Search

The article offers information on the bipolar dichotomy, an understandable and pragmatic solution to an emerging clinical problem. It mentions the clinical utility of a diagnostic label is underpinned by its reliability, prognostic value and ability to guide treatment; and also mentions a lack of diagnostic specificity also means that research and clinical trials are unable to advance our understanding of bipolar disorders.

Objective: Neuroimaging of psychiatric disorders has increased exponentially in the last decade; however, much of the uptake thus far has been in the realm of research. We anticipate that clinical use of neuroimaging modalities in psychiatry will increase dramatically in the near future and suggest that clinicians need to be aware of the potential applications. Method: The authors conducted an extensive MEDLINE, EMBASE, PubMED and PsychInfo search of the published literature (1965–2007) using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further scrutinised for publications of interest, as were indices of books. Articles that reported clinically significant findings and research reports conducted using pertinent neuroimaging modalities were reviewed in detail. Results: The review suggests that exciting neuroimaging advances are being made that have relevance to psychiatry. Novel neuroimaging applications with potential clinical utility are rapidly emerging and the accessibility and use of these technologies will increase in coming years. Clinically meaningful findings have begun to emerge in mood disorders, post-traumatic stress disorder, schizophrenia and dementia. Coupling multimodal imaging with genetics and pharmacotherapeutic studies will further assist in understanding the pathophysiology of neuropsychiatric disorders. Conclusion: It is important that clinicians understand the benefits and limitations of modern neuroimaging techniques and are also suitably equipped to appraise future developments. The use of neuroimaging in evaluating psychopathology is likely to impact upon the future nosology of psychiatric disorders, and assist in diagnosis and clinical management. The integrated use of neuroimaging in conjunction with clinical assessments promises to improve clinical care and markedly alter psychiatric practice. [ABSTRACT FROM AUTHOR]

Objective: This case report suggests that screening of patients with psychiatric symptoms using modern neuroimaging can help identify organic causes of mental illness. Method: A single case study was reported. Results: We report the case of a 25-year-old woman with a recent diagnosis of bipolar II disorder having an magnetic resonance imaging (MRI) scan as part of a research project that reveals an intraventricular brain tumour. The latter is most likely the cause of her irritability and ‘hypomanic’ symptoms and is defined anatomically using diffusion tensor imaging and structural and functional imaging using MRI and positron emission tomography. Conclusion: The lesion in this individual case most probably produces mood symptoms by impinging upon the fornix, a component of the limbic system. However, more generally, the increase in diagnosis of bipolar disorder has to be tempered against alternate causes of similar symptoms and necessitates vigilance of potential organic mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To better define treatment-resistant depression (TRD) so as to assist clinical management and refine treatment guidelines. Method: In this study, we examine a broad range of clinical variables in depressed patients ( n = 196) referred to a tertiary referral Mood Disorders Unit (MDU). Information was collected from patients, referrers and assessors over a period of 32 months and included evaluations of treatments, treatment resistance and related variables. Data were analysed across trichotomized ‘high’, ‘low’ and ‘no’ treatment resistance groupings of patients. Results: A significantly greater proportion of patients with melancholia were amongst the high TRD group, and this was consistent across different strategies for evaluating melancholia. Conclusion: Melancholia perhaps provides a prototypic TRD subset that perhaps reflects some innate aspects of melancholic depression or factors such as the impact of ageing. Research into TRD is needed to both replicate this finding and perhaps explicate it further. [ABSTRACT FROM AUTHOR]

Parker G, Parker K, Malhi G, Wilhelm K, Mitchell P. Studying personality characteristics in bipolar depressed subjects: how comparator group selection can dictate results. Acta Psychiatr Scand 2004: 109: 376–382. © Blackwell Munksgaard 2004. To examine the extent to which identification of any distinct personality characteristics in bipolar subjects are influenced by selection of the comparison diagnostic group. Scores were compared on several general measures of personality style and, additionally, the prevalence of disordered personality functioning was examined in a sample of 198 non-psychotic depressed subjects, 39 with bipolar depression and 159 with unipolar depression. When the bipolar subjects were separately compared with unipolar subjects, and to sub-sets of those with clinically and DSM-IV defined melancholic and non-melancholic depression, quite differing results were suggested. In essence, clinically-defined melancholic subjects had the least personality psychopathology in comparison with the non-melancholic and bipolar subjects. Whether subjects with bipolar disorder have any distinct personality characteristics or over-represented co-morbid personality disorders remains quite unclear when reference is made to the literature. We suggest that inconsistencies across studies may reflect choice and representation of depressive sub-types within the unipolar comparator group. [ABSTRACT FROM AUTHOR]

Berk M, Malhi GS. The platelet window: examining receptor regulated second messenger processes in psychosis and depression. Peripheral markers of psychiatric illness provide a potentially important window into the pathophysiology of a number of psychiatric illnesses. Direct access to pathophysiological processes is fraught with difficulty. However, receptor-regulated second messenger-mediated calcium shifts are an accessible and practical method by which to examine changes in a clinical population. This is possible because platelets and neurons share some physiological features. The platelet intracellular calcium response to receptor stimulation has previously been used as a peripheral marker of psychiatric illness across a range of neurotransmitters, including serotonin, dopamine and glutamate. This review considers the specificity and selectivity of this response and its use in psychotic and mood disorders. [ABSTRACT FROM AUTHOR]

Objective: This paper presents a case of chronic mania and reviews the diagnosis with respect to its definition and utility. Method: A case of chronic mania is described. Results: Unremitting mania poses a diagnostic and management challenge. Conclusion: Persistent mania of this duration is rare, but a diagnosis of chronic mania should not be rejected on the basis of chronicity. [ABSTRACT FROM AUTHOR]

Berk M, Malhi GS. Mood disorders: mechanisms and pathophysiology. [ABSTRACT FROM AUTHOR]