Text in English / Literature notes an increase in the number of children and adolescents diagnosed with bipolar disorder. Several challenges faced by clinicians who diagnose and treat early-onset bipolar disorder have been discussed with particular emphasis being placed on its pharmacological management. The contributions made by psychologists including psychosocial interventions, have been explored in this regard; however, there still exists a paucity of voices in the field of psychology that discuss the experiences surrounding the management of this disorder. Most studies on early-onset bipolar disorder do not distinguish between childhood and adolescent presentations. Adolescence has been recognized herein, as a distinct developmental and transitional phase and thus, it forms the basis of this inquiry. This qualitative study thus explores clinical psychologists’ experiences ofmanaging adolescents diagnosed with bipolar disorder and will be approached from a social constructionist perspective which was selected as a means of exploring the meanings that individuals attribute to their experiences as they engage with others in their environment. A literature review evaluated the current available literature on juvenile bipolar disorder. Clinical psychologists in private practices were interviewed using semi-structured interviews. The participants were selected using purposive sampling. Two pilot studies were used to pre-test the study. One participant took part in pilot study 1 and one in pilot study 2. Thereafter, four semi-structured interviews were held with four participants who took part in the main study. Themes were drawn from the data and were explored using thematic content analysis. An analysis of the themes revealed several shared experiences in clinical psychologists’ management of juvenile bipolar disorder which were similar to what is reflected in the current available literature on early-onset bipolar disorder. / Psychology / M.A. (Clinical Psychology)

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)

This study seeks to explore the challenges and difficulties faced by children raised by a parent with bipolar disorder, with a specific focus on the experiences and memories of daughters of these individuals. Bipolar disorder, previously known as manic-depressive illness, is characteristically referred to as an episodic, yet lifelong and clinically severe affective (mood) disorder. Bipolar disorder is a severe mental illness, which is stressful not only for patients, but also for family members. Very little work has been done to define more precisely the family burden associated with the illness. Studies that do focus on the impact of bipolar disorder on caregivers or families of the patient have looked at the family as a whole. There seems to be a scarcity of research looking at the experiences of children of parents with bipolar disorder. The children of individuals with bipolar disorder are at high risk for developing a range of mental disorders. Overall, parents with bipolar disorder tend to create a familial environment that is unstable and lacking in structure. Therefore in addition to being at genetic risk for the development of mental disorders, are exposed to a stressful familial environment that increases the risk of psychopathology and difficulties. Despite the importance of assessing the impact parental bipolar disorder can have on children, there is a lack of relevant literature. A non-probability sample of eight female individuals raised by a parent with bipolar disorder was selected from the student population at Wits University. Semi-structured face-to-face interviews were used to gain in depth information regarding the memories and experiences of these individuals. One interview was conducted per participant. Once the data was collected, thematic content analysis was used in order to analyse and draw conclusions from the data. From this method of analysis ten main themes were found, as well as six sub themes. The findings of this study suggest that bipolar disorder has a profound effect, not only on the individual suffering from the illness, but on their children as well. Manic episodes appear to be a particularly stressful time, featuring with great prominence in the memories of respondents. Participants felt strongly that their family environment was affected by their parent’s illness. In general it seemed as if participants with ill mothers described a far more chaotic family environment as compared to those participants with ill fathers. This study also found that knowledge and understanding help these individuals make sense of their parent’s illness, seemingly providing a sense of power and control. A number of participants mentioned the negative effects that stigma associated with mental illness has on the families concerned, often leading to adverse outcomes. In contrast to this, support and understanding by both healthcare professionals as well as the broader community is considered indispensable. The children of patients with bipolar disorder, in addition to being at genetic risk for the development of mental disorders, are exposed to a stressful environment that increases the risk of psychopathology and other difficulties. It is therefore imperative that further research be conducted in this area, as relatively little is known about the long term effects of the parent’s illness on their child.

