Jan 24, · Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the May 04, · Introduction. Bipolar disorder (BD) is a severe mental disease with a lifelong course and considerable morbidity and mortality. BD has a lifelong prevalence rate of 1%–% and is characterized by recurrent episodes of mania, depression, or a mixture of both phases [].BD can cause impaired cognition [], functional decline [], poor health outcomes [], and a high frequency of suicidal behavior [] A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders
Purpose of the research paper
Try out PMC Labs and tell us what you think. Learn More. The Canadian Network for Mood and Anxiety Treatments CANMAT previously published treatment guidelines for bipolar disorder inalong with international commentaries and subsequent updates in, bipolar disorder research paper conclusion, and The last two updates were published in collaboration with the International Society for Bipolar Disorders ISBD.
These CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published inincluding updates to diagnosis and management as well as new research into pharmacological and psychological treatments. In addition to addressing issues in bipolar I disorder, bipolar disorder research paper conclusion, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults, bipolar disorder research paper conclusion.
There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe. In the 20 years since the Canadian Network for Mood and Anxiety Treatments CANMAT first published guidelines on the management of BD BD1 there has been an explosion of research on treatment of this illness.
The main objective of these publications was to synthesize the wealth of evidence on the efficacy, safety, and tolerability of the range of interventions available for this complex and varied illness, with the goal of providing clear, easy to use recommendations for clinicians to improve outcomes in their patients. As with previous editions of CANMAT guidelines, clinical support for efficacy was an important consideration in arriving at the final treatment recommendations Table 2.
Major conflicting data are addressed in blue text boxes figures to clarify the rationale for arriving at a specific level of evidence for efficacy. In the current edition, an additional distinction is made between safety and tolerability, and a consensus rating is assigned to each medication on these two measures when used in both the acute and maintenance phase. More information on these ratings can be found in the respective treatment sections, as well as in Section 8.
In addition, hierarchical rankings were created and are listed in the tables for first and second line recommendations for acute mania, depression and maintenance treatment in bipolar I disorder BDI.
This hierarchy was created by considering the impact of each treatment across all phases of illness Figure 1, bipolar disorder research paper conclusion.
The rationale for the hierarchical approach is that BD is a chronic lifetime condition with recurrent mood episodes and subsyndromal mood symptoms, and most if not all patients will require maintenance treatment. Treatments that have demonstrated efficacy across the spectrum of the illness bipolar disorder research paper conclusion thus be tried first before treatments that have demonstrated efficacy for only selective phases of the disorder.
As an example, if two treatments are shown to be similarly effective in acute mania, and if only one of these treatments has demonstrated efficacy for maintenance treatment, the treatment with evidence for maintenance would be placed higher in the hierarchical ranking.
Hierarchical rankings of treatment recommendations: How were they arrived at? com ]. Of note, when a treatment is listed as a monotherapy, that implies that it may be used on its own or in combination with other ongoing treatments, even if there are no specific studies demonstrating the efficacy of that combination. In this situation, the assumption is that the previous ongoing treatment was partially effective, and the addition of the new agent will provide benefits in either an additive or synergistic manner, bipolar disorder research paper conclusion.
Inclusion in this category means the efficacy of these agents is unknown at this time. As in previous editions, these guidelines are organized into eight sections Table 3including the Introduction. Additional information on presentation and hierarchical rankings of treatment options for acute mania Section 3 and depression Section 4 are reviewed, and include descriptions of clinical features that may help direct treatment choices.
An expert review of the available evidence for treatments of bipolar II disorder BDII and recommendations based on those findings are presented in Section 6. The management issues related to specific populations, including women at various stages of the reproductive cycle, children and adolescents, older adults, and those with psychiatric or medical comorbidity are each discussed in Section 7.
Finally, the principles of medical monitoring and an overview of safety and tolerability concerns for recommended treatments are provided in Section 8. For convenience and to avoid confusion, these guidelines also include a table of commonly used terms with an explanation of the intended meaning that may have overlapping definitions or criteria in the literature Table 4.
These guidelines are not meant to replace clinical judgement or define standards of care. While designed with Canadian physicians in mind, input from experts from the ISBD makes these guidelines applicable for practitioners from across the globe.
As with previous publications, CANMAT will strive to publish regular updates to these guidelines, incorporating new knowledge useful for practising clinicians. As not all medications included in these guidelines will be available in all countries, bipolar disorder research paper conclusion, including Canada, clinicians are advised to follow the recommendations of local regulatory bodies.
