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Bipolar disorder : the ultimate guide
\"The shocking truth is that one in fifty of us will have Bipolar Disorder at some point in our lives. If you, a friend or a family member, is diagnosed with Bipolar, or if you suspect that someone you know may have Bipolar, this book is a fantastic first port of call for advice and support. Written in a highly-accessible question and answer format, this comprehensive and compassionate guide draws on a broad range of expert opinion, the very latest research, and personal experience to explain what Bipolar Disorder is. Including numerous real-life case studies, a full list of support organisations and online resources, this book is designed to answer all your questions, from how to recognise the symptoms to how to explain to a child that their parent has been diagnosed.\" -- Provided by publisher.
Book
Probiotic Formulation for Patients With Bipolar or Schizophrenia Spectrum Disorder: A Double-Blind, Randomized Placebo-Controlled Trial
Abstract
Background and Hypothesis
Probiotic augmentation offers a promising treatment for bipolar disorder (BD) and schizophrenia spectrum disorder (SSD). By targeting microbiome deviations, they may improve both gut and brain health.
Study Design
In this double-blind, randomized, placebo-controlled trial with the multi-strain probiotic formulation Ecologic BARRIER, we aimed to improve psychiatric and cognitive symptoms, intestinal permeability, and gastrointestinal symptoms in patients with BD or SSD. A total of 131 patients were randomized 1:1 to receive either the probiotic supplement (n = 67) or a placebo (n = 64) for 3 months, in addition to treatment-as-usual. The primary outcomes were symptom severity assessed by the Brief Psychiatric Rating Scale and cognitive functioning by the Brief Assessment of Cognition in Schizophrenia.
Study Results
No significant effect of probiotics was observed on psychiatric symptoms, but borderline significant improvement was observed in the cognition category of verbal memory (Linear Mixed Model (LMM) 0.33; adjusted P = .059). Probiotics beneficially affected markers of intestinal permeability and inflammation, including zonulin (LMMserum = −18.40; adjusted P = .002; LMMfecal = −10.47; adjusted P = .014) and alpha-1 antitrypsin (LMM 9.26; adjusted P = .025). Indigestion complaints significantly decreased in male participants in the probiotics group (LMM = −0.70; adjusted P = .010). Adverse events were similar between groups.
Conclusions
Our study observed significant advantages of probiotics for gut health in BD and SSD, with excellent safety and tolerability. A borderline effect on verbal memory was also indicated. These results underscore the need for further research into microbiome-targeted interventions for patients with complex brain disorders.
Journal Article
Identifying, assessing, and treating bipolar disorder at school
\"Identifying, Assessing, and Treating Bipolar Disorder at School presents child and education practitioners with an evidence-based framework for accurate identification, assessment, and intervention of bipolar disorder. This straightforward resource clears up misconceptions about the condition, and outlines its complex presentation in young people, where it may appear in tandem with other disorders and bring challenges to treatment. By providing information to assist in referrals, consultations, and recommendations for special education, the authors give the reader a unique vantage point for improving students' learning environment and helping to facilitate the work of fellow professionals. Among the topics: Prevalence and associated conditions. Case finding, screening, and referrals. Diagnostic and psycho-educational assessment Treatment of bipolar disorder in children and adolescents. Plus suggested resources to assist students and their families. Identifying, Assessing, and Treating Bipolar Disorder at School is an essential reference for school psychologists and allied educational professionals, special education teachers, speech and language therapists, counselors, clinical child psychologists, and mental health practitioners\"--Back cover.
Book
Cognitive behavioural therapy in comparison to treatment as usual in young adults at high risk of developing bipolar disorder (Bipolar At Risk): a randomised controlled trial to investigate the efficacy of a treatment approach targeted at key appraisal change: Bipolar At Risk Trial II (BART II)
Background
Research has demonstrated the ability to identify and treat individuals at high risk of developing psychosis. It is possible to use a similar strategy to identify people who have an emergent risk of bipolar disorder (BD). Interventions during the early phase may improve outcomes and reduce risk of transition. Criteria have been established to identify individuals considered to be at high risk for developing BD, also known as Bipolar At Risk (BAR). Offering a psychological intervention may provide the possibility of prevention. Evaluating efficacy and the mechanisms by which this treatment works is now required.
Methods
A multicentre, rater-masked randomised controlled trial with two parallel arms will compare cognitive behaviour therapy (CBT) for young people meeting BAR criteria (CBT
BAR
) + Treatment as Usual (TAU) vs. TAU alone. Participants will be recruited from five National Health Service (NHS) sites in the UK. Outcome and mediational variables will be collected at baseline, 17-weeks (in treatment), 27-weeks (post-CBT
BAR
/TAU), and 52-weeks. Qualitative work will examine the perceived mechanisms of change and implementation of CBT
BAR
in the NHS.
Discussion
Our efficacy hypotheses are CBT
BAR
+ TAU (compared to TAU alone) will lead to improvement in mood swings, a reduction in the likelihood of transition to BD, and improvements to functioning and quality of life. Our mechanistic hypothesis is CBT
BAR
+ TAU causes improvement in mood swings due to the reduction of extreme positive and negative appraisals of internal states which in turn improves subsequent behaviours used to control mood and then internal states. Our trial will explore the perceived mechanism of change via this novel intervention (CBT
BAR
) and if the approach can be implemented within current services in the UK.
Trial registration/Status
The trial protocol is registered with
ISRCTN
(ISRCTN13363197, registered on 25th January 2023). Recruitment started in February 2023 and is ongoing.