OBJECTIVE: Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder (BP). We aimed to examine the prevalence, correlates, persistence (>50% of the follow-up time), and the onset of new anxiety disorders in youth with comorbid anxiety disorders and BP. METHODS: As part of the Course and Outcome of Bipolar Youth study (COBY), 446 youth ages 7 to 17, who met DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized criteria for BP not otherwise specified (BP-NOS; n=154) were included. Subjects were evaluated for current and lifetime Axis-I psychiatric disorders at intake using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present and Lifetime version (K-SADS-PL), and standardized instruments to assess functioning and family history. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. RESULTS: Forty-four percent (n=194) of the sample met DSM-IV criteria for at least one lifetime anxiety disorder, most commonly separation anxiety (24%) and generalized anxiety disorders (16%). Nearly 20% met criteria for two or more anxiety disorders. Overall, anxiety disorders predated the onset of BP. BP-II subjects were more likely than BP-I or BP-NOS subjects to have a comorbid anxiety disorder. After adjusting for confounding factors, BP youth with anxiety were more likely to have BP-II, longer duration of mood symptoms, more severe ratings of depression, and family history of depression, hopelessness and somatic complaints during their worst lifetime depressive episode than those without anxiety. Of the 170 youth who had anxiety at intake, 80.6% had an anxiety disorder at any time during the follow-up. Most of the anxiety disorders during the follow-up were of the same type as those present at intake. About 50% of the youth had persistent anxiety, particularly Generalized Anxiety Disorder (GAD). Persistence was associated with multiple anxiety disorders, less follow-up time in euthymia, less conduct disorder, and less treatment with antimanic and antidepressant medications (all p-values≤0.05). Twenty-five percent of the sample who did not have an anxiety disorder at intake developed new anxiety disorders during follow-up, most commonly GAD. New onsets were significantly associated with being female, lower socioeconomic status, presence of attention-deficit/hyperactivity disorder and substance use disorder and more follow-up time with manic or hypomanic symptoms (all p-values≤0.05) CONCLUSIONS: Comorbid anxiety disorders are common in youth with BP, and most often predate BP onset. BP-II, a family history of depression, and more severe lifetime depressive episodes distinguish BP youth with comorbid anxiety disorders from those without. In addition, anxiety disorders in youth with BP tend to persist and new anxiety disorders onset in a substantial proportion of the sample. Careful consideration should be given to the assessment of comorbid anxiety in BP youth. Furthermore, early identification of factors associated with the persistence and onset of new anxiety disorders may enable the development of strategies for treatment and prevention. / OBJECTIUS: Els trastorns d'ansietat són les condicions comòrbides més comuns en nens i adolescents amb trastorn bipolar (TB), però fins on sabem, cap estudi ha examinat l'evolució dels trastorns d'ansietat en joves i adults amb TB. L'objectiu de l'estudi va ser examinar els factors associats amb la persistència (>50% del temps de seguiment) i l'aparició de nous trastorns d'ansietat en nens i adolescents amb TB. MÈTODE: Com a part de l’estudi Course and Outcome of Bipolar Youth (COBY), 413 nens i adolescents entre 7 i 17 anys que complien els criteris per el Manual Diagnòstic i Estadístic IV (DSM-IV) pel TB-I (n=244), TB-II (n=28) o el criteri operacionalitzat pel TB no especificat (TB-NOS; n=154) van ser reclutats principalment de consultoris d'atenció ambulatòria. Els subjectes van ser seguits de mitjana durant 5 anys utilitzant el Longitudinal Interval Follow-up Evaluation. RESULTATS: Dels 170 nens i adolescents que presentaven ansietat a l'inici de l’estudi, el 80.6% tenia un trastorn d'ansietat en qualsevol moment durant el seguiment. La majoria dels trastorns d'ansietat durant el seguiment van ser del mateix tipus que els presents a l'inici de l'estudi. Al voltant del 50% dels joves tenien persistència d'ansietat, sobretot trastorn d'ansietat generalitzada (TAG). La persistència es va associar amb trastorns d'ansietat múltiple, menys temps de seguiment en eutimia, menys trastorn de conducta i menor tractament amb medicaments antidepressius i antimaníacs. Vint-cinc per cent de la mostra que no tenien un trastorn d'ansietat a l'inici, va desenvolupar nous trastorns d'ansietat durant el seguiment, en general TAG. L'inici de nous trastorns d'ansietat es va associar significativament amb ser dona, baix nivell socioeconòmic, presència del trastorn per dèficit d'atenció i hiperactivitat, trastorn per consum de substàncies i més temps de seguiment amb símptomes maníacs o hipomaníacs. CONCLUSIONS: Els trastorns d'ansietat en nens i adolescents amb TB tendeixen a persistir i l'ansietat de nou inici apareix en una proporció substancial de la mostra. S'ha de prestar atenció a l'avaluació de l'ansietat comòrbida en nens i adolescents amb TB i la identificació precoç dels factors associats amb la persistència i l'aparició de nous trastorns d'ansietat poden permetre el desenvolupament d'estratègies pel tractament i la seva prevenció.