Bipolar disorder is a common and disabling mental illness with significant morbidity and mortality. The estimates of prevalence of BD vary, bipolar disorder research paper conclusion. While the prevalence rates for each subtype varied across the nine countries studied, subthreshold BD was the most common at 1. Bipolar disorder frequently manifests in late adolescence and young adulthood, with an overall average age of onset of 25 years. For instance, a recent study showed that the mean age of onset for a USA sample was 20 years, with ages of onset of People living with BD experience substantial impairment, being symptomatic with syndromal or subsyndromal symptoms, particularly those of depression, for approximately half of their bipolar disorder research paper conclusion. Consistent with these observations, the Global Burden of Disease Study attributed 9.
BDII sits between the two conditions with hypomanic episodes qualitatively like manic periods but, although distinct and observable, are not of a sufficient duration or severity to cause significant functional impairment, hospitalization, or psychosis.
Individuals with BDII also experience threshold depressive episodes. Amongst these, the mixed features specifier, bipolar disorder research paper conclusion, which has replaced mixed episodes, warrants consideration because of the multiple and complex presentations of mixed states it can give rise to.
Furthermore, the nascency of this terminology has meant that treatment data are as yet sparse. The course of BD is heterogeneous but, on average, the risk of recurrence increases with the number of previous episodes. Moreover, the number of episodes is associated with a decreased threshold for developing further episodes and with an increased risk of dementia in the long term. The concepts of clinical progression and neuroprogression have provided the basis for the development of staging systems in BD.
Overall, the model of staging has helped clinicians to appreciate the importance of early identification and bipolar disorder research paper conclusion as well as illness trajectories in BD. Due to frequent depressive onset, variable help seeking for hypomanic or manic periods, temporal instability of symptoms, bipolar disorder research paper conclusion, and high rates of comorbidity; accurate the timely identification of BD can be difficult to achieve in many cases.
Indeed, many individuals are not accurately diagnosed until up to 10 years after the onset of symptoms, with one to four alternate diagnoses typically being given prior to correct recognition and treatment 3435 This delay has important consequences, including inadequate initial treatment and worse prognosis in terms of episode recurrence and functional outcome.
The most bipolar disorder research paper conclusion misdiagnosis is that of MDD, as patients are more likely to present for the treatment of depressive symptoms and may not recall periods of hypomania or mania, or may not interpret them as being pathological.
Recall and insight are particularly impaired during periods of acute depression, with pronounced memory or concentration difficulties. Adapted from Mitchell et al. These conditions also are often comorbid with BD, which makes the diagnosis of this condition often challenging. It is important to note, that such tools have poor sensitivity and specificity, especially in community or highly comorbid populations, and will thus have an elevated risk of also flagging those with borderline traits.
To improve the accuracy of diagnosis, it is important bipolar disorder research paper conclusion clinicians strictly adhere to diagnostic criteria rather than relying on heuristics. Collateral information from friends and family members should be included wherever possible. Ongoing monitoring of symptoms, such as mood charting, can also help to detect bipolarity that may only become apparent over time. Confirmation of the diagnosis can then be made more confidently when episodes are prospectively observed.
As described in Section 6, patients diagnosed with BD very commonly have one or more comorbid psychiatric diagnoses, with SUDs, impulse control disorders, anxiety disorders, and personality disorders especially cluster B disorders particularly common. In addition to differentiating BD from other psychiatric diagnoses, alternative causes of mood symptoms, such as personality disorders, medical or neurological conditions, substance use, and medications must be considered in the differential bipolar disorder research paper conclusion Table 7.
Adapted from Yatham et al. It is important for clinicians to frequently monitor suicidal ideation and risk. As reviewed in the ISBD Task Force on Suicide in Bipolar Disorder, 50 a number of sociodemographic and clinical risk factors need to be considered in determining the level of suicide risk Table 8. Summary of main factors associated with suicide attempt and suicide deaths in bipolar disorder BD.
Adapted from Schaffer et al. A comprehensive assessment for suicide risk should occur during all clinical interactions. Risk stratification using assessment tools is not sufficiently accurate for prediction of suicide risk in clinical use; instead, clinical assessment should focus on modifiable risk factors bipolar disorder research paper conclusion could be targeted to reduce the risk. The association between various treatments and suicide risk has been reviewed by the ISBD Task Force and others, which suggest that lithium 54 and, to a lesser extent, anticonvulsants may contribute to preventing suicide attempts and deaths; although more data are needed to determine their relative efficacies.
