This manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patient's current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.

Im vorliegenden Artikel werden Besonderheiten im Krankheitsverlauf und in der Pharmakotherapie bipolar erkrankter Frauen diskutiert. Geschlechtstypische Unterschiede betreffen sowohl Symptomatik und Krankheitsverlauf als auch Aspekte, die mit der speziellen biologischen Situation der Frau zusammenhängen. Typisch für bipolare Frauen ist die Dominanz depressiver Krankheitssymptome und das im Vergleich zu bipolaren Männern etwa 8fach höhere Risiko für einen ungünstigen Krankheitsverlauf im Sinne eines „rapid cycling“. Abhängig von der gegenwärtigen Lebensphase sind bezüglich der pharmakologischen Behandlung weiblicher Patientinnen die Aspekte Fertilität, Kontrazeption und Schwangerschaft in besonderem Maße mit einzubeziehen. Trotz hoher Relevanz für den Krankheitsverlauf ist das sexuelle Erleben und Verhalten bipolarer Frauen bisher ebenso wenig untersucht worden wie spezifische sexuelle Veränderungen in manischen und depressiven Erkrankungsphasen.

Fragestellung: Arbeitsgedächtnisleistungen als Teilbereich der exekutiven Funktionen scheinen bei schizophrenen Erkrankungen eine Schlüsselfunktion zu besitzen. Funktionelle MRT Studien an diesem Patientenkollektiv belegen eine Störung kortikaler, subkortikaler als auch zerebellärer Regionen. Kognitive Disorganisation und Aufmerksamkeitsdefizite als typische psychotische Symptome werden als Konsequenz einer neuronalen Dyskonnektivität postuliert. Ziel der Studie lag in der Verlaufsmessung zerebraler Aktivierungen schizophrener Patienten nach einer 12-wöchigen psychopharmakologischen Behandlung mit dem Atypika Quetiapin.

Although generalized anxiety disorder (GAD) was once an understudied illness, there has been an increase in research on the disorder over the past several years. A subset of studies has focused on the psychosocial treatment of late-life GAD. It was initially expected that cognitive behavior therapy (CBT) would prove to be the most effective treatment for GAD in the elderly. Although group format CBT has outperformed no-treatment control conditions in some studies, the existing body of work does not clearly indicate the superiority of CBT over alternative interventions [e.g., supportive therapy (ST)]. Trials of individual format CBT have tested augmented or otherwise nonstandard versions of the therapy. Therefore, it may not be appropriate to assume a smooth transfer of CBT benefits across age groups in the treatment of GAD. This review summarizes and discusses the current state of psychosocial interventions for late-life GAD, including group and individual format CBT, limitations of existing research, and suggestions for future directions.

BACKGROUND:In recent years, several controlled studies could show that psychoeducational interventions have been effective for relapse prevention in bipolar disorders. We therefore established a cognitive-psychoeducational group intervention with 14 sessions providing information about the illness, early warning signs, cognitive and behavioural strategies for stress management and social rhythm. Additionally we offered a group intervention for the patients' relatives. The objective of this study was to describe the outcome associated with our psychoeducational intervention in bipolar patients and their relatives.METHODS:Sixty-two bipolar patients attended 14 sessions (à 90 min) of cognitive-psychoeducational group therapy. Patients' knowledge of bipolar disorder and their satisfaction with the treatment were assessed using self-developed questionnaires before and after the group intervention. Additionally, 49 relatives of bipolar patients received two psychoeducational workshops of 4 hours each. We assessed demographic variables, burden, high expressed emotion and depressive symptoms of the relatives before and after the two workshops and at 1-year follow-up.RESULTS:Patients significantly improved their knowledge of bipolar disorder. They also have benefited from the discussions and the exchange of useful coping strategies. Burden and high expressed emotions showed no significant reductions at post-assessment, however they were significantly reduced at 1-year follow-up. Relatives also felt significantly better informed about the illness.CONCLUSIONS:These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.