La aparición de los antipsicóticos atípicos o de segunda generación ha supuesto un gran cambio en el manejo de los pacientes con trastorno bipolar. Los ensayos controlados han demostrado la eficacia de prácticamente todos los antipsicóticos atípicos en la manía aguda. Además, la mayor parte de ellos disponen de datos positivos para el tratamiento de mantenimiento del trastorno bipolar, lo que sugiere propiedades normotímicas. E incluso algunos de ellos han mostrado datos positivos en la depresión bipolar. Sin embargo, apenas existen estudios independientes comparando la acción de los atípicos con la de los clásicos, mas allá del uso de haloperidol como comparador activo en algunos estudios de manía aguda. En este contexto, esta tesis tiene como objetivo evaluar el comportamiento de los antipsicóticos atípicos en las fases de manía aguda y depresión, en comparación con el de los antipsicóticos clásicos (haloperidol) y placebo respectivamente, para testar las posibles propiedades normoreguladoras en los episodios agudos. Se utilizaron para ello las técnicas de metanálisis, estructurándose la tesis en dos metanálisis separados. El primero en manía aguda, comparando antipsicóticos atípicos con antipsicóticos clásicos. Dentro de este metanálisis se escogieron dos variables principales: la velocidad de inicio de acción, operativizada como la disminución en la puntuación en la escala de manía a la primera semana, y el viraje depresivo. En los dos casos, se trata de variables de interés clínico, escasamente estudiadas hasta la actualidad, y que señalan el perfil de acción de los fármacos. En segundo lugar, se llevó a cabo un segundo metanálisis comparando la acción de los antipsicóticos atípicos con la del placebo (no existían estudios comparativos con antipsicóticos clásicos) en depresión bipolar. Los resultados de la primera variable del metanálisis en manía aguda, que dan lugar al primer artículo de esta tesis, confirman que el haloperidol muestra un inicio de acción más rápido que los antipsicóticos atípicos. El tamaño del efecto fue pequeño (SMD = 0,17 [0,01 - 0,32] tal como cabria esperar entre dos grupos de eficacia demostrada. Sin embargo, este resultado sugiere que el haloperidol puede seguir siendo un tratamiento de primera línea en la manía aguda en casos graves en los que se requiere una mejoría sintomática urgente, siempre y cuando el riesgo de efectos adversos extrapiramidales y de viraje depresivo sea bajo. El segundo artículo de la tesis analiza las diferencias en el riesgo de viraje depresivo tras el tratamiento de la manía aguda con antipsicóticos atípicos en comparación con haloperidol. El resultado del metanálisis es que los atípicos conllevan un 42% menos de riesgo de viraje que el haloperidol. No obstante, se observa heterogeneidad en este análisis y las diferencias entre grupos son atribuibles especialmente a la acción de tres de los atípicos: olanzapina, quetiapina, y ziprasidona. El segundo metanalisis, que da lugar al tercer lugar de la tesis, observa que existe un efecto positivo en la depresión bipolar, en comparacion con placebo, pero que solo es atribuible a algunos de los antipsicóticos atípicos, concretamente, a la olanzapina y la quetiapina. De modo que se concluye que no se trata de un efecto de clase de la familia. Analizando los resultados de los dos metanálisis en conjunto se observa que se puede establecerse un gradiente en función de la afinidad por el receptor dopaminergico D2, modulado por la acción sobre otros receptores, en el que la mayor afinidad y selectividad antiD2 supondría mayor potencia antimaníaca, inicio de acción antimaníaca más rápido, mayor riesgo de viraje depresivo, e ineficacia y/o agravamiento de la depresión bipolar. Haloperidol se situaría en el extremo izquierdo del gradiente y se propone la siguiente ubicación para los antipsicóticos atípicos: Risperidona – Aripiprazol – Ziprasidona – Olanzapina – Quetiapina. Además, este gradiente coincide con el de los valores del Índice de Polaridad obtenidos en los estudios de prevención de recurrencias con los antipsicóticos atípicos, de lo que se desprende que los efectos en los episodios agudos tiende a perdurar durante