Key Points A “kindling hypothesis” of mood instability led to the search for anticonvulsant medications that might improve the course of illness in bipolar disorder (BPD). Divalproex sodium (valproate) and carbamazepine (in extended-release form) are effective in the treatment of…
Key Points Lithium remains a first-line