THIRD INTERNATIONAL CONFERENCE 
ON BIPOLAR DISORDER

The Use of Medications in Bipolar Women During Pregnancy and Postpartum

Lori Altshuler, M.D.
Bibliography

Slide Presentation

Abstract
Although pregnancy has typically been viewed as a time of emotional well-being, recent data do not substantiate this optimistic view for women with bipolar disorder. In this talk, the literature will be reviewed for the natural history of bipolar disorder, specifically, the course of bipolar illness in pregnancy. The potential risks to mother and fetus of untreated psychiatric illness during pregnancy will be reviewed. Risk factors associated with worsening of psychiatric illness in pregnancy will be discussed. Decision-making guidelines regarding whether or not to discontinue medications during pregnancy will be presented. Impact of mood stabilizing medication on reproductive status will also be included.

We will review the potential teratogenicity of each class of psychotropic medication, as well as the treatment dilemmas and options of prescribing psychotropic medications to the pregnant patient. We will also cover the three major postpartum psychiatric syndromes (postpartum blues, depression and psychosis). Likelihood of postpartum recurrence after one postpartum event will be reviewed and prophylactic strategies will be covered.

Complex Bipolarity: Temperament, Anxious Comorbidity, and Mixed States

Hagop S. Akiskal, M.D.
Bibliography

Abstract
The two phases of bipolar disorder in their most "typical" expressions consist of retarded depression and euphoric mania. Since antiquity it has been known that the illness may take more complex expressions in at least 50% of cases, and these are variations on the theme of mixed states, which represent various admixtures of mania and depression. Officially, mixed states, constitute simultaneous manic and full-blown depressive states, so-called dysphoric mania; however, Kraepelin had described anxious manic states as well. There also exists full-blown depressive states with subthreshold manic or hypomanic symptoms, often agitated, irritable and anxious. More formally diagnosable panic, social phobic and obsessional disorders may also co-exist with mixed states, particularly those from a bipolar II base. Recent research indicates that temperamentally many of these conditions arise from an unstable cyclothymic temperamental baseline. In addition, dysphoric mania often represents intrusion of mania into a depressive temperament (especially women), while depressive mixed states represent intrusions of a depressive state into a hyperthymic temperament. Substance and/or alcohol abuse often complicates mixed states, producing even greater degrees of complexity.

Akiskal HS, Hantouche EG, Bourgeois, JM, et al.: Gender, temperament and the clinical picture in dysphoric mixed mania. J Affect Disord 50: 175-186, 1998.

Perugi G. Akiskal HS, Ramacciotti S, et al,: Depressive comorbidity of panic, social phobic, and obsessive-compulsive disorders re-examined: is there a bipolar II connection? J Psychiatr Res 33: 53-61, 1999.

The Impact of Substance Abuse on the Course and Treatment of Bipolar Disorder

Michael E. Thase, M.D.
Bibliography

Abstract
At least one-third of all people with bipolar affective disorder have a comorbid substance abuse disorder and among some subgroups, such as younger men, the rates of concomitant alcohol or drug abuse exceed 50%. Substance abuse complicates the natural history of bipolar disorder and worsens response to standard pharmacotherapies. Moreover, substance abuse may increase the risks of suicide and development of medical and neurological complications. Although much is known about the hazards of drug and alcohol abuse, more refined knowledge about treatment approaches has been thwarted by the systematic exclusion of comorbid patients from clinical research studies. It is suggested that both traditional psychiatric and chemical dependence approaches to treatment of the comorbid bipolar patient are inadequate and fail to address the complexity of the problems. Thus, an optimized treatment regimen consisting of pharmacotherapy, specifically tailored chemical dependence counseling, family psychoeducation, and appropriate self-help activities (i.e., "double-trouble" groups) may be needed to stabilize this potentially devastating comorbid disorder. It is now incumbent upon the field to demonstrate that such a labor-intensive treatment approach is indeed cost-effective.

Top of Page