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Understanding Premenstrual Dysphoric Disorder (PMDD)

Imagine a mood disorder in which intense mood swings come predictably every month, wreaking havoc on any idea of calm normalcy. Depressed mood, lethargy, decreased interest and hopelessness occur along with marked irritability, anger, agitation and insomnia.   One has the sense of being overwhelmed and “out of control.” Arguments and heightened tearfulness ensue. Then everything returns to normal for the next week or two, only to be turned upside down by the dreaded monthly roller-coaster.

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“Plastics”

Many of us of a certain age will never forget the sage, one-word piece of occupational advice given to Benjamin Braddock in the movie, The Graduate:  “Plastics.”  In the early 1960’s, plastics were thought to be the next big area of economic growth.  Benjamin, as we all remember, takes in this recommendation with alienated befuddlement.  However from the vantage point of 21st century psychiatric research, this advice may have been unwittingly prescient.

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Bipolar Disorders and the Case of the Missing Self

Every few years, a new author comes along who is uniquely capable of giving voice to the ineffable aspects of their experience with serious mood problems:  Kay Jamison with her (An) Unquiet Mind, William Styron who perceived Darkness Visible, and Sylvia Plath’s The Bell Jar are the more modern prototypes.    Recently, a freelance journalist, Linda Logan, published a brief piece in the New York Times:  The Problem With How We Treat Bipolar Disorder 1.   This mini-memoir is second-to-none in capturing the roller-coaster ride that is far-too-often the case with this illness.

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Brain Problems in Bipolar Disorder: What We Know and How We Know it, circa 2013.

“Is there something wrong with my brain?”  “Does part of my brain not work correctly?”  Each time we make a diagnosis of bipolar disorder in our practice, these questions inevitably and understandably come up.  People want to know about their illness.   This conversation is often an essential part of the treatment.

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Postpartum Troubles Point to Increased Risk of Future Bipolarity

In our clinical work, we are always striving to determine who is at high risk of developing bipolar disorder.   Our patients come to us with a variety of mood and anxiety problems.  Often, those who are ultimately diagnosed with bipolar disorder have experienced a long period of misdiagnosis and incorrect treatment.

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The Treatment of ADHD: ADDenda

I can’t resist adding some extra ideas to Dr. Plyler’s review of Amy Arnsten’s article, Catecholamine Influences on Dorsolateral Prefrontal Networks 1.  As he indicated, ADHD is one of the conditions on which we focus in this practice.   Dr. Arnsten’s paper made several points that deserve special emphasis.

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Fine-Tuning our Understanding of the ADHD Brain

The greater our understanding of an illness state, the better we are able to treat it.  As one of the core disorders in our practice, we constantly review and update our knowledge on ADHD. In the course of a recent review, I came across a wonderful compilation issue on ADHD in Biological Psychiatry (Biol Psychiatry June 15 2011, vol. 69).  The review issue covers a wide range of topics from psychostimulants as cognitive enhancers to the molecular genetics of ADHD.  The most relevant and clinically applicable article, however, was Amy Arnsten’s paper on “Catecholamine Influences on Dorsolateral Prefrontal Cortical Networks” (Biol Psychiatry. 2011 June 15;69(12):e89-99).  She does a masterful job of presenting complex material in a clear and elegant manner.  Dr. Arnsten is able to capture the fluidity and dynamics of cortical functions associated with ADHD while still giving the reader anchor points that are useful in everyday clinical practice.

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IPSRT as monotherapy in bipolar II disorder: can psychotherapy be more than an ‘adjunct’ in the treatment of bipolar disorder?

Clinicians who work with patients suffering from bipolar disorder have known this for quite some time: medication alone, while helpful in controlling many of the acute symptoms of bipolar disorder, is not enough to help patients manage this complex illness.   Patients often feel overwhelmed by the diagnosis and need support to adjust to the realities of fluctuating mood states, which frequently result in interpersonal and occupational dysfunction.   For these and other reasons, psychotherapy is an important component of bipolar disorder treatment.

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New Wonder Drug Remarkably Effective in Bipolar Disorder: Lithium (Yes, Lithium).

The single most important research study in the past year in the area of clinical therapeutics of bipolar disorder was conducted  by Geddes and colleagues at Oxford University in England[1].  Using a randomized open-label design (no placebo control group and subjects knew which medications they were receiving), the BALANCE study sorted 330 subjects with bipolar disorder type I into three treatment groups: lithium alone, valproate (Depakote) alone, or combination treatment with both lithium and valproate.  The outcome measures were time to recurrence of a major mood episode, either mania or depression.  The study design allowed for an extended, two year follow-up on these subjects.  This time frame allows for meaningful assessment of genuine prophylactic effects.  The results found that combination therapy was most effective, marginally more so that lithium alone, but significantly greater than valproate monotherapy.  The interpretation of the data supports the unique efficacy of lithium as the single-most effective mood stabilizer available.

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Acute Antidepressant Effects of Lamotrigine: More and More Disappointing.

In the past several years, two new studies have been published examining the efficacy (in pristine, experimental conditions; rigorous selection criteria, minimal comorbid conditions) and effectiveness (real world variability) of lamotrigine (Lamictal) in the treatment of acute bipolar depression [1, 2].  These and other studies were recently summarized in a review paper by Amann and colleagues in the Journal of Psychopharmacology[3].  Attempting to synthesize disparate findings, Amann concludes that “…the antidepressant effect of LTG in acute bipolar depression, if it exists, is small.

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