Neurosciences, McMaster University and Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON, Canada

Alan C. SwannDepartment of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1300 Moursund Street, Houston, TX 77037, USA

Holly A. SwartzDepartment of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA

Mary Jane TacchiInstitute of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, NE1 7RU, UK

Mauricio TohenUniversity of Texas Health Science Center at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229, USA

Ivan J. TorresDepartment of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Riverview Hospital, British Columbia Mental Health and Addictions Services, 2601 Lougheed Highway, Coquitlam, BC V3C 4J2, Canada

Jun Feng WangDepartment of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1, Canada

Po W. WangDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA

Elizabeth B. Weller*Deceased

Allan H. YoungInstitute of Mental Health, Department of Psychiatry, University of British Columbia, Suite 430, 5950 University Blvd., Vancouver, BC V6T 1Z3, Canada

Trevor Young, MDDepartment of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1, Canada

Laura E. ZajacDepartment of Psychology, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA

Carlos A. Zarate, Jr.Experimental Therapeutics, Mood and Anxiety Disorders Research Program, National Institute of Mental Health (NIMH-NIH), Bldg 15K, 15 North Drive, Bethesda, MD 20892-2670, USA

*Sadly, Elizabeth B. Weller died during preparation of the manuscript

CHAPTER 1

From Mania to Bipolar Disorder

David Healy

Hargest Unit, North Wales Department of Psychological Medicine, Cardiff University, Ysbyty Gwynedd, Bangor, UK

From Pinel to Kraepelin

When the first asylums opened, around 1800, mania was a generic term for insanity. Philippe Pinel’s Treatise on Insanity that appeared in 1800 was accordingly named Traité sur la Manie.

For 2000 years before Pinel, the chief determinant of diagnosis in medicine lay in the visible presentation of the patient. These visible presentations could lead to reliable diagnoses of tumours, diabetes, catatonia, epilepsy and insanity. The visible presentations of insanity involved flushing, overactivity and maniacal behaviour. Mania was diagnosed in patients who were overactive and who might now be seen as having schizophrenia, depression, delirium, senility, imbecility and other conditions.

Pinel took a stand on the importance of science in medicine, and was the first to call for an Evidence Based Medicine. Faced with patients hospitalized for years, he was the first to incorporate the course of a patients’ disorders into his diagnostic considerations. He recorded outcomes where patients were treated or left untreated, and noting responses followed by relapses, argued that some disorders were periodic or recurrent and that the vast majority of available treatments made the underlying condition worse.

When a final and more complete version of his treatise was published in 1809, it distinguished in its title, Traité Médico-Philosophique sur l’Aliénation Mentale ou la Manie, between insanity in general and a new, more specific diagnosis of mania [1]. Once this distinction was made, and mania was separated out from idiocy dementia and melancholia, the rates of admission for mania settled at approximately 50% of all admissions in asylums in Europe and America until around 1900.

While asylum nomenclature remained relatively constant for a century, there was an evolution in the thinking about insanity. The idea that there might be a distinct mood faculty that could be disordered in its own right was put forward in the 1830s by one of Pinel’s pupils, Jean-Dominique Etienne Esquirol, who described profound sadness – lypemanie – as a distinct disorder.