The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.

/pdf/canadian-network-for-mood-and-anxiety-treatments-canmat-and-2qkz8pbmtg.pdf

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.

Diagnostic and Statistical Manual of Mental Disorders, 4th ed

Schizophrenia, “just the facts” 4. Clinical features and conceptualization

The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.

/pdf/canadian-network-for-mood-and-anxiety-treatments-canmat-and-2s1irfxih8.pdf

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.

https://gwern.net/docs/modafinil/2008-minzenberg.pdf

Modafinil: A Review of Neurochemical Actions and Effects on Cognition

Mania in a boy treated with modafinil for narcolepsy.

Validation of the Pediatric Catatonia Rating Scale (PCRS)

Compared to the large number of studies exploring difficulties in emotion recognition in maltreated children, few (N=12) have explored the cognitive aspect of theory of mind, i.e., the ability to understand others’ thoughts and intentions. A systematic review of these studies shows inconsistent results regarding cognitive theory of mind tasks. Youths with a history of maltreatment are more likely to fail at false belief tasks (N=2). However, results are less conclusive regarding other tasks (perspective-taking tasks, N=4; and hostile attribution tasks, N=7). Additionally, only one study controlled for potential psychopathology. Measures of psychopathology and other cognitive abilities, in addition to theory of mind, are required to establish a specific association between maltreatment and the cognitive dimension of theory of mind.

/pdf/a-systematic-review-of-the-evidence-for-impaired-cognitive-2mo2h77vtf.pdf

A Systematic Review of the Evidence for Impaired Cognitive Theory of Mind in Maltreated Children

Objectives: To assess the effect of age at onset on the phenomenology of Cotard's syndrome (CS) as a recent study reported a high rate of occurrence of bipolar disorder (BD) in adolescents and young adults with CS followed up for ≥2 years.

Methods:  We reviewed all cases of CS reported since it was first described. A statistical analysis was carried out to determine the effect of age at onset on CS phenomenology.

Results:  We found 138 cases including 21 cases aged 25 years or younger. In these younger CS patients, BD was more frequent, and the risk of associated BD was increased nine times (p < 0.0001). Within the BD sub-group (n = 27), admixture analysis identified two sub-groups with mean ages at onset of 18.7 years [standard deviation (SD) = 3.2] and 50.5 years (SD = 11.7).

Conclusions:  Young people with CS should be monitored carefully for the onset of BD, and families should be educated about this risk. Treatment with mood stabilizers can be helpful for those who develop BD. Within BD associated with CS, early versus late onset should be distinguished.

http://speapsl.aphp.fr/pdfpublications/2007/2007-7.pdf

Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder

The existence of bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children is more controversial. We reviewed the literature on acute and prophylactic treatment of bipolar disorder in youths. The guidelines for the treatment of bipolar disorder in children and adolescents are generally similar to those applied in adult practice. But no evidence-based data support the use of mood stabilisers or antipsychotics since we only found two placebo-randomised controlled trials testing the efficacy of lithium in the paediatric literature. Therefore, we support the view that prescriptions should be limited to the most typical cases. In fact, the use of mood stabilisers or antipsychotics in the treatment of bipolar disorder in children and adolescents appears to be of limited use when a comorbid condition, such as attention deficit hyperactivity disorder, occurs unless aggressive behaviour is the target symptom.

Angèle Consoli

Papers

Mania in a boy treated with modafinil for narcolepsy.

Validation of the Pediatric Catatonia Rating Scale (PCRS)

A Systematic Review of the Evidence for Impaired Cognitive Theory of Mind in Maltreated Children

Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder

Treatments in child and adolescent bipolar disorders