The term treatment-resistant depression (TRD) has been the focus of hundreds of studies and clinical trials, though it is not a diagnosable mental health condition according to current clinical standards. The term implies depression that is particularly difficult to treat. However, as we illustrate here, the use of the TRD construct creates significant concerns regarding patient welfare and optimal distribution of resources. First, TRD is frequently defined as depression that failed to respond to antidepressant medication. Therefore, patients may be labeled with TRD after having tried just one medication, without consideration of effective non-pharmacological treatments such as psychotherapy or holistic interventions to improve sleep, nutrition, and exercise. Second, TRD implicitly contextualizes depression as a problem within an individual's brain, ignoring larger systemic, developmental, and sociological factors known to be depressogenic. Important structural determinants of health such as social isolation, environmental stressors, systemic oppression, unmet basic needs for shelter, food, and safety are excluded. Third, TRD does a disservice to patients when it rapidly escalates treatment decisions to increasingly risky and experimental options. And finally, the existing concept of TRD is used to justify enormous financial investment – on the order of billions of dollars - in research aimed at identifying precise biological treatment targets. The quest for biomedical treatments struggles to provide the anticipated return on investment in the form of decreased depression burden despite over 50 years of costly effort. Drawing from historical perspectives, we highlight these issues and propose recommendations to address them.

The Internet has a powerful effect on society and thereby also on psychiatric patients. It offers suicide prevention services but also is a source of information and exchange of thoughts on how to commit suicide. This paper describes an 18-year-old female who learned about methods of suicide in the Internet and then ordered barbiturates. She survived because of early intervention.

Despite many advances in making the diagnosis of bipolar disorder, five to twelve years lie between the first affective episode and the introduction of an effective treatment. However, it is estimated that approximately only one-fourth of the patients with bipolar disorder are recognized as such at all. Clinical experience plays an important role in the diagnosis. Manias are often the cause for the first treatment with drugs, but the daily lives of patients with bipolar depression are often clearly more negatively affected. The acute therapy of bipolar depression is more complicated than that of mania and the difficult long-term treatment is always associated with a high suicide risk. A long-term therapy of bipolar disorders is not only meaningful for the prevention of new disease episodes, but also because it has a positive effect on comorbidities.

Bipolar disorder is a common, recurrent, often severe mental disorder that, without adequate treatment, is associated with high rates of morbidity and mortality. We review the evidence on the efficacy of a spectrum of antiepileptic drugs (AED) in bipolar disorder. Most studies have been carried out with carbamazepine (CBZ), valproate (VPA), and lamotrigine (LTG). All three of these AEDs have been shown to be of value in the management of patients with bipolar illnesses. VPA and CBZ seem to exert stronger antimanic effects and, to a lesser degree, acute antidepressant efficacy. LTG seems to be effective against depression and mania, with a more robust activity against depression. No firm evidence supports a role for vigabatrin, tiagabine, topiramate, or levetiracetam in these disorders.

Bipolar disorders are often diagnosed too late with an average often years elapsing between the first disease episode and the correct diagnosis and treatment. The most common mis-diagnoses are unipolar depression, schizophrenia and ADHD (Attention Deficit Hyperactivity Disorder). The suicide rate associated with bipolar disease is very high.Treatment consists in the administration of mood stabilizers, in the first instance lithium, but also atypical neuroleptics or lamotrigine. In the depressive phase, additional antidepressants or lamotrigine, in the manic phase valproate or an antipsychotic agent may be needed. Medication must be continued unchanged for several months beyond acute treatment. The subsequent relapse prophylaxis depends on effectiveness, tolerability, comorbidity, suicidal risk and compliance. Pharmacotherapy is supplemented by psychotherapy and psycho-education.

Bipolar disorders are often diagnosed too late with an average of ten years elapsing between the first disease episode and the correct diagnosis and treatment. The most common misdiagnoses are unipolar depression, schizophrenia and ADHD (Attention Deficit Hyperactivity Disorder). The suicide rate associated with bipolar disease is very high. Treatment consists in the administration of mood stabilizers, in the first instance lithium, but also atypical neuroleptics or lamotrigine. In the depressive phase, additional antidepressants or lamotrigine, in the manic phase valproate or an antipsychotic agent may be needed. Medication must be continued unchanged for several months beyond acute treatment. The subsequent relapse prophylaxis depends on effectiveness, tolerability, comorbidity, suicidal risk and compliance. Pharmacotherapy is supplemented by psychotherapy and psycho-education.

The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in the SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar II disorder. The mean +/- SD age of the study participants was 42.08 +/- 13.5 years, and the mean +/- SD age of onset 24.44 +/- 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration over time. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapid-cycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history.

Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGI-BP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders.