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

Kostas N. Fountoulakis Bipolar Disorder An Evidence-Based Guide to Manic Depression 123

Bipolar Disorder

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

Kostas N. Fountoulakis Division of Neurosciences 3rd Department of Psychiatry Aristotle University of Thessaloniki School of Medicine Thessaloniki Greece ISBN 978-3-642-37215-5 ISBN 978-3-642-37216-2 (ebook) DOI 10.1007/978-3-642-37216-2 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2014956965 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 (www.springer.com)

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

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

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

Contents 1 Historical Perspective...................................... 1 1.1 Antiquity............................................. 1 1.2 Middle Ages.......................................... 6 1.3 Modern Era........................................... 9 References................................................ 23 2 Clinical Description........................................ 27 2.1 Normal Emotions, Neurobiology and Ethological Considerations......................................... 27 2.2 The Conceptualization of Bipolar Disorder.................. 31 2.3 Bipolar Depression..................................... 35 2.4 Mania................................................ 44 2.5 Hypomania........................................... 51 2.6 Mixed States.......................................... 52 2.7 Psychotic Features...................................... 56 2.8 Other Clinical Issues.................................... 59 2.9 The Subjective Experience of Manic Depressive Patients....... 60 2.10 List and Definitions of Symptoms and Signs................. 62 2.10.1 Mood......................................... 62 2.10.2 Psychomotor Disorder........................... 64 2.10.3 Neurocognitive Disorder.......................... 65 2.10.4 Thought Disorder............................... 66 2.10.5 Psychotic Features.............................. 67 2.10.6 Somatic and Neurovegetative Symptoms............. 68 2.10.7 Behavioural Disorder............................ 70 References................................................ 70 3 Long-Term Course......................................... 81 3.1 Predominant Polarity.................................... 81 3.2 Seasonality........................................... 84 3.3 Rapid Cycling......................................... 87 References................................................ 96 ix

x Contents 4 Neurocognitive Functioning in Bipolar Disorder: A Comprehensive Review of Recent Data...................... 109 4.1 General Neurocognitive Functioning and Intelligence Quotient (IQ).......................................... 110 4.2 Psychomotor and Mental Speed........................... 113 4.3 Attention............................................. 114 4.4 Learning and Memory................................... 115 4.5 Verbal Skills.......................................... 117 4.6 Visuospatial Skills...................................... 118 4.7 Executive Function..................................... 118 4.8 Social Cognition and Theory of Mind (ToM)................. 120 4.8.1 ToM.......................................... 121 4.8.2 Emotion Processing............................. 121 4.8.3 Emotional Decision-Making....................... 122 4.8.4 Reviews and Meta-analyses....................... 122 4.9 Clinical Correlations.................................... 123 4.9.1 The Effect of Medication......................... 123 4.9.2 The Effect of Psychotic Symptoms.................. 126 4.9.3 The Effect of Mood Symptoms..................... 127 4.9.4 The Effect of Age and Age at Onset and Personal Psychiatric History.............................. 129 4.9.5 The Role of Other Clinical Factors.................. 130 4.10 BD-II................................................ 131 4.11 Long-Term Development of the Neurocognitive Deficit........ 133 4.12 Awareness of the Neurocognitive Deficit.................... 136 4.13 Gender and the Neurocognitive Deficit...................... 137 4.14 The Neurocognitive Deficit as an Endophenotype for BD....... 137 4.14.1 Twin Studies................................... 138 4.14.2 Studies on First-Degree Relatives................... 138 4.14.3 Studies on Mixed Samples of Relatives.............. 139 4.14.4 Reviews and Meta-analyses....................... 139 References................................................ 142 5 The Role of Temperament................................... 163 5.1 Historical Perspective................................... 163 References................................................ 174 6 The Bipolar Spectrum...................................... 181 References................................................ 186 7 Schizoaffective Disorder.................................... 189 References................................................ 193 8 Personality Disorders (Narcissistic, Antisocial, Borderline)....... 197 References................................................ 202

Contents xi 9 Alcohol and Substance Use in BD Patients..................... 205 9.1 Epidemiology......................................... 205 9.1.1 Epidemiology of Alcohol Use Disorder.............. 206 9.1.2 Epidemiology of Cannabis Use Disorder............. 207 9.1.3 Epidemiology of Gambling........................ 207 9.1.4 Epidemiology of Methadone....................... 207 9.1.5 Epidemiology of Cocaine......................... 207 9.1.6 Epidemiology of Opioids......................... 208 9.1.7 Epidemiology of Smoking........................ 208 9.2 Etiopathogenesis of SUD in BD........................... 208 9.2.1 General Causative Factors and Mechanisms........... 208 9.2.2 Neurobiology.................................. 209 9.3 Clinical Issues......................................... 210 9.3.1 Clinical Issues Related to Alcohol Use............... 211 9.3.2 Clinical Issues Related to Cannabis Use.............. 212 9.3.3 Clinical Issues Related to Cocaine Use.............. 213 9.3.4 Clinical Issues Related to Opioid Use............... 213 9.3.5 Clinical Issues Related to Nicotine Use and Smoking... 213 9.3.6 Substance Use and Neurocognitive Disorder.......... 214 9.3.7 Comorbidity................................... 214 9.3.8 Disability...................................... 214 9.3.9 Suicidality..................................... 214 9.4 Legal Issues........................................... 215 9.5 Treatment............................................ 215 References................................................ 216 10 Comorbidity.............................................. 225 10.1 Psychiatric Comorbidity................................ 226 10.1.1 Comorbid Anxiety.............................. 230 10.1.2 Comorbid Obsessive Compulsive Disorder (OCD).... 246 10.1.3 Comorbid Attention Deficit Hyperactivity Disorder (ADHD)...................................... 250 10.1.4 Comorbid Complicated Grief (CG)................ 255 10.1.5 Comorbid Eating Disorders....................... 255 10.1.6 Various Other Comorbid Conditions................ 257 10.1.7 Comorbid Psychiatric Disorders and BD-II.......... 260 10.2 Medical Comorbidity.................................. 260 10.2.1 General Medical Comorbidity..................... 260 10.2.2 Metabolic Syndrome and Related Medical Conditions.................................... 262 10.2.3 Comorbid Vascular Disease...................... 275 10.2.4 Comorbid Neurological Conditions................ 277 10.2.5 Infectious Diseases............................. 286 10.2.6 Cancer....................................... 290 10.2.7 Endocrinological Disorders....................... 290