el tratamiento de mantenimiento. / Introduction of atypical antipsychotics has involved a great change in the management of bipolar disorder during last decade. Not only they show efficacy in mania, but also for recurrence prevention, and some of them have also been shown to work in bipolar depression. However, comparisons with classical neuroleptics to assess advantages and disadvantages are scarce. In this context, the goal of this thesis was to assess the behavior of atypical antipsichotics in the acute phases of mania and depression, compared to classical antipsychotics in the former and with placebo in the latter, and study their possible normothymic properties. Metanalysis techniques were used. The thesis was structured in two different metanalysis. The first one in acute mania, comparing atypical and classical antipyschotics. Two different outcomes were assessed: speed of onset of action and switch to depression. The second metanalysis studied the efficacy of atypical antipsychotics in bipolar depression versus placebo. The first article of the thesis shows that haloperidol has a faster onset of action than atypical antipsychotics in acute mania. The size of the effect was small (SMD = 0,17 [0,01 - 0,32] but could still be clinically significant in the subset of severe manic patients who require an urgent relief of symtpoms. On the other hand, as it is shown in the second paper of the thesis, treatment with atypicals involves a 42% reduction in the risk of switch to depression compared to haloperidol. However, heterogeneity was present which could be due to differences in the group of atypicals, as three of them (olanzapine, quetiapine, and ziprasidone) could explain the effect. The third article, corresponding to the second metanálisis, shows only some atypicals, namely olanzapine and quetiapine, are efficacious in bipolar depression. Therefore, there is no class effect. A global view of both metanalysis shows that dopaminergic D2 affinity is likely to be the most important factor over the different profile of antipsychotics, with lower affinity involving more clear normothymic actions.

Bipolär sjukdom är en kronisk sjukdom där personen upplever maniska och depressiva perioder. Under manin får personen en ökad energinivå, tankarna flödar samt omdömet försämras. Depressionen kännetecknas av nedstämdhet och en dyster sinnesstämning. Syftet med denna studie var att beskriva vilka erfarenheter en person har av att leva med bipolär sjukdom. En narrativ analys har använts. Denna bygger på fyra självbiografier. I resultatet framkom det att det kan ta lång tid innan diagnosen ställs och därmed rätt behandling sätts in. Samtidigt är det vanligt att patienterna slutar ta sina mediciner på grund av biverkningar. Personer med bipolär sjukdom känner ofta oro och ångest inför att insjukna i nya maniska eller depressiva perioder. Känslor som oro och ångest kan i kombination med depressiva perioder leda till självskadebeteende. Till exempel att de skär sig. Den som drabbas av bipolär sjukdom kan ha stor nytta av familjen som skyddsnät. Även andra personer som är i en likande situation kan vara ett stort stöd. / Bipolar disorder is a chronic disease where the person experiencing manic and depressive episodes. During mania has the person an increased energy level, the thoughts flow and impaired reviewed. Depression is characterized by sadness and a gloomy mood. The purpose of this study was to describe the experience a person has to live with bipolar disorder. A narrative analysis was used. This is based on four autobiographies. The results showed that it can take a long time before getting diagnosed and therefore the appropriate treatment. While it is common that patients stop taking their medications because of side effects. People with bipolar disorder often feel anxiety before falling ill with manic or depressive episodes. Emotions such as worry and anxiety can be combined with depressive episodes lead to self-injury. For example, they cut themselves. Those who suffer from bipolar disorder can benefit greatly from their family as a safety-net. Even other people who are in a similar situation can be a great support.

