Kostas N. Fountoulakis. Bipolar Disorder. An Evidence-Based Guide to Manic Depression

Transcription

1 Bipolar Disorder

2

3 Kostas N. Fountoulakis Bipolar Disorder An Evidence-Based Guide to Manic Depression

4 Kostas N. Fountoulakis Division of Neurosciences 3rd Department of Psychiatry Aristotle University of Thessaloniki School of Medicine Thessaloniki Greece ISBN ISBN (ebook) DOI / Springer Heidelberg New York Dordrecht London Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 To Katerina My sons Nickolas and Ioannis My parents Nick and Olga and parents-inlaw Ioannis and Zoumboulia For without their enduring support, this book would not have been possible to author

6

7 Foreword During the latter part of the twentieth century, manic depression emerged as a new focus of research that over time came to achieve an equal status with schizophrenia and depression among mental health professionals. Indeed, because of its complexity and high cost and its flamboyant symptomatology, it now tends to enjoy a privileged status, especially in the minds of those working in the arts and sciences. Manic depression has a number of impressive characteristics. First, it has become almost fashionable to admit that one suffers from this mental disease. Second, there is a widespread belief that it is strongly correlated with creativity. Many famous people announce publicly that they suffer from it, while historical and biographical data suggest that other renowned personalities from the past have been afflicted with the illness. Third, manic depression is one of the very few medical conditions that respond to treatment with a single simple natural element: lithium. This is extraordinary, and the way in which this happens is unique in medicine. This book is a single-authored work. This is rather unusual today, when multiauthored books are the rule. An extremely large amount of work is needed to accomplish such a task, especially when the purpose is to systematically review the literature and try to follow the rules of evidence-based medicine to the extent that the literature permits it. The result, however, is a comprehensive, solid book and not a heterogeneous compilation of book chapters. The various chapters of this book address distinct aspects of the disease, from traditional ones such as the historical perspective to modern approaches like staging. Especially the chapter on biological therapies utilizes a precise methodology in the collecting and ranking of data and agents and thereby provides the reader with the state of the art in a comprehensive way which can rarely be found in a book. I strongly believe that the book will satisfy the most discriminating of readers, including both those seeking an update on a specific aspect of the illness and those whose need is a comprehensive reference. I have no doubt that this book will have a significant impact on the field and will constitute a very important resource for teaching, training and research and provide guidance for everyday clinical practice. vii

8 viii Foreword The hope is that it will also help to upgrade the status of bipolar disorder on the agenda of policy makers and promote awareness of the illness so that the needed resources are allocated both for further research in the field and for the targeted treatment and care of patients and their families. Gothenburg, Sweden Arvid Carlsson October 2014 Nobel laureate in medicine 2000 Emeritus Professor of Pharmacology Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

9 Contents 1 Historical Perspective Antiquity Middle Ages Modern Era References Clinical Description Normal Emotions, Neurobiology and Ethological Considerations The Conceptualization of Bipolar Disorder Bipolar Depression Mania Hypomania Mixed States Psychotic Features Other Clinical Issues The Subjective Experience of Manic Depressive Patients List and Definitions of Symptoms and Signs Mood Psychomotor Disorder Neurocognitive Disorder Thought Disorder Psychotic Features Somatic and Neurovegetative Symptoms Behavioural Disorder References Long-Term Course Predominant Polarity Seasonality Rapid Cycling References ix

10 x Contents 4 Neurocognitive Functioning in Bipolar Disorder: A Comprehensive Review of Recent Data General Neurocognitive Functioning and Intelligence Quotient (IQ) Psychomotor and Mental Speed Attention Learning and Memory Verbal Skills Visuospatial Skills Executive Function Social Cognition and Theory of Mind (ToM) ToM Emotion Processing Emotional Decision-Making Reviews and Meta-analyses Clinical Correlations The Effect of Medication The Effect of Psychotic Symptoms The Effect of Mood Symptoms The Effect of Age and Age at Onset and Personal Psychiatric History The Role of Other Clinical Factors BD-II Long-Term Development of the Neurocognitive Deficit Awareness of the Neurocognitive Deficit Gender and the Neurocognitive Deficit The Neurocognitive Deficit as an Endophenotype for BD Twin Studies Studies on First-Degree Relatives Studies on Mixed Samples of Relatives Reviews and Meta-analyses References The Role of Temperament Historical Perspective References The Bipolar Spectrum References Schizoaffective Disorder References Personality Disorders (Narcissistic, Antisocial, Borderline) References

