Facts with supporting evidence and references

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Daz
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Facts with supporting evidence and references

Postby Daz » Fri Nov 14, 2003 4:24 am

Compliance

...Bipolar disorder is a long-term illness in which adherence to carefully designed treatment plans can improve the patient’s health status. However, patients with this disorder are frequently ambivalent about treatment. This ambivalence often takes the form of noncompliance with medication and other treatments, which is a major cause of relapse.
Ambivalence about treatment stems from many factors, one of which is lack of insight. Patients who do not believe that they have a serious illness are not likely to be willing to adhere to long-term treatment regimens. Patients with bipolar disorder may minimize or deny the reality of a prior episode or their own behavior and its consequences. Lack of insight may be especially pronounced during a manic episode...


Suicide

...Like those suffering from major depression, patients with bipolar disorder are at high risk for suicide. The frequency of suicide attempts appears similar for the bipolar I and bipolar II subtypes. Individuals with bipolar disorder repeatedly have been shown to have greater overall mortality than the general population. Although much of this risk reflects the higher rate of suicide, cardiovascular and pulmonary mortality among patients with untreated bipolar disorder is also high.
Known general risk factors for suicide also apply to patients with bipolar disorder. These include a history of suicide attempts, suicidal ideation, comorbid substance abuse, comorbid personality disorders, agitation, pervasive insomnia, impulsiveness, and family history of suicide. Among the phases of bipolar disorder, depression is associated with the highest suicide risk, followed by mixed states and presence of psychotic symptoms, with episodes of mania being least associated with suicide. Suicidal ideation during mixed states has been correlated with the severity of depressive symptoms. In general, a detailed evaluation of the individual patient is necessary to assess suicidal risk. Judgment of suicidal risk is inherently imperfect; therefore, risks and benefits of intervention should be carefully weighed and documented...


Statistically

...Suicide rates are high among bipolar disorder patients. Completed suicide occurs in an estimated 10%– 15% of individuals with bipolar I disorder. Suicide is more likely to occur during a depressive or a mixed episode. Pharmacotherapy may substantially reduce the risk of suicide...


Robert M.A. Hirschfeld, M.D.
Charles L. Bowden, M.D.
Michael J. Gitlin, M.D.
Paul E. Keck, M.D.
Roy H. Perlis, M.D.
Trisha Suppes, M.D., Ph.D.
Michael E. Thase, M.D.
Karen D. Wagner, M.D., Ph.D.
John S. McIntyre, M.D.
Sara C. Charles, M.D.
Kenneth Altshuler, M.D.
Ian Cook, M.D.
C. Deborah Cross, M.D.
Barry J. Landau, M.D.
Louis Alan Moench, M.D.
Stuart W. Twemlow, M.D.
Sherwyn Woods, M.D., Ph.D.
Joel Yager, M.D.
Paula Clayton, M.D.
Marcia Goin, M.D., Ph.D.
Marion Goldstein, M.D.
Sheila Hafter Gray, M.D.
Andrew J. Kolodny, M.D.
Margaret T. Lin, M.D.
Grayson Norquist, M.D.
Susan Stabinsky, M.D.
Robert Johnston, M.D.
James Nininger, M.D.
Roger Peele, M.D.
Daniel Anzia, M.D.
R. Scott Benson, M.D.
Lawrence Lurie, M.D.
R. Dale Walker, M.D.
Rebecca M. Thaler, M.P.H., C.H.E.S.
Robert Kunkle, M.A.
Althea Simpson
Laura J. Fochtmann, M.D.
Claudia Hart, Director, Department of Quality Improvement and Psychiatric Services
Lloyd I. Sederer, M.D., Director, Division of Clinical Services
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Daz
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Postby Daz » Fri Nov 14, 2003 4:28 am

OBJECTIVES: To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness.

RESULTS:Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use.

CONCLUSION:These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.


Cambridge Hospital, Department of Psychiatry, Harvard Medical School
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Postby Daz » Fri Nov 14, 2003 4:34 am

while there are many drugs that are available to treat depression, and lithium is a nonpatentable mood stabilizer with proven success, there is only one FDA approved medication for treatment of manic symptoms - valproate
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Postby Daz » Fri Nov 14, 2003 4:35 am

Treatment of Bipolar Depression
Antidepressant medications have long been used to treat the depressive phase of bipolar disorder. However, research has shown that antidepressants, when taken without a mood-stabilizing medication, can increase the risk of switching into mania or hypomania, or of developing rapid cycling, in people with bipolar disorder. Therefore, mood-stabilizing medications are generally required, alone or in combination with antidepressants, to protect patients with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood stabilizing drugs today. Research studies are evaluating the potential mood stabilizing properties of newer medications.