xii Contents 10.2.8 Gastroenterological Disorders..................... 296 10.2.9 Disorders of the Blood.......................... 296 10.2.10 Respiratory System Disorders..................... 296 10.2.11 Various Comorbid Medical Disorders............... 301 10.3 Genetics and Endophenotypes........................... 311 References................................................ 314 11 Classification and Epidemiology.............................. 341 11.1 Classification......................................... 341 11.1.1 General Considerations.......................... 341 11.1.2 Contemporary Classification Systems............... 342 11.1.3 Contemporary Classification of BD and Related Disorders........................... 343 11.2 Epidemiology of BD................................... 347 11.2.1 The Amish Study............................... 348 11.2.2 The Epidemiological Catchment Area (ECA)........ 348 11.2.3 The National Comorbidity Survey (NCS)............ 351 11.2.4 The Cross-National Collaborative Group (CNCG)...................................... 351 11.2.5 Zurich Switzerland............................. 352 11.2.6 Shatin, Hong Kong............................. 352 11.2.7 Nottingham, UK............................... 352 11.2.8 The Netherlands Study.......................... 352 11.2.9 The Australian Study............................ 353 11.2.10 The Butajira Study............................. 353 11.2.11 The Merikangas Study.......................... 353 11.2.12 Other Smaller Studies........................... 353 11.2.13 Epidemiology of the Bipolar Spectrum.............. 354 11.2.14 Conclusions on Epidemiology.................... 355 References................................................ 355 12 Disability and Overall Burden Related with Bipolar Disorder..... 361 12.1 Disability............................................ 361 12.1.1 Overview and Definitions........................ 361 12.1.2 Disability in BD Patients......................... 362 12.2 Quality of Life....................................... 367 12.3 Caregiver and Family Burden............................ 367 12.3.1 Prevalence of Caregiver Burden................... 368 12.3.2 Objective Burden............................... 369 12.3.3 Subjective Burden.............................. 370 12.3.4 Influence of Sociodemographic Factors on Caregiver Burden............................ 372 12.3.5 Special Topics Related to Caregiver Burden.......... 373 12.3.6 Comparison with Burden Caused by Other Disorders..................................... 374 12.3.7 Interventions.................................. 374 12.3.8 Caregiver Burden and Patient Outcome............. 375

Contents xiii 12.4 Cost................................................ 376 12.5 Stigma.............................................. 378 References................................................ 379 13 Aetiopathogenesis of Bipolar Disorder........................ 389 13.1 Social Theories....................................... 389 13.2 Psychological Theories................................. 390 13.2.1 Aggression-Turned-Inward Model................. 391 13.2.2 Object Loss................................... 391 13.2.3 Loss of Self-Esteem............................ 392 13.2.4 Cognitive Model............................... 392 13.2.5 Learned Helplessness Model...................... 392 13.2.6 Depression and Reinforcement.................... 393 13.3 Neurobiology of BD................................... 393 13.3.1 Neuroanatomy of BD........................... 393 13.3.2 Functional Studies.............................. 398 13.3.3 Neurotransmitters and Receptors.................. 400 13.3.4 Genetic Studies................................ 406 References................................................ 408 14 Psychometric and Neuropsychological Assessment.............. 421 14.1 Introduction.......................................... 421 14.2 Psychometric Tools.................................... 422 14.2.1 Depression Rating Scales......................... 422 14.2.2 Mania Rating Scales............................. 425 14.2.3 Anxiety Rating Scales............................ 425 14.2.4 Psychotic Symptoms Rating Scales................. 427 14.2.5 Disability and General Assessment................. 428 14.2.6 Temperament and Personality Inventories............ 429 14.2.7 Adverse Events Scales........................... 430 14.2.8 Substance Use Scales............................ 431 14.2.9 Other Rating Scales.............................. 432 14.3 Neuropsychological Tools.............................. 432 References................................................ 434 15 Staging of Bipolar Disorder................................. 437 15.1 The Concept of Staging................................ 437 15.2 Staging of BD........................................ 438 15.2.1 Clinical Determinants of BD Staging............... 438 15.2.2 Neurobiological Determinants of BD Staging........ 441 15.2.3 Treatment Data Supporting the Staging Approach..... 445 15.3 Existing Models for the Staging of BD.................... 446 15.3.1 The Model of Berk............................. 446 15.3.2 The Model of Kapczinski........................ 449 15.3.3 The Model of Post.............................. 449 15.3.4 The Model of Cosci and Fava..................... 450 15.3.5 The Model of Frank............................ 450 15.4 The Future of Staging of BD............................ 451 References................................................ 452