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Bipolar Disorder (Mania)

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A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence.

Also Known As:

Mania; Manias; Manic Depressive Psychosis; Depression, Bipolar; Bipolar Disorders; Manic State; Manic Disorders; Psychoses, Manic-Depressive; Bipolar Affective Psychosis; Bipolar Depression; Disorder, Bipolar; Disorder, Manic; Manic States; Manic-Depressive Psychoses; Psychoses, Bipolar Affective; Psychoses, Manic Depressive; Psychosis, Bipolar Affective; Psychosis, Manic Depressive; State, Manic; States, Manic; Affective Psychosis, Bipolar; Manic Disorder; Manic-Depressive Psychosis; Psychosis, Manic-Depressive

Networked: 9428 relevant articles (1224 outcomes, 2121 trials/studies)

Relationship Network

Disease Context: Research Results

Mental Disorders: 2989
- Mood Disorders: 6344
  - Psychotic Affective Disorders: 150
    - Bipolar Disorder: 9428
      - Cyclothymic Disorder: 12

Related Diseases

1.	Bipolar Disorder (Mania)
2.	Schizophrenia (Dementia Praecox)
3.	Depressive Disorder (Melancholia)
4.	Mood Disorders (Mood Disorder)
5.	Psychotic Disorders (Schizoaffective Disorder)

Experts

1.	Vieta, Eduard: 123 articles (11/2015 - 06/2002)
2.	Calabrese, Joseph R: 115 articles (11/2015 - 01/2002)
3.	Ketter, Terence A: 79 articles (12/2015 - 01/2002)
4.	Keck, Paul E: 75 articles (05/2015 - 01/2002)
5.	Berk, Michael: 70 articles (11/2015 - 12/2002)
6.	Bowden, Charles L: 69 articles (06/2015 - 01/2002)
7.	McElroy, Susan L: 68 articles (12/2015 - 01/2002)
8.	McIntyre, Roger S: 67 articles (01/2016 - 01/2002)
9.	Tohen, Mauricio: 65 articles (05/2015 - 01/2002)
10.	Suppes, Trisha: 63 articles (01/2016 - 01/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Bipolar Disorder:

1.	LithiumIBA 06/01/2011 - "Bipolar Disorders are among the ten leading causes of morbity and lithium is considered first-line treatment and the most cost-effective. " 02/16/2006 - "The mood stabilizing drug lithium is a highly effective treatment for bipolar disorder. " 01/01/2005 - "Lithium is best described as the bench mark treatment for bipolar disorder, rather than the gold standard, because only a minority of patients show major clinical benefit. " 08/01/2002 - "Lithium is also highly effective in the treatment of bipolar disorder, however, the mechanism of lithium action in the treatment of this psychiatric disorder is still unknown. " 01/01/2000 - "Lithium is currently the gold standard and most appropriate initial treatment for the depressive phase of bipolar disorder. "
2.	Valproic Acid (Valproate, Semisodium)FDA LinkGeneric 01/01/2007 - "Guidelines for the treatment of type I bipolar disorder in children and adolescents, with or without psychotic features, recommend valproate, alone or in combination with an atypical antipsychotic, as a first-line treatment option; however, most randomised and open-label studies investigating valproate in paediatric populations have only evaluated a small number of participants. " 09/01/2013 - "Sodium valproate (especially if started intravenously) is a highly efficacious, cost-effective treatment approach for acute mania. " 06/01/2003 - "Valproate appears at best modestly effective for bipolar depression. " 10/01/2000 - "Sodium valproate is a highly effective treatment for bipolar disorder, but its mechanism of action remains poorly understood. " 10/01/2000 - "Divalproex has proven efficacy in the treatment of bipolar disorder. "
3.	Antipsychotic Agents (Antipsychotics)IBA 07/01/2010 - "Most second-generation antipsychotics have demonstrated efficacy in the treatment of mania, both in monotherapy and as adjuncts to mood stabilizers. " 12/01/2011 - "The second-generation antipsychotics, with their proven efficacy against manic symptoms, are emerging as candidates for use against the depressive phase of bipolar disorder. " 01/01/2005 - "The atypical antipsychotics, with their proven efficacy against manic symptoms, are emerging as candidates for use against the depressive phase of bipolar disorder. " 01/01/2005 - "Atypical antipsychotics appear to have broadly similar efficacy against manic symptoms of bipolar disorder, but there are important differences in their tolerability profiles, which are likely to be of particular relevance during long-term treatment. " 01/01/2007 - "With mania or mixed presentation atypical antipsychotics produced significantly better rates of response and symptomatic remission than placebo, with NNTs of about 5 up to six weeks, and 4 at 6-12 weeks, but more adverse event withdrawals (NNH of about 22) in studies of 6-12 weeks. "
4.	olanzapine (Zyprexa)FDA Link 05/01/2006 - "Olanzapine is most effective for avoiding acute mania episodes. " 05/01/2010 - "In a randomized, double-blind, multicentre, 3-week trial in adolescents, aged 13-17 years, with manic or mixed episodes associated with bipolar I disorder, the mean reduction from baseline to 3 weeks in the Adolescent Structured Young Mania Rating Scale (YMRS) total score (primary endpoint) was significantly greater with olanzapine than with placebo. " 11/01/2004 - "Olanzapine monotherapy significantly improved depressive symptoms compared with placebo in patients with bipolar disorder in an 8-week randomized, controlled clinical study, but the magnitude of the clinical effect was small. " 07/01/2015 - "Subgroup analyses showed that cannabis use was significantly associated with lower remission rates on the Hamilton Depression Rating Scale in females (n=139) and patients prescribed mood stabilizers alone (n=151), whereas in males (n=95) and patients prescribed olanzapine and/or a mood stabilizer (n=83), cannabis use was significantly associated with lower remission rates on the Young Mania Rating Scale. " 10/01/2007 - "The mean baseline-to-endpoint change in the Young Mania Rating Scale total score was significantly greater for patients receiving olanzapine relative to patients receiving placebo, and a greater proportion of olanzapine-treated patients met response and remission criteria (44.8% versus 18.5% and 35.2% versus 11.1%, respectively). "
5.	lamotrigine (Lamictal)FDA LinkGeneric 10/01/2002 - "Lamotrigine has undergone a remarkable series of systematic studies since 1994 that now establish it as an efficacious, well-tolerated treatment in bipolar disorder. " 05/01/2006 - "The base-case model for patients with a recent manic episode indicated that lamotrigine is the most effective treatment for avoiding both acute depression episodes and all types of acute episodes (depression and mania). " 01/01/2004 - "Lamotrigine is the most widely studied and is effective in treating and preventing bipolar depression, and it is the only anticonvulsant approved by the U.S. " 05/01/2000 - "Lamotrigine has the most evidence in favor of its efficacy, with two double-blind studies in which it was more efficacious than placebo in the treatment of bipolar depression. " 01/01/2014 - "In contrast, lamotrigine, a mood stabilizer, has been proven to be effective in preventing depression in patients with bipolar disorder. "
6.	quetiapine (Seroquel)FDA Link 01/01/2007 - "Quetiapine as monotherapy, or in combination with Li or DVP, was a highly effective treatment for acute mania, as shown by overall change scores in the total YMRS. " 01/01/2007 - "Quetiapine was associated with significantly higher response and remission/euthymia rates compared with placebo with most criteria used, in patients with acute mania at the end of both 3 and 12 weeks." 01/01/2012 - "In bipolar disorder, quetiapine XR has also proven effective in relieving acute depressive and manic symptoms. " 12/01/2008 - "Quetiapine monotherapy is effective in improving impairment in important aspects of life that accompany improvements in depressive symptoms in patients with acute bipolar depression." 10/01/2010 - "The aim of this study was to evaluate the tolerability and efficacy of rapid quetiapine loading in youth diagnosed with pediatric bipolar disorder (PBD). "
