Allan H Young

..Recent meta-analyses confirm the benefits of maintenance lithium treatment and show that it reduces suicide and suicidality. Psychiatrists should continue to utilise this efficacious treatment for bipolar disorder...

..The aim of this study was to compare the efficacy and tolerability of quetiapine and lithium monotherapy with that of placebo for a major depressive episode in bipolar disorder...

..Overall, the combination of quetiapine with lithium or divalproex was well tolerated...

..To correctly diagnose patients with bipolar disorder, clinicians must be aware of associated comorbidities and methods of differentiating bipolar disorder from other illnesses...

..Computerized testing, using the interpretive methodology presented, represents an efficient methodology for identifying cognitive problems in patients who present with untreated depression...

..Well-tolerated and effective therapies for bipolar mania are required...

....

..This is of particular importance when considering the long term use of antidepressant therapies for relapse prevention...

..These include similar motivations for switching due to limited efficacy and unacceptable adverse effects. Particular attention must be paid to the phase of treatment and coprescribed medications...

..Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder...

..Nonetheless, QOL appears to be a meaningful and important indicator of outcome and recovery in this patient population, and one that warrants further scientific interest and energy...

..Taken together, these data demonstrate that glucocorticoids act locally within the prefrontal cortex to modulate mesocortical dopamine efflux leading to the cognitive impairments observed during acute stress...

..We tested the hypothesis that exposure to stressors in adulthood may unmask an increased vulnerability to depressive- and anxiety-like behaviors in PAE animals...

..6% of the bipolar sample and only 6.4% of the control sample scored in this range. A subset of outpatients with bipolar disorder has frank neurocognitive impairments identifiable with this 30-40-minute computerized assessment battery...

..It is also associated with an increased liability for new episodes, both manic and depressive, consequent upon stoppage of treatment. These factors limit the clinical effectiveness of lithium...

..It is timely since awareness of the specific needs of bipolar patients is growing and there is an increased choice of effective treatments for all phases of the illness...

..These data demonstrate that patients taking lithium have elevated post-dexamethasone AVP levels compared to both healthy controls and patients not on lithium...

..This paper explores changes in SNS with ageing to ascertain whether BD is associated with a progressive neurological decline or a relatively fixed, persistent deficit...

..There is little evidence of similar biases in persons with bipolar disorder when manic. CONCLUSIONS: These data show a mood-congruent bias in sensitivity to facial expressions in bipolar depressed patients...

..These data suggest that afternoon hypercortisolaemia is evident in symptomatic bipolar and schizophrenic patients compared to controls. However, an elevation in DHEA levels may represent a specific endocrine marker in schizophrenia...

..BALANCE is now actively recruiting in the UK and USA...

..The aim of the present study was to investigate BDNF levels in patients with bipolar disorder and schizophrenia before and after treatment with the glucocorticoid receptor antagonist mifepristone...

..We used functional magnetic resonance imaging (fMRI) to investigate the core components of language processing as well as the impact of task demand in a group of bipolar subjects...

..Bipolar disorder (BD) is a leading cause of disability. Systematic reviews of randomized trials for the treatment of the maintenance phase of BD are lacking...

..However, the component operations that contribute to this deficit remain unclear. The aim of the present study was to further profile the nature and specificity of WM impairment in euthymic BD...

..This may in part underlie the putative therapeutic effects of such drugs...

....

..Our results suggest a growing role for atypical antipsychotics in the treatment of bipolar disorder and further data are anticipated...

..001) and between India and UK (P<0.001) rater groups. Overall, differences between India and US rater groups were less marked (P=0.28). These differences suggest that cultural biases influence the interpretation of manic symptoms...

....

..Altered perception of facial expressions that has been found to accompany depressed mood may instead reflect mood-congruent biases...

..This measure of HPA axis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness...

..These data require replication but provide preliminary evidence that glucocorticoid receptor antagonists may have useful cognitive-enhancing and possibly antidepressant properties in bipolar disorder...

..It has been suggested that corticosteroid-serotonin interactions are central to the pathophysiology of depression. These interactions have been investigated in healthy and depressed humans, primarily using neuroendocrine techniques...

..However, it still falls short in a number of respects of such recommendations as exist and this requires further examination and monitoring...

..It remains to be seen whether long-term use leads to tolerance, dependence and withdrawal or discontinuation reactions...

..We examined the relationship between age of onset and family history in bipolar-I disorder in an attempt to identify subgroups...

..The EEG may therefore be a sensitive marker of 5-HT function in bipolar disorder. We examined the effects of acute tryptophan depletion (ATD) on EEG activity in bipolar patients...

....

..CONCLUSIONS: Our findings support the notion that, in euthymic bipolar disorder, failure to engage fronto-executive function underpins the core neuropsychological deficits...

..ANCOVA indicated that impaired executive function underpinned patients' CBT performance. Implications for the interface between executive and slave systems of working memory are discussed...

..9% and the specificity 71.4%. The sensitivity of 1500 h cortisol (the DST) was 66.6% and the specificity was 47.6%. This suggests that the two tests measure common pathology but that the dex/CRH test has better diagnostic utility...

..Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions...

..CONCLUSIONS: Cognitive dysfunction, social dysfunction and soft signs occur in euthymic patients with bipolar disorder and may represent trait deficits...

..No such relationship was evident in controls. CONCLUSION: Deficits in declarative memory and WM are evident in patients with bipolar disorder. The deficit in retrieval accuracy from WM appears to be correlated with abnormal GR function...

..Three family-based studies have shown association of the common Valine (Val) allele of the Val66Met polymorphism of the BDNF gene with susceptibility to bipolar disorder...

..These data suggest that decreased dopamine release may mediate the mood stabilizing action of lithium. However, in this paradigm a rebound increase in dopamine release was not found after withdrawal from lithium treatment...

..997; p < 0.0005). CONCLUSION: The data suggests that the cortisol response to the dex/CRH test is stable over time and independent of mood state...

..CONCLUSIONS: Neurocognitive impairment persists in patients whose bipolar disorder is in remission. This may represent a trait abnormality and be a marker of underlying neurobiological dysfunction...

..Effects on specific 'executive' functions are less clear, and should be the focus for future research...