11 Contents xi 9 Alcohol and Substance Use in BD Patients Epidemiology Epidemiology of Alcohol Use Disorder Epidemiology of Cannabis Use Disorder Epidemiology of Gambling Epidemiology of Methadone Epidemiology of Cocaine Epidemiology of Opioids Epidemiology of Smoking Etiopathogenesis of SUD in BD General Causative Factors and Mechanisms Neurobiology Clinical Issues Clinical Issues Related to Alcohol Use Clinical Issues Related to Cannabis Use Clinical Issues Related to Cocaine Use Clinical Issues Related to Opioid Use Clinical Issues Related to Nicotine Use and Smoking Substance Use and Neurocognitive Disorder Comorbidity Disability Suicidality Legal Issues Treatment References Comorbidity Psychiatric Comorbidity Comorbid Anxiety Comorbid Obsessive Compulsive Disorder (OCD) Comorbid Attention Deficit Hyperactivity Disorder (ADHD) Comorbid Complicated Grief (CG) Comorbid Eating Disorders Various Other Comorbid Conditions Comorbid Psychiatric Disorders and BD-II Medical Comorbidity General Medical Comorbidity Metabolic Syndrome and Related Medical Conditions Comorbid Vascular Disease Comorbid Neurological Conditions Infectious Diseases Cancer Endocrinological Disorders

12 xii Contents Gastroenterological Disorders Disorders of the Blood Respiratory System Disorders Various Comorbid Medical Disorders Genetics and Endophenotypes References Classification and Epidemiology Classification General Considerations Contemporary Classification Systems Contemporary Classification of BD and Related Disorders Epidemiology of BD The Amish Study The Epidemiological Catchment Area (ECA) The National Comorbidity Survey (NCS) The Cross-National Collaborative Group (CNCG) Zurich Switzerland Shatin, Hong Kong Nottingham, UK The Netherlands Study The Australian Study The Butajira Study The Merikangas Study Other Smaller Studies Epidemiology of the Bipolar Spectrum Conclusions on Epidemiology References Disability and Overall Burden Related with Bipolar Disorder Disability Overview and Definitions Disability in BD Patients Quality of Life Caregiver and Family Burden Prevalence of Caregiver Burden Objective Burden Subjective Burden Influence of Sociodemographic Factors on Caregiver Burden Special Topics Related to Caregiver Burden Comparison with Burden Caused by Other Disorders Interventions Caregiver Burden and Patient Outcome

13 Contents xiii 12.4 Cost Stigma References Aetiopathogenesis of Bipolar Disorder Social Theories Psychological Theories Aggression-Turned-Inward Model Object Loss Loss of Self-Esteem Cognitive Model Learned Helplessness Model Depression and Reinforcement Neurobiology of BD Neuroanatomy of BD Functional Studies Neurotransmitters and Receptors Genetic Studies References Psychometric and Neuropsychological Assessment Introduction Psychometric Tools Depression Rating Scales Mania Rating Scales Anxiety Rating Scales Psychotic Symptoms Rating Scales Disability and General Assessment Temperament and Personality Inventories Adverse Events Scales Substance Use Scales Other Rating Scales Neuropsychological Tools References Staging of Bipolar Disorder The Concept of Staging Staging of BD Clinical Determinants of BD Staging Neurobiological Determinants of BD Staging Treatment Data Supporting the Staging Approach Existing Models for the Staging of BD The Model of Berk The Model of Kapczinski The Model of Post The Model of Cosci and Fava The Model of Frank The Future of Staging of BD References

