The Bipolar Spectrum: Critical Diagnoses
Peter F. Buckley, MD
Professor and Chairman
Department of Psychiatry & Health Behavior
Medical College of Georgia, Augusta
Consultant/Received Honoraria/Research Grants: Abbott Laboratories, Alamo Pharmaceuticals, LLC, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, Novartis AG, and Pfizer Inc.
Received research grants: Solvay Pharmaceuticals, Inc.; Speaker's Bureau: Abbott. Single-Action or Dual-Action Antidepressant
David Sack, MD
Senior Vice President and National Director
Clinical Trials Division
Comprehensive Neuroscience, Inc.
Cerritos, California
No financial relationships to disclose; discusses the investigational use of milnacipran for the treatment of depression. Beyond Major Despressive Disorder
Michael Gitlin, MD
Professor of Clinical Psychiatry
University of California, Los Angeles
No financial relationships to disclose. Sleep Disorders and Their Treatment
Milton K. Erman, MD
Clinical Professor of Psychiatry
University of California, San Diego
Consultant/Received Honoraria/Research Grants: Cephalon, Inc., Elan Pharmaceuticals, Inc., King Pharmaceuticals, Inc., Mallinckrodt Inc., and Sanofi-Aventis; Received Honoraria: Neurocrine Biosciences Inc., Orphan Pharmaceuticals USA, Inc., and Sepracor, Inc.; Consultant: Cypress Pharmaceutical, Inc. Janssen, Takeda and Somaxon Pharmaceuticals, Inc.; Received Research Grants: Merck & Co., Inc., Neurocrine, Orphan, Pfizer, ResMed, Somaxon, and Takeda; Advisory Board/Speaker's Bureau: Cephalon, King, Sanofi-Aventis, and Sepracor; Advisory Board: Elan and Takeda; Shareholder: Cephalon, Forest Laboratories, Inc., Merck, Pfizer, Neurocrine, Sanofi-Aventis, and Sepracor. Metabolic Issues: A Psychiatrist's Perspective
Ramachandiran Cooppan, MBCHB, FRCP(C), FACE
Assistant Clinical Professor of Medicine
Harvard Medical School
Assistant Director of CME
Senior Staff Physician
Joslin Diabetes Center, Boston
Speaker's Bureau/Consultant/Received Research Grants: Bristol-Myers Squibb, Lilly, Pfizer, and Takeda Pharmaceuticals. Stephen M. Stahl, MD, PhD
Adjunct Professor
Department of Psychiatry
University of California, San Diego
Chairman, Neuroscience Education Institute
Carlsbad, California
Consultant/Received Honoraria/Research Grants: Abbott, Asahi Kasei Corporation, AstraZeneca, Cephalon, Cypress Bioscience Inc., Lilly, GlaxoSmithKline, Pfizer, Pierre Fabre Médicament, and Wyeth; Consultant/Received Honoraria: Organon USA and Sanofi-Aventis.
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Bipolar disorder is a highly complex psychiatric condition leading to functional impairment and shortened life expectancy; because it involves recurring episodes of hypomania, mania, depression, and subsyndromal phases, proper diagnosis and treatment often require diligent attention to distinguishing clinical features. Similarly, care must be taken to diagnose psychotic depression, bipolar depression, and treatment-resistant unipolar depression in order to optimize patient outcome. Although newer dual-action antidepressants may be safer than tricyclic antidepressants, their side effect profiles may be less desirable than those of selective serotonin reuptake inhibitors; familiarity with the current treatment options, especially with regard to suicide risk, is crucial. Another prevalent family of disorders is related to sleep disturbances; by understanding the separate neural circuits governing sleep and wakefulness, clinicians can select treatment interventions more confidently. Finally, weight issues for people with schizophrenia due to lifestyle, antipsychotic medications, and predisposition; monitoring metabolic status should enable the psychiatrist more successful intervention with antipsychotic agents.
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After reading and studying this supplement, participants should be able to discuss: • Differentially diagnose and treat a range of bipolar disorders from bipolar II to acute mania, including treatment-resistant, mixed, and rapid cycling states, with special attention paid to hypomania and subsyndromal symptoms. • Differentially diagnose and treat a range of depressive disorders, including psychotic depression, nonpsychotic depression, bipolar depression, and treatment-resistant unipolar depression. • Appreciate the clinical consequences of mechanisms of antidepressant action, including such issues as residual symptoms, risk of suicide, and managing at-risk pediatric patients. • Describe the neural circuits underlying symptoms and treatment of sleepiness, insomnia, and shiftwork disorder. • Outline the risk factors for diabetes mellitus and ways to facilitate their monitoring.
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