By Gordon Parker

Bipolar melancholy is referred to now to exist as a spectrum of problems instead of a unmarried disorder entity. Bipolar II illness exists in this spectrum as a the place the depressive episodes are as serious as in Bipolar I affliction, yet the place the temper elevation states will not be as severe. This unforeseen blend may end up in a failure to discover a idea to impact as much as 6% of the inhabitants. This publication experiences, for the 1st time, our wisdom of this debilitating disease, protecting its heritage, type and neurobiology. In a special part, fourteen the world over well-known specialists debate administration ideas, construction to a couple consensus, and leading to therapy instructions the place no such suggestion presently exists. it's going to be learn via all well-being pros handling temper problems and may be informative to these wishing to benefit extra concerning the situation.

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Surely this line of thought is making some clinicians anxious about the potential for over-diagnosis. Granted, the spectrum model clearly broadens the territory which can be thought of as bipolar. Moreover, with less precise boundaries and less precise rules for diagnosis, there is far more room for debate about where bipolarity ends than with the DSM system. g. 4 days of hypomania, not less) have the advantage of limiting such debate. They also convey a degree of rigour which a spectrum model may appear to lack: after all, if there is no defined edge to the condition, how are we going to study it and refer to it?

We have almost no data on which to base an answer to this question. In one recent post hoc analysis, Frye et al. (2006) have reported that even the most minimal hypomanic symptoms, and far short of the DSM diagnostic threshold, predict a doubling of antidepressantassociated switching into hypomania/mania. However, these patients had 24 James Phelps previously been diagnosed as having bipolar disorder and were receiving mood stabiliser treatment. Whether this study has relevance to patients who have never had sufficient symptoms for this diagnosis is not yet established – it is, nevertheless, worth thinking about.

2004) quantified the risk at 2–4%, earlier literature reviews had estimated much higher rates such as 30–40% (Goldberg and Truman, 2003). , 2006). Using the most conservative criteria and the least problematic antidepressant (bupropion, in this Stanley Foundation Bipolar Network study), the rate was 4%. Lacking any placebo group to demonstrate a comparable base rate of switching, which we can presume is not likely to be zero, it is impossible to draw firm conclusions regarding switch rates. At minimum, these studies suggest that venlafaxine, which had the 38 James Phelps highest switch rates, is a poor choice for patients with bipolar depression, but even that result warrants replication.

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