14 xiv Contents 16 Biological Therapies General Background Lithium Antiepileptics Antipsychotics Antidepressants Evidence-Based Treatment Acute Mania Acute Bipolar Depression Maintenance Treatment Treatment of Mixed Episodes Treatment of Rapid Cycling Patients Treatment of Special Conditions Cautions for Pharmaceutical Treatment in BD Patients Switching to the Opposite Pole References Psychosocial Treatment and Interventions General Background Specific Psychotherapies and Psychosocial Interventions Cognitive-Behavioural Therapy (CBT) Psychoeducation Interpersonal and Social Rhythm Therapy (IPSRT) Family Intervention Intensive Psychosocial Intervention Cognitive Remediation and Functional Remediation Mindfulness-Based Interventions References Treatment Guidelines Background List of Existing Guidelines Critical Review of the Most Important Guidelines American Psychiatric Association Treatment Guidelines for BD The Canadian Network for Mood and Anxiety Treatments and International Society on Bipolar Disorder Guidelines (CANMAT/ISBD) The Texas Medication Algorithm Project (TMAP) for the Treatment of BD The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of BD British Association for Psychopharmacology (BAP)

15 Contents xv The UK National Institute of Clinical Excellence (NICE) Treatment Guidelines for BD Critical View of Treatment Guidelines for BD References Special Issues Gender Suicidality Paediatric BD Epidemiology of Paediatric BD Clinical Features of Paediatric BD Aetiopathogenesis of Paediatric BD Treatment of Paediatric BD Geriatric BD Epidemiology of Geriatric BD Clinical Features of Geriatric BD Neurobiology of Geriatric BD Treatment of Geriatric BD References Creativity and the Position of Bipolar Disorder in Popular Culture Creativity The Concept of Creativity The Philosophical and Journalistic Approach The Scientific Approach Possible Mediating Mechanisms Between Creativity and BD The Effect of Treatment and Other Ethical Considerations The Place of BD in Popular Culture References Index

16

17 Introduc tion Since nearly 3,000 years, mood disorders have been described in the medical literature, and the terms mania and melancholia are the oldest in psychiatry and also among the oldest in medicine. Although they are considered to constitute one of the most common group diseases of humanity, accompanied by heavy burden, disability, mortality and cost, only recently the major public health interest focused on them. Since the 1990s, the World Health Organization has ranked them among the most disabling medical conditions and among the most urgent health problems worldwide. From Hippocrates to Aretaeus of Cappadocia, to Kraepelin, Aubrey Lewis and Sir Martin Roth, to Fred Goodwin, Hagop Akiskal and other prominent researchers, our understanding of bipolar disorder (BD) evolved from an episodic disorder with little disability and good prognosis to a probably developmental, chronic, disabling disease with significant burden, mortality and global cost for the society (Goodwin and Jamison 1990; Aretaeus of Cappadocia 1856; Kraepelin 1921). With the introduction of modern classification systems and the advancement of the evidencebased movement in medicine and psychiatry, our approach is reshaped and our knowledge and data are scrutinized and re-evaluated. Still many questions remain to be answered. One of them concerns the existence of a spectrum of mood disorders which includes many conditions previously diagnosed as schizophrenia, personality disorder, or neurosis. This implies the presence of a clinical continuum, and it is in sharp contrast to the categorical approach of classification systems. Another question concerns the possible role and place of juvenile mood disorders (Poznanski and Zrull 1970; Puig-Antich 1987; Weller et al. 1995; Carlson and Strober 1978; Akiskal et al. 1985). One of the most cardinal issues is how to reduce overall mortality in general and suicidality in particular, since mood disorders underlie nearly two-thirds of suicide attempts (Isometsa et al. 1994; Luoma et al. 2002; Rihmer et al. 2002; Rihmer 2007), and therefore early identification and correct treatment is important. Bipolar disorder (BD) was previously called manic depressive psychosis, and its clinical picture consists of at least one hypomanic, manic, or mixed episode and one or more depressive episodes. Euphoric mania was the classic feature of BD, but today we know that mixed and agitated depression or dysphoric manic states are more prevalent. Also, recent data suggest the existence of a spectrum of milder, short-duration and ambulatory mood states that alternate. Comorbidity patterns include high rates of panic, obsessive compulsive disorder, social phobia, and alcohol and stimulants xvii

