Bipolar disorder (BD) affects over 1% of the global population, with varying prevalence rates across different types, including bipolar I, bipolar II, and sub-threshold bipolar disorder. Acute mania, a psychiatric emergency, is marked by elevated mood, impulsivity, and risky behavior, leading to significant functional impairment. Treatment relies on pharmacological therapies, primarily mood stabilizers and antipsychotics, with polypharmacy common in both inpatient and outpatient settings. Treatment decisions depend on efficacy, safety, patient characteristics, and the influence of treatment resistance, psychiatric comorbidities, and patient history.

This 14-year study in Taiwan analyzed medication prescription trends for patients discharged with bipolar mania. It found significant shifts, including increased use of second-generation antipsychotics (SGAs) and valproate, alongside a decline in first-generation antipsychotics (FGAs). Complex polypharmacy also rose, reflecting the challenges of treating bipolar disorder. The study highlights the need for further research into the long-term effects of these prescribing trends, especially regarding medical nonadherence, adverse side effects, and drug interactions. Researchers also underscore the need for tailored approaches to managing acute mania.

Reference: Chiu HP, Shih Y, Lin CH. Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan. Medicine (Baltimore). 2024 Mar 1;103(9):e37270. doi: 10.1097/MD.0000000000037270. PMID: 38428897; PMCID: PMC10906621.

Bipolar disorder in late life presents significant challenges due to high rates of medical service use, disability, increased mortality, and higher risk for suicide and dementia. Although lithium and divalproex are commonly prescribed mood stabilizers for older adults with bipolar disorder, there is limited research specifically addressing their use in this population. While lithium is widely recognized for its efficacy in midlife adults with bipolar disorder, its tolerability in older patients can be compromised, leading to the use of lower concentrations or alternative medications. Similarly, divalproex has shown potential in treating late-life mania but lacks definitive evidence from randomized controlled trials comparing its efficacy and tolerability to lithium or other agents.

A randomized, double-blind study was conducted to compare the tolerability and efficacy of lithium and divalproex in older adults with bipolar disorder presenting with mania. The results showed that both medications were generally well tolerated, with no significant differences in sedation or side effects between the two groups. Lithium demonstrated slightly greater efficacy in reducing mania severity, with more patients achieving a clinical response or remission by the ninth week. The study concluded that both lithium and divalproex are viable treatment options for older adults with bipolar disorder, with lithium showing a stronger effect on mania severity. It also suggested the potential benefit of using lithium over antipsychotics in elderly patients.

Reference: Young RC, Mulsant BH, Sajatovic M, et al. GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Am J Psychiatry. 2017 Nov 1;174(11):1086-1093. doi: 10.1176/appi.ajp.2017.15050657. Epub 2017 Aug 4. PMID: 29088928; PMCID: PMC6214451.

Bipolar disorder (BD) affects about 4.4% of the US population and often relapses with episodes of mania, hypomania, and depression. Women are particularly vulnerable during pregnancy and postpartum, with increased risks for rapid cycling, mixed states, and postpartum depression or psychosis. Early identification and differentiation from unipolar depression using tools like the Mood Disorder Questionnaire (MDQ) alongside EPDS or PHQ-9 are essential. Obstetricians play a key role in screening and initiating care when psychiatric services are limited, especially during high-risk postpartum periods.

Pharmacotherapy is the primary treatment for BD during pregnancy and lactation. Mood stabilizers like lithium and lamotrigine require careful dosing and monitoring due to pregnancy-related metabolic changes. While lithium carries a small risk of congenital heart defects, it remains effective with appropriate management. Lamotrigine is generally well-tolerated and safe. Second-generation antipsychotics are also used, with attention to weight and dose adjustments. Bright light therapy and electroconvulsive therapy provide effective adjunct options, particularly for treatment-resistant cases. Coordinated care and ongoing monitoring are essential to balance maternal mental health with fetal and neonatal safety.

Reference: Clark CT, Wisner KL. Treatment of Peripartum Bipolar Disorder. Obstet Gynecol Clin North Am. 2018 Sep;45(3):403-417. doi: 10.1016/j.ogc.2018.05.002. PMID: 30092918; PMCID: PMC6548543.

Researchers investigated the relationship between neuroinflammation and neuropsychiatric symptoms in individuals with bipolar disorder (BD), focusing on the hippocampus and cingulate regions of the brain. Previous research has shown peripheral inflammation markers in BD, but the connection to clinical symptoms remains unclear. This study explores the inflammatory profiles of specific brain regions, finding that neuropsychiatric symptoms correlate with increased levels of inflammatory cytokines, such as IL-1β and IL-6, in the hippocampus and cingulate. The findings suggest that neuroinflammatory changes in BD may directly influence clinical manifestations, with specific brain regions being differentially affected by inflammatory responses.

The results highlight the complexity of neuroinflammation in BD, showing that neuropsychiatric symptoms are linked to inflammatory markers in specific brain areas. Elevated levels of IL-6 and IL-1β in the hippocampus were associated with higher neuropsychiatric symptom scores. Correlations between these markers and cortisol levels suggest a connection between neuroinflammation and mood regulation in BD. These findings underscore the need for further research into neuroinflammation in BD to better understand its role in symptomatology and potentially inform more targeted treatments for the disorder.

Reference: Nascimento C, Villela Nunes P, Paraizo Leite RE, et al. The relationship of neuropsychiatric symptoms with inflammatory markers in the hippocampus and cingulate cortex of bipolar disorder subjects: A post-mortem study. J Psychiatr Res. 2024 May;173:25-33. doi: 10.1016/j.jpsychires.2024.03.001. Epub 2024 Mar 2. PMID: 38479345; PMCID: PMC11037553

A study explored whether familial risk for bipolar disorder and childhood-onset conditions like ADHD and anxiety contribute to distinct genetic profiles for mood disorder risk. The research followed 1065 participants, including 660 offspring of parents with bipolar disorder, using polygenic scores (PGS) to estimate genetic liability for conditions such as depression, bipolar disorder, ADHD, anxiety, neuroticism, and addiction. Mixed-effects and Cox regression models analyzed relationships between genetic profiles, childhood psychopathology, and mood disorder onset.

Results showed that in offspring of unaffected parents, higher PGS for ADHD and neuroticism were linked to ADHD and anxiety, respectively. Comorbid ADHD and anxiety increased PGS for neuroticism, ADHD, and bipolar disorder in the absence of familial risk. In offspring without familial risk, PGS for anxiety, depression, and neuroticism predicted mood disorder onset when ADHD and anxiety were present. PGS for addiction was also associated with mood disorder onset in those without familial risk. In offspring with familial risk, PGS for addiction predicted mood disorder onset only with comorbid ADHD and anxiety. These findings suggest a unique genetic basis for childhood-onset comorbidities in offspring with familial risk for bipolar disorder, contributing to mood disorder risk.

Reference: Freeman K, Zwicker A, Fullerton J, et al. Genetic contribution to developmental psychopathology in offspring with familial risk for bipolar disorder. Eur Neuropsychopharmacol. 2023;75(Suppl 1):S122. doi: 10.1016/j.euroneuro.2023.08.223.