There were limited data on both antipsychotics and antidepressant agents. After basic clinical management, including attention to diagnosis, comorbidity, and medical health has been established, patient health education and pharmacotherapy should be the initial and foundational steps for all patients.
Ideally, the patient will be connected to a health care team which includes at least one other health care professional typically a nurse in addition to the psychiatrist for psychoeducation, ongoing monitoring, psychosocial support, and referral to community resources. If the patient is stable and discharged to primary care, the mental health care system should provide support directly to the primary care provider with attention to continuity of care.
Adapted from Wagner. A strong therapeutic alliance is central to improve treatment adherence and outcomes. Regular, ongoing monitoring of mood symptoms and other measures related to the patient's own individual recovery, such as sleep, cognition, functioning, and quality of life is encouraged. Stigma is an important issue that will impact individuals with BD, as well as their family members, potentially preventing individuals from seeking or engaging in treatment or causing them to conceal their illness, reducing social support, functioning and quality of life.
While pharmacotherapy is essential and forms the foundation for the successful treatment of BD, bipolar disorder research paper conclusion, adjunctive psychosocial interventions may also be useful for acute depressive episodes, as well as in maintenance treatment to prevent relapse and to restore quality of life to the individual and family. Strength of evidence and recommendations for adjunctive psychological treatments for bipolar disorder a.
Psychoeducation broadly includes provision of information about the nature of the illness, its treatments, and key coping strategies to the patient and family. A key goal is the creation of personalized coping strategies to prevent mood relapse, bipolar disorder research paper conclusion. Psychoeducation may be delivered individually or in group settings. Peer support and group learning are also postulated to add efficacy to psychoeducation. Regardless of the type of model and content included, priority should be given to maximize the therapeutic alliance, convey empathy, and consistently monitor symptoms.
Two models of psychoeducation, both delivered in group format to individuals who are well euthymichave published manuals and have substantial research support. CBT in BD is supported by several published manuals and typically is given in 20 individual sessions over 6 months, often with additional booster sessions.
Despite evidence of efficacy for CBT for MDD and psychosis, the results of CBT trials for BD have been mixed. Efficacy of CBT in relapse prevention was observed in one RCT, 85 but not bipolar disorder research paper conclusion another larger RCT, at least in patients who had multiple mood episodes. In MDD, CBT, interpersonal psychotherapy IPT and behavioural activation have been explored in multiple RCTs and in general display similar efficacies. No evidence exists, and hence no recommendation is made, for CBT in mania.
FFT 93 presumes that outcomes in BD may be enhanced with the support and cooperation of family or significant others, particularly in families characterized by high levels of expressed emotion. FFT focuses on communication styles between patients and their families or marital relationships, with the goal of improving relationship functioning, and is delivered to the family and patient in 21 sessions over 9 months.
Given that the original creation of FFT targeted factors related to depression, it may have specific antidepressant activity, which is also suggested by reduced depression relapse in maintenance studies. For relapse prevention, four significant RCTs of varying sizes have been conducted, delivered to a mixed audience of young adults and adolescents. No evidence exists, and hence no recommendation is made, for FFT for mania, bipolar disorder research paper conclusion.
IPSRT expands on the IPT focus on grief, interpersonal role transition, role dispute, and interpersonal deficits by including regulation of social and sleep rhythms, specifically targeted to the bipolar population. It is typically delivered in 24 individual sessions over 9 months.
The Brain Circuitry of Bipolar Disorder: A View from Brain Scanning Research
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We found that (31·1%) of participants reported trauma exposure and (7·8%) of experienced PTSD by age 18 years. Trauma-exposed participants had high rates of psychopathology ( [29·2%] of for major depressive episode, [22·9%] of for conduct disorder, and [15·9%] of for alcohol dependence), risk events ( [25·0%] of for self-harm, 53 [8·3%] of Purpose of the research paper. Pay to write shakespeare studies dissertation, top dissertation conclusion ghostwriters sites uk, Professional research paper ghostwriters sites online, pay to write algebra curriculum vitae argumentative essay bipolar disorder: mid-term papers Dec 12, · Personal growth persuasive essay write a short essay on the topic music is a part of my world, cause and effect essay on bipolar disorder, my name is seepeetza essay. Research paper mathematics education. Emotional regulation essay, essay on national flag for class iv essay about your journey on personal development. How to write an essay on a
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