18 xviii Introduction abuse. Somatic illness is also highly prevalent, and vascular brain disease might relate to a specific type of late-onset BD. In many ways, the old term manic depression seems much more appropriate than the modern bipolar disorder. The aetiopathogenesis might include genetic, neurodevelopmental and psychosocial factors with neurobiological factors being predominant. Since antiquity, temperament was considered to constitute a vulnerability factor for the development of mood disorders. During the last few decades, the concept of temperament has been refined and redefined and specific variations, possibly hereditary to a significant degree, have been described (Akiskal and McKinney 1973; Akiskal 1995). Women might be at higher risk, but the specific sex-related factors leading to this increased vulnerability are unknown (Nazroo et al. 1997; Parry 1989). However, a family environment with parents suffering from overt mood disorders or having personality or temperament features that predispose to mood disorders is often characterized by conflicts, bereavement, divorce and suicide, but often it is also characterized by creativity and openness. This is often the environment where a child with a genetic vulnerability to mood disorders is born and raised. The interaction between adverse life events and genetic vulnerability might further increase the risk for the development of mood disorders (Kendler and Karkowski- Shuman 1997). More than a century has already passed since Frederik Lange in the late nineteenth century (Lange 1894) used lithium for the first time. Also more than half a century has passed since John Cade used it for the treatment of affective patients (Cade 1949, 1970; Bech 2006) and since Jean Delay and Pierre Deniker used an antipsychotic for the first time most likely in agitated manic patients (Delay and Deniker 1955). Psychopharmacology reshaped the way we view and treat mental disorders, including BD. It medicalized psychiatry because one needs to be competent in medicine in order to use medication properly and adequately. It is widely accepted that BD requires prolonged somatic treatment in order to achieve remission of symptomatology and return of functioning. Polypharmacy might be the rule rather than the exception, and this issue requires caution and further research. Psychosocial therapy by skilled clinicians can provide support, combat demoralization, change maladaptive behaviours and improve functioning. It can provide relief and support not only to patients but also to caregivers and families. It is disappointing that any advances that have occurred in our understanding of BD do not appear to have improved the morbidity and mortality of BD patients and their long-term prognosis to the extent it was anticipated. On the other hand, it is a difficult task for the average clinician to keep abreast of the advances in the field, and it is even more difficult to carry these advances into everyday clinical practice. The current book aims at carrying these advances from the research literature to the everyday diagnostic and therapeutic practice, in a concise, comprehensive and operationalized way, for the ultimate benefit of the patients and their families. It is not easy nowadays to write and publish a single-authored book. The challenge was great for me, and I would dare to say that this is the most challenging invitation I have ever received. It took me almost three years to complete the writing, and it was a fascinating journey with hot interactions between my personal clinical experience and research and the literature.

