Guidelines lay out strategies for maintenance treatment of bipolar I disorder, with an algorithm for pharmacologic and psychosocial interventions. Dr Suppes describes guideline recommendations and situations when you might need to vary from the algorithm.
When should you rely on top-ranked treatment options for acute bipolar mania, and when should you skip down to lower-ranked options? In this brief CME activity, expert Dr Suppes describes guideline recommendations and provides a case illustration.
Patients with severe mental illness tend to have a higher prevalence of metabolic disorders. This review updates the current evidence on the effectiveness of add-on medications to treat weight gain in patients with severe mental illness.
Since 2013, when DSM-5 was published, a third of the patients previously diagnosed with bipolar disorder no longer qualify as having the disorder. So what does this say about those who did meet the stricter DSM-5 criteria?
Treatment of severely depressed children at risk for bipolar disorder is challenging. Read about an 11-year-old girl with depression, suicidal ideation, and family history of bipolar disorder whose symptoms remitted after lithium monotherapy.
Family history plays an important role in bipolar disorder, with apparent polygenic interactions. This case report highlights the importance of monitoring family members of patients with bipolar disorder as a preventive strategy.
Women who take mood stabilizers have a greater risk of placenta-mediated pregnancy complications. But are the mood stabilizers themselves responsible for this higher risk? This study explores that question.
Given the similarity in clinical presentation between major depressive disorder (MDD) and the depressive episodes of bipolar disorder (BP), misdiagnoses occur too often. Read this Academic Highlights to learn to make an accurate differential diagnosis between MDD and BP while recognizing complexities related to not only psychiatric and medical comorbidities but also the evolving presentation of symptoms as the disorders progress.
Clozapine is essential for the management of treatment-refractory schizophrenia, but its use is often limited by side effects. Read this report of a man who developed dysarthria and delirium after receiving subtherapeutic doses of clozapine.
The prevalence of pediatric bipolar disorder is an ongoing topic of debate, and the body of research has grown in recent years. Read this article to learn about current prevalence and the factors that may affect prevalence.
Baclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit
To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1
First, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282; 320 patients, as with Bacloville), was negative (see Braillon et al2).
Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. As Ronald H. Coase warned, “If you torture the data long enough, it will confess.”