Objective: The aim of the current study was to investigate the differences in baseline characteristics and three-year outcomes between two diagnostic categories with presentation of first-episode psychosis: bipolar affective disorder (mania with psychotic features) and schizophrenia. The comparison was based on pre-treatment characteristics, clinical presentation, symptomatic and functional outcomes, and engagement in risk behaviours. Methods:461 schizophrenic patients and 54 bipolar affective disorder (BAD) patients between the ages of 15 to 25 years from a local first-episode psychosis treatment program within the years2001 to 2003 were studied. Researchers collected detailed data on baseline and three-year follow up variables from systematic medical file review for statistical analyses. Results: At service entry, compared to schizophrenic patients, bipolar affective disorder(BAD)patients exhibited more prominent positive symptoms (p = 0.01), were younger at first presentation and had a higher unemployment rate (p < 0.01), were more likely to have acute onset of psychosis, shorter duration of untreated psychosis (DUP), a higher rate of hospital admission within first month after initial contact, and lower pre-treatment functioning (Social and Occupational Functioning Assessment Scale (SOFAS), p < 0.001). There was no significant difference in gender, education level, age of onset and pre-treatment risk taking behaviours. After applying univariate analysis of variance (ANCOVA)by controlling baseline variables that showed significant differences, the three year follow up reveals that schizophrenic patients displayed fewer numbers of hospitalization (p <0.01)with no difference in the total length (days) of hospitalization, more prominent positive symptoms(p < 0.01), poorer functioning at year 3 (p <0.05), and consistently significant lower employment rate at 12 month (p < 0.001), 24 month (p < 0.001) and 36 month (p < 0.01). Finally, more schizophrenic patients received social benefits (p < 0.05). Conclusion: The outstanding baseline poorer functioning level of bipolar affective disorder patients have progressively made a modest improvement in functional outcomes at the end of three-year follow up. BAD patients also displayed a marked improvement with fewer positive symptoms in the follow up. The results suggest a differentiation in symptomatology and the course of illness between bipolar affective disorder and schizophrenia with first-episode psychosis. In coherence with other scholastic literature, duration of untreated psychosis (DUP) associates with remission(Crumlish et al., 2009;Chang et al., 2012a), positive symptoms(Barnes et.al., 2008; Chang et.al., 2012b; Clarke et al., 2006; Crumlish et.al., 2009;), and functional outcomes(Barnes et al., 2008; Chang et al., 2012b; Clarke et.al., 2006; Crumlish et.al, 2009; Fusar-Poli et al., 2009). Moreover, further exploration about the diagnostic-specific therapeutic window for early intervention, symptoms management, and rehabilitation strategies in occupational training are in demand. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Jana Rambousková Supervisor: Prof. MUDr. Radomír Hrdina, CSc. Title of diploma thesis: Pharmacotherapy of mood disorder This diploma thesis deals with the characterization of mood disorders concentrating especially on depression disorders. It presents the classification of mood disorders according to classification MKN-10. The diploma thesis presents patophysiology of depression disorders, their causes, symptoms and progress. It analyses the choice of pharmacotherapy in depression disorders and bipolar affective disorder. It describes individual groups of antidepressants and drugs used for treatement of bipolar affective disorder. It analyses their mechanism of action, indications, contraindications and adverse effects. At the end of diploma thesis states the other use of antidepressants in non- psychiatric indications.

Made available in DSpace on 2015-04-14T13:21:48Z (GMT). No. of bitstreams: 1 429591.pdf: 1086339 bytes, checksum: af9671d65231fdf5a83a4e2639251f6c (MD5) Previous issue date: 2011-01-26 / Esta disserta??o problematiza os processos de reabilita??o e inclus?o social de pessoas institucionalizadas, com extin??o de medida de seguran?a cumprida no Instituto Psiqui?trico Forense de Porto Alegre/RS. A pesquisa foi realizada com os pacientes, ap?s a sa?da do Instituto, e que t?m experienciado processos de organiza??o de suas vidas fora dos muros da institui??o. A indica??o dos participantes foi feita pelos integrantes do Grupo de Trabalho Interinstitucional (GT), institu?do em setembro de 2007 pela Promotoria de Direitos Humanos e Judici?rio, que avaliou os casos emblem?ticos, ou aqueles nos quais se fez necess?rio ampliar os processos reflexivos e dial?gicos para dar seguimento ao acompanhamento efetivado. Foram utilizados os pressupostos da Reforma Psiqui?trica e da Pol?tica Nacional de Humaniza??o para nortear a discuss?o acerca dos resultados obtidos. A partir de entrevistas, de documentos produzidos pelo referido GT e do di?rio de campo elaborado no decorrer do processo de investiga??o estabeleceu-se o corpus para as an?lises referentes ao tema. Dentre os resultados destacam-se temas como a institucionaliza??o, a viol?ncia institucional, o duplo estigma doen?a mental associada ao delito viola??o de direitos e entraves da vida dentro e fora do manic?mio judici?rio. Tais temas evidenciam as marcas que o tempo de cumprimento da medida de seguran?a provocou nas vidas dos participantes da pesquisa. Entretanto, tamb?m aparecem nas narrativas, perspectivas de projetos de vida, nas quais ocorre a manifesta??o de desejos de outro modo de inser??o social, sem a restri??o da liberdade e, portanto, longe dos muros manicomiais.