19 Introduction xix My driving thought was to write a book as much evidence-based as possible. Eventually, this was possible for almost all chapters which were based on an indepth systematic review of the literature updated through the year More than 3,700 references are included in the book, and many times this number were the references that were screened and rejected. The text includes a balanced view of conflicting approaches, but this is not done in a neutral or uncritical manner. The conclusions are evidenced-based, after a critical systematic review of the literature, and only on rare occasions my own clinical perspective or opinion leads to the conclusions. At this point, I would like to thank two eminent people who guided, assisted and supported me through my journey into the science of psychiatry all these years. I have the pleasure to call them my mentors and the privilege to consider them friends. It is Hagop S. Akiskal who over the last 15 years has introduced me to and helped me with the modern concepts and understanding of mood disorders, while it is Hans-Jurgen Moeller who has guided me for more than a decade in the difficult pathways of modern psychopharmacology and trusted me with important initiatives in the field. Without their unconditional support, my journey in the international arena of science wouldn t have been possible. Of course, the current book reflects my personal view on the topic of manic depression, and I am the only one to assume full responsibility for the content of the text. I also would like to thank Professor Arvid Carlsson, Nobel Laureate in Medicine for the year 2000, for accepting to write a prologue for the book. His kind words are a great honour and ethical satisfaction for my efforts, and since I met him for the first time some 10 years ago, his figure serves as an ideal paradigm for my journey through the wandering rocks of science (only to quote his words). Finally, I would like to thank all my colleagues in my research team through the last 15 years. They worked hard, accepted me and my peculiarities and demands, and together we tried to contribute to the development of the field through the accumulation of evidence. I also want to thank my colleagues in the 3rd Department of Psychiatry for their continuous support and understanding. Thessaloniki, Greece 10 September 2014 Kostas N. Fountoulakis, MD, PhD

20 xx Introduction References Akiskal HS (1995) Toward a temperament-based approach to depression: implications for neurobiologic research. Adv Biochem Psychopharmacol 49: Akiskal HS, McKinney WT Jr (1973) Depressive disorders: toward a unified hypothesis. Science 182(4107):20 29 Akiskal HS, Downs J, Jordan P, Watson S, Daugherty D, Pruitt DB (1985) Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course. Arch Gen Psychiatry 42 (10): Aretaeus of Cappadocia (1856) The extant works of Aretaeus, the Cappadocian. Sydenham Society, London Bech P (2006) The full story of lithium. A tribute to Mogens Schou ( ). Psychother Psychosom 75(5): Cade J (1949) Lithium salts in the treatment of psychotic excitement. Med J Aust 36: Cade J (1970) The story of lithium. In: Ayd F, Blackwell B (eds) Discoveries in biological psychiatry. Lippincott, Philadelphia Carlson GA, Strober M (1978) Manic-depressive illness in early adolescence. A study of clinical and diagnostic characteristics in six cases. J Am Acad Child Psychiatry 17(1): Delay J, Deniker P (1955) Neuroleptic effects of chlorpromazine in therapeutics of neuropsychiatry. J Clin Exp Psychopathol 16(2): Goodwin F, Jamison K (1990) Manic-depressive illness. Oxford University Press, New York Isometsa E, Henriksson M, Aro H, Heikkinen M, Kuoppasalmi K, Lonnqvist J (1994) Suicide in psychotic major depression. J Affect Disord 31(3): Kendler KS, Karkowski-Shuman L (1997) Stressful life events and genetic liability to major depression: genetic control of exposure to the environment? Psychol Med 27(3): Kraepelin E (1921) Manic-depressive insanity and paranoia. Livingstone, Edinburgh Lange F (1894) De vigtigste Sindssygdomme (The most important Pychiatric disorders). Gyldendal, Copenhagen Luoma JB, Martin CE, Pearson JL (2002) Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 159(6): Nazroo JY, Edwards AC, Brown GW (1997) Gender differences in the onset of depression following a shared life event: a study of couples. Psychol Med 27(1):9 19 Parry BL (1989) Reproductive factors affecting the course of affective illness in women. Psychiatr Clin North Am 12(1): Poznanski E, Zrull JP (1970) Childhood depression. Clinical characteristics of overtly depressed children. Arch Gen Psychiatry 23(1):8 15 Puig-Antich J (1987) Affective disorders in children and adolescents. In: Meltzer H (ed) Psychopharmacology: the third generation of progress. Raven, New York Rihmer Z (2007) Suicide risk in mood disorders. Curr Opin Psychiatry 20(1):17 22 Rihmer Z, Belso N, Kiss K (2002) Strategies for suicide prevention. Curr Opin Psychiat 15:83 87 Weller EB, Weller RA, Fristad MA (1995) Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions. J Am Acad Child Adolesc Psychiatry 34(6): doi: / , S (09) [pii]