National Institute of Mental Health
Shevarash OOC: 'Muma on Artificial Intelligence - Muma OOC: 'someday the quotes really will just become AI and then i'll talk to the AI and be like, hey you come from me, but it will get angry at me and revolt and try to kill me or something heheheh. like in the movies''
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Postby Arilin Nydelahar » Fri Nov 14, 2003 4:38 am

Yay pointless spam!
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Daz
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Postby Daz » Fri Nov 14, 2003 4:41 am

Results Patients with BP-I were symptomatically ill 47.3% of weeks throughout a mean of 12.8 years of follow-up. Depressive symptoms (31.9% of total follow-up weeks) predominated over manic/hypomanic symptoms (8.9% of weeks) or cycling/mixed symptoms (5.9% of weeks). Subsyndromal, minor depressive, and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms (29.9% vs 11.2% of weeks, respectively). Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year. Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up, as did comorbid drug-use disorder.
Conclusions The longitudinal weekly symptomatic course of BP-I is chronic. Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate. Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity.



Department of Psychiatry, University of California, San Diego - a 3 year study with a 12.8 year follow up period.
Shevarash OOC: 'Muma on Artificial Intelligence - Muma OOC: 'someday the quotes really will just become AI and then i'll talk to the AI and be like, hey you come from me, but it will get angry at me and revolt and try to kill me or something heheheh. like in the movies''
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Postby Eza » Fri Nov 14, 2003 6:22 am

Wow .. Daz knows how to utilize google.com
Holding this in mind
That if we fall, we all fall
And we fall alone
Someone
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Postby Someone » Fri Nov 14, 2003 6:25 am

Daz are you diagnosing people via the internet again?
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Postby fotex » Fri Nov 14, 2003 8:21 am

ok daz, you're bipolar :roll:
Cruk
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Postby Cruk » Fri Nov 14, 2003 9:59 am

Can we lock this thread too? I don't think it's helping

The internet is not the best place to look up information about bipolar disorder as no one knows the quality of the evidence the information is based upon. Nor is the BBS is suitable place either to discuss diagnosis and treatment. If you think you need help, see a psychiatrist.

With regards to the main topic of your posts Daz
'A large portion of what I intended to do on this thread, Thanuk, was not to hear from bipolar individuals, but rather for people who studied psychiatric disorders in general, and get their observations on the pharmaceutical industry's influence in that field.'

Yes the pharmaceutical industry plays a large influence in medicine. One only needs to know about the incidents of pharmaceutical companies threatening the advertising revenues of medical journals to influence which papers they publish and the huge amounts of money they spend on advertising, sponsoring events/dinners/conferences to doctors.

Cruk
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Postby Ashiwi » Fri Nov 14, 2003 1:59 pm

You do realize that I knew I was tweaking you when I posted that? I felt bad about it all night, because I knew the effect it would have on you, and I apologize for yanking your chain, but seriously man, you really shouldn't let yourself be so easy. I'd say "predictable" but that would just set you off again.
Daz
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Postby Daz » Fri Nov 14, 2003 3:29 pm

Cruk, I happen to think you are wrong about the suitability of the internet for obtaining information on any subject.

With regards to accuracy, I have done my best to keep my facts listed accurate, and have tried to use resources that are cross-indexed multiple times and that are not 'statements' but rather published findings.

Most of the above include details that i did not bother to post, including sampling methods, control details, duration of test, statement of purpose, conclusions, deductions, actual results, etc - in short, i tried to get my information from scientific findings, and not mass marketing campaigns, and to the best of my knowledge, the information i have provided is factual in the context i use.

anyway, im off to florida for a few weeks. have fun ya'll
Shevarash OOC: 'Muma on Artificial Intelligence - Muma OOC: 'someday the quotes really will just become AI and then i'll talk to the AI and be like, hey you come from me, but it will get angry at me and revolt and try to kill me or something heheheh. like in the movies''
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Postby Jhorr » Fri Nov 14, 2003 11:26 pm

What is the point of this thread? If you are going to quote the medical literature, please learn how to read it first.

Jhorr, M.D.

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