Journal Article
Assessing the Causal Effects of Human Serum Metabolites on 5 Major Psychiatric Disorders
Psychiatric disorders are the leading cause of disability worldwide while the pathogenesis remains unclear. Genome-wide association studies (GWASs) have made great achievements in detecting disease-related genetic variants. However, functional information on the underlying biological processes is often lacking. Current reports propose the use of metabolic traits as functional intermediate phenotypes (the so-called genetically determined metabotypes or GDMs) to reveal the biological mechanisms of genetics in human diseases. Here we conducted a two-sample Mendelian randomization analysis that uses GDMs to assess the causal effects of 486 human serum metabolites on 5 major psychiatric disorders, which respectively were schizophrenia (SCZ), major depression (MDD), bipolar disorder (BIP), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Using genetic variants as proxies, our study has identified 137 metabolites linked to the risk of psychiatric disorders, including 2-methoxyacetaminophen sulfate, which affects SCZ (P = 1.7 × 10–5) and 1-docosahexaenoylglycerophosphocholine, which affects ADHD (P = 5.6 × 10–5). Fourteen significant metabolic pathways involved in the 5 psychiatric disorders assessed were also detected, such as glycine, serine, and threonine metabolism for SCZ (P = .0238), Aminoacyl-tRNA biosynthesis for both MDD (P = .0144) and ADHD (P = .0029). Our study provided novel insights into integrating metabolomics with genomics in order to understand the mechanisms underlying the pathogenesis of human diseases.
Journal Article
Unshrunk : a story of psychiatric treatment resistance
\"The powerful memoir of one woman's experience with psychiatric diagnoses and medication, and her journey to discover her true self outside the mental health system At age thirteen, Laura Delano's parents brought her to her first psychiatrist who quickly diagnosed her with bipolar disorder and started her on a treatment of psychiatric drugs. At school, Delano was the model student, earning straight-As, a national squash ranking, and elected president of her class; at home, she unleashed all the rage she felt, lashing out at her family and locking herself in her bedroom, contemplating her death. Delano's initial bipolar diagnosis marked the beginning of a life-altering saga. For the next fourteen years, she sought treatment at the country's best psychiatric hospitals, collected an expanding catalog of diagnoses, and was prescribed a medication cascade of twenty-one drugs. Delano welcomed the pharmaceutical regimen in the hopes that it would bring her stability, peace, and treatment for what she'd been convinced was an incurable, lifelong disease. But as her symptoms became more severe and untenable, and eventually deemed \"treatment resistant,\" she started to wonder if the drugs she was prescribed were contributing to her illness. After years of being an obedient patient, Delano made the radical decision to uncover her baseline-the unadulterated state-of-being where she could experience the full intensity of feelings that she'd never truly known: happiness, sadness, anger, desire, and joy. It was a decision that would require her to leave behind the diagnoses and the drugs, all she had known for the better part of her life. Weaving Delano's medical records and doctors' notes from her time in treatment with illuminating research on the drugs she was prescribed, Unshrunk questions the dominant, rarely critiqued role that the American mental health industry, and the pharmaceutical industry in particular, plays in shaping what it means to be human\"-- Provided by publisher.
BOOK
Bipolar Disorder
Bipolar disorder has a yearly prevalence of 2%. Other mental and physical conditions occur with bipolar disorder, which is also associated with an increased risk of suicide. Treatment is complex and relies on lithium or intermittent use of antipsychotic drugs.
Journal Article
A phase 2a randomised, double-blind, placebo-controlled, parallel-group, add-on clinical trial of ebselen (SPI-1005) as a novel treatment for mania or hypomania
RationaleLithium is an effective prophylactic and anti-manic treatment in bipolar disorder; however, its use is declining through perceived poor tolerance and toxicity. Lithium inhibits inositol monophosphatase (IMPase), a probable key therapeutic mechanism. The anti-inflammatory drug, ebselen, also inhibits IMPase and appears well-tolerated and safe.ObjectivesTo assess the efficacy of adjunctive ebselen in mania using the Young Mania Rating Scale (YMRS) (primary outcome) and the Altman Self-Rating Mania (ASRM) Scale and Clinical Global Impression-Severity Scale (CGI-S) among the secondary outcomes.MethodsRandomised, double-blind, placebo-controlled, parallel-group trial conducted between October 2017 and June 2019, at Oxford Health NHS Foundation Trust. Pharmacy-controlled randomisation was computer-generated, with full allocation concealment. In/outpatients (n = 68) aged 18–70, experiencing mania or hypomania, were assigned to 3 weeks ebselen (600 mg bd) (n = 33) or placebo (n = 35). Participants received usual clinical care and psychotropic medication.ResultsEbselen was numerically, but not statistically, superior to placebo in lowering scores on the YMRS (adjusted mean difference and 95% confidence interval, − 1.71 (− 5.34 to 1.91), p = 0.35) and ASRM (− 1.36 (− 3.75 to 1.17), p = 0.29). However, scores on the CGI-S were significantly lower at week 3 in ebselen-treated participants (adjusted mean difference, − 0.58 (− 1.14 to − 0.03), p = 0.04). A post hoc analysis excluding patients taking concomitant valproate treatment magnified the difference between ebselen and placebo on the YMRS. Adverse events were comparable between groups, and mild.ConclusionsEbselen merits further investigation where concomitant psychotropic medication is better controlled and participants taking valproate are excluded. If effective, ebselen’s superior tolerance and safety could make it a useful alternative to lithium.Trial registrationTrial Registry: www.clinicaltrials.gov, Identifier: NCT03013400.
Journal Article