7.	Carbamazepine (Tegretol)FDA LinkGeneric 03/01/2005 - "Extended-release carbamazepine monotherapy had significantly greater efficacy compared with placebo in the treatment of acute mania in this large, randomized, double-blind, placebo-controlled trial." 01/01/2005 - "At study end, reductions from baseline in Young Mania Rating Scale scores were significantly greater with carbamazepine than with placebo (primary endpoint). " 04/01/1993 - "Although controlled trials have demonstrated the efficacy of carbamazepine for the treatment of rapid cycling bipolar disorder, the response to carbamazepine frequently deteriorates. " 02/01/2010 - "Carbamazepine is effective in treating symptoms of both mania and depression, and there are no significant differences in the relative efficacy of the IR or ERCC formulations." 01/01/2006 - "Recently, two large, 3-week, randomised, double-blind, placebo-controlled trials using nearly identical protocols demonstrated that monotherapy with carbamazepine extended-release capsules (CBZ-ERC) was effective for the treatment of acute mania in patients with bipolar I disorder. "
8.	Risperidone (Risperdal Consta)FDA LinkGeneric 02/01/2010 - "The combination of risperidone with mood stabilizers significantly improved the scores on the Young Mania Rating Scale (YMRS), 17-item Hamilton Rating Scale for Depression (HAMD), 18-item Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), and Clinical Global Impression Scale for use in bipolar illness Severity (CGI-BP) at 24 weeks (P < 0.0001). " 02/01/2008 - "Although both hyperactive/impulsive (-7.5 +/- 5.5.6, p < 0.05) and inattentive (-6.8 +/- 5.0, p < 0.05) ADHD symptoms were significantly improved with risperidone, improvement was modest, and only 29% of subjects (N = 6) showed a 30% reduction in ADHD rating scale scores and had a CGI-I </= 2. These results suggest that that treatment with risperidone is associated with tangible but generally modest improvement of symptoms of ADHD in children with bipolar disorder." 01/01/2005 - "At week 3, mean Young Mania Rating Scale (YMRS) score reductions from baseline were significantly greater in patients receiving risperidone than placebo (p<0.001). " 06/01/2004 - "Improvement in mean Young Mania Rating Scale total score (adjusted for covariates) was significantly greater in the risperidone than in the placebo group at endpoint (mean change=-10.6 [SD=9.5] versus -4.8 [SD=9.5], respectively), with significant between-group differences seen as early as 3 days after start of treatment (change with risperidone: mean=-6.8 [SD=5.8]; change with placebo: mean=-4.0 [SD=5.8]) and continuing throughout all time points. " 05/01/2004 - "At double-blind endpoint, mean reductions in Young Mania Rating Scale (YMRS) scores were significantly greater in patients receiving risperidone plus mood stabilizer than in those receiving placebo plus mood stabilizer (-14.3 vs. -8.2, p <.001). "
9.	Antidepressive Agents (Antidepressants)IBA 01/01/2008 - "Most of the standard randomized controlled trials report the efficacy of antidepressants in the acute phase of BPD, but the data also indicate higher switch rates to mania and acceleration of mood cycle with their use. " 10/01/2001 - "Thirty-five (37%) of the 95 acute treatment phases were associated with a much or very much improved rating in depression on the CGI-BP. Thirteen (14%) of these 95 acute trials of antidepressants as adjuncts to mood stabilizers were associated with switches, seven into hypomania and six into mania. " 04/01/2010 - "This first randomized discontinuation study with modern antidepressants showed no statistically significant symptomatic benefit with those agents in the long-term treatment of bipolar disorder, along with neither robust depressive episode prevention benefit nor enhanced remission rates. " 02/01/1999 - "Currently available antidepressants may increase the risk of mania and rapid cycling, and mood stabilizers appear to be less effective in treating depression than mania. " 03/01/1992 - "Antidepressant drugs are effective in the acute treatment and prevention of depression only, and can even precipitate hypomanic or manic "switches," or "rapid cycling" between mania and depression. "
10.	aripiprazole (Abilify)FDA Link 01/01/2015 - "Factors most predictive of endpoint efficacy for aripiprazole were judgment/impulsivity at day 4 and mania at week 1. Optimal factor score improvement for outcome prediction was approximately 40% to 50%. " 10/01/2007 - "Aripiprazole was effective in improving mania and ADHD symptoms, but neither JBD nor ADHD symptom remission was observed in most of the cases. " 09/01/2007 - "Aripiprazole was superior to placebo in reducing the severity of both mania and agitation in highly agitated patients with bipolar I disorder and showed significant antimanic activity in patients with low levels of agitation without increasing agitation. " 02/01/2014 - "Using trial data together with ancillary analyses, the European Medicines Agency concluded that aripiprazole 10 mg once daily for 12 weeks was effective in reducing symptoms of mania, but because of the high drop-out rate, efficacy over 30 weeks of treatment was not proven. " 02/01/2011 - "aripiprazole has proven to be an effective medication for the acute treatment of manic and mixed episodes, as well as for the prophylactic-maintenance phase of bipolar disorder in patients recovering from a manic/mixed episode. "

