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BIPOLAR DISORDER –
A PORTRAIT OF A COMPLEX
MOOD DISORDER
Edited by Jarrett Barnhill
Bipolar Disorder – A Portrait of a Complex Mood Disorder
Edited by Jarrett Barnhill
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published February, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Bipolar Disorder – A Portrait of a Complex Mood Disorder, Edited by Jarrett Barnhill
p. cm.
978-953-51-0002-7
Contents
Preface IX
Part 1 Basic Science Issues 1
Chapter 1 Bivalent Cations in Bipolar Disorders 3
Mihai Nechifor, Cristina Vaideanu and Florina Crivoi
Chapter 2 Anti-Stress Effects of Mood Stabilizers and
Relevance to Their Therapeutic Actions 17
Young-Ki Chung and Seungmin Yoo
Chapter 3 Lithium Enhances Synaptic Plasticity:
Implication for Treatment of Bipolar Disorder 41
Seong S. Shim
Part 2 Neuropharmacological Challenges 55
Chapter 4 Li
+
in Bipolar Disorder – Possible
Mechanisms of Its Pharmacological Mode of Action 57
Carla P. Fonseca, Liliana P. Montezinho and M. Margarida C.A. Castro
Chapter 5 Memantine: A New Mood Stabilizer for
Treatment-Resistant Bipolar Disorders 99
Gino Serra, Giulia Serra, Alexia E. Koukopoulos,
Francesca Demontis and Athanasio Koukopoulos
Chapter 6 Bipolar Disorder and Suicide 121
Dagmar Breznoščáková
Part 3 Neurodevelopmental Aspects 143
Chapter 7 Correlations Between the Monoaminergic
Status and the Psychoneuroendocrine
Typology in a Murine Model – Possible Biomolecular
Predictions for an Individualized Pharmacotherapy 145
Andreea Letitia Arsene, Niculina Mitrea and Dumitru Lupuliasa
VI Contents
Chapter 8 Paediatric Bipolar Disorder –
Are Attachment and Trauma Factors Considered? 165
Peter I. Parry
Part 4 Psychosocial Approaches 191
Chapter 9 Psychosocial Functioning in
Bipolar Disorder from a Social Justice Perspective 193
Emily Manove, Lauren M. Price and Boaz Levy
Chapter 10 Star Shots: Stigma,
Self-Disclosure and Celebrity in Bipolar Disorder 221
Wendy Cross and Ken Walsh
Preface
This volume addresses the many faces of Bipolar Disorder (BD). To complete this
portrait, we need to explore not only clinical symptoms and treatment responses, but
also gene-environment interactions, epigenetics, stress response systems, and
psychosocial forces that impact mood disorders in general and BD in particular. From
a clinical perspective, the age of onset, severity, and patterns of cycling and symptoms
influence clinical course, venue, and treatment decision making. In this edition we
address the complexity of BD by focusing on basic neurosciences research, especially
the role of neuro-plasticity; multiple neurotransmitter systems; first and second
messenger systems; the capacity of several mood stabilizers to alter stress response
systems, regulators of circadian rhythms, and the underlying neurophysiology of
treating BD. The fundamental processes are addressed in depth by Drs Mahai
(bivalent cations in mania); Seong (lithium effects on neuroplasticity); Gino (a novel
treatment approach to treatment based on modulating glutaminergic activity
treatment with Memantine) and Margarida (the effects of lithium on intracellular
mechanisms related to phosphoinositol, GSK3 and other messenger systems).
Clinical heterogeneity is the most challenging feature of major psychiatric disorders. A
significant contributor to this heterogeneity is gene-environmental interactions. In
keeping with this challenge, Dr Young-Ki addresses the relationship between stress,
BD and the role many mood stabilizers pay in modulating the stress response systems
(neuro-immunological and neuro-endocrinological systems). Her insights and
observations are germane to our understanding of the lifelong changes in the nature
and course of BD. One area of intense interest is the boundary and transformation
point between high levels of reactivity early in the course of BD to one that seems to be
an expression of primarily endogenous events. This “developmental” characteristic of
BD is complicated by frequent relapses over time and points us toward kindling,
episode sensitization and alterations in neuroplastic responses by recurring
symptoms.
In recent years, there is growing interest in the relationship between “soft” forms of
BD, namely sub-clinical or sub-syndromal forms (BD. NOS). These subsyndromal
forms are grouped under BD spectrum disorder. If we turn our attention to
prepubertal onset BD we also confront boundary problems associated with atypical or
temperamental presentations of ADHD and severe affective instability, irritability, and
X Preface
explosive behaviors. In this edition Dr Andreea addresses neurobiological features of
affect regulation and expression. This chapter dovetails nicely into Dr Peter's review of
the problems child psychiatrists encounter, and in some situations create, when
dealing with prepubertal onset BD. The boundary between genetic risk for BD and
severe temperamental differences, ADHD, abuse and neglect, and affect dysregulation
enter into these considerations.
These variations in the presentation of classic BD segue into the markedly increased
risk for both attempted and completed suicide in the disorder. Factors such as
recurring depression in BP II patients, presence of mixed mood states and subtype
early age of onset, substance use, and psychiatric comorbidity contribute to potential
suicidal behaviors. For example, many individuals with BD.NOS, Bipolar II (recurring
depression), and mixed mood states experience longstanding social and occupational
morbidity, prolonged periods of mood-related symptoms and increased risk of
suicide. Dr Dagmar provides a thorough analysis of epidemiological research and
clinical data that addresses the risks for suicidal behavior and completed suicide in
BD.
Dr Levy addresses the complex psychosocial issues that encompass BD. In our era of
psychopharmacological treatments, various psychotherapy formats are often
overlooked or underemphasized. The role of psychotherapy in enhancing quality of
life, relapse prevention, adjuncts for treatment resistant patients, and a methodology
of closely monitoring patients for early relapse at key points in their clinical course,
can be critical for successful outcomes. Increased mastery of the psychosocial
consequences of BD may also play a key role in suicide prevention by enhancing
family functioning as well as cognitive behavioral and interpersonal skill sets.
Dr Wendy culminates this volume on a broader medical sociological note. BD is a
costly and life-altering disorder that can adversely affect not only quality of life but
also occupation, educational, and family functioning. Dr Wendy explores the impact of
disclosure on these parameters. In addition, the author investigates the often
ambiguous territory of illness disclosure in terms of stigmatization and social role
changes due to occupational and family dysfunction and repeated hospitalizations.
These psychosocial issues affect one's willingness to accept the diagnosis, comply with
treatment recommendations, and levels of subjective distress and morbidity related to
a chronic relapsing disorder. The author then turns to the impact of disclosure by
celebrities on stigmatization and social acceptance. Even though Dr Wendy focuses on
psychosocial factors, these findings can be extrapolated to chapters on
neurophysiological parameters associated with occupational distress, social isolation,
and sense of alienation, shame/guilt, and other risk factors for both recurrence and
treatment resistance.
Bipolar Disorder: A Portrait of a Complex Mood Disorder captures only a portion of the
variability and heterogeneity of what we call BD. This book begs the question of
approaching BD in terms of a combination of descriptive and etiopathogenic
. BIPOLAR DISORDER –
A PORTRAIT OF A COMPLEX
MOOD DISORDER
Edited by Jarrett Barnhill
Bipolar Disorder – A Portrait of a Complex.
Mechanisms of Its Pharmacological Mode of Action 57
Carla P. Fonseca, Liliana P. Montezinho and M. Margarida C .A. Castro
Chapter 5 Memantine: A New Mood
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