Therapies and Procedures

1.	Drug Therapy (Chemotherapy) 11/01/2010 - "Pharmacotherapy is the primary treatment for bipolar disorder, and several medications have proven efficacy for treating patients with the disorder. " 03/01/2015 - "IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. " 10/01/2009 - "High-frequency supra-threshold right prefrontal rTMS in bipolar, mania patients was well tolerated and found to be effective as add-on to standard pharmacotherapy." 05/01/2008 - "Evidence suggests that adjunctive psychosocial interventions in bipolar disorder are clinically beneficial and cost effective when used in conjunction with pharmacotherapy. " 01/01/2014 - "This study aimed to determine the efficacy of group psycho-education on medication adherence and global functioning of patients with bipolar disorder type I. 45 patients with bipolar disorder type I were allocated one of the three groups of psycho-education plus pharmacotherapy, pharmacotherapy and placebo plus pharmacotherapy. "
2.	Therapeutics 08/01/2012 - "By comparing the degree of phenotypic rescue with the mechanism of action of each therapeutic we have shown that the low-concentration PTZ model can produce a number of intermediate phenotypes that model symptoms of bipolar disorder, may be useful in modelling other disease states, and will help predict the efficacy of novel therapeutics." 08/01/2008 - "The therapeutics for bipolar disorders are still far from adequate, and new options with improved effectiveness, safety, and tolerability in a wide range of patients are necessary. " 01/01/2003 - "These new models hold much promise in delineating the underlying pathophysiology of bipolar disorder and for the development of novel, improved therapeutics. " 10/01/2014 - "Targeting mitochondrially mediated plasticity to develop improved therapeutics for bipolar disorder." 06/01/2013 - "Both DAT models may help to identify therapeutics that impact the full spectrum of BD mania."
3.	Injections 05/01/2014 - "What is the evidence for the use of second-generation antipsychotic long-acting injectables as maintenance treatment in bipolar disorder?" 01/01/2013 - "Treating symptomatic hyperprolactinemia secondary to a long-acting injectable atypical antipsychotic in a patient with bipolar disorder due to an anoxic brain injury." 01/01/2013 - "Patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, who were prescribed long acting antipsychotic (depot) injections but had received 75% or less of the prescribed injections. " 01/01/2008 - "This observational long-term study provides support to long-acting injectable risperidone being effective for the maintenance treatment of mania and improving treatment adherence, reducing relapses and re-hospitalization rates." 04/01/2006 - "The findings suggest that injectable sodium valproate is a safe and effective mood stabilizer for patients with mania."
4.	Phototherapy (Light Therapy) 01/01/2008 - ""Dark Therapy", in which complete darkness is used as a mood stabilizer in bipolar disorder, roughly the converse of light therapy for depression, has support in several preliminary studies. " 12/01/2007 - "To perform a dose-ranging safety and efficacy study of bright light therapy for depression in women with bipolar disorder (BD). " 12/01/2015 - "We conducted a comprehensive review using Medline and Google Scholar databases up to August 2014 using the following keywords combination: "bipolar disorder" and "light therapy" or "phototherapy". " 03/30/2012 - "Forty-four adults with bipolar disorder, depressed phase were randomized to treatment with bright light therapy, low-density or high-density negative ion generator for 8 weeks. " 12/01/2007 - "Light therapy for bipolar disorder: a case series in women."
5.	Aftercare (After-Treatment) 01/01/2002 - "This study assessed whether therapist adherence to the family focused treatment model for patients with bipolar disorder and their relatives was associated with patient outcomes at one year after treatment entry. " 10/01/2014 - "Among patients treated with a concurrent mood stabilizer, no acute change in risk of mania was observed during the 3 months after the start of antidepressant treatment (hazard ratio=0.79, 95% CI=0.54, 1.15), and a decreased risk was observed during the period 3-9 months after treatment initiation (hazard ratio=0.63, 95% CI=0.42, 0.93). " 01/01/2013 - "Measurements included baseline demographics with follow-up measurements at discharge, 3 months, 6 months and 2 years after treatment, including alcohol consumption, depression, mania/elation, anxiety, craving, drug use and sample blood tests. " 01/01/2011 - "MicroRNA-134 plasma levels before and after treatment for bipolar mania." 01/30/2010 - "To evaluate the clinical symptoms, we used the Young Mania Rating Scale at baseline and 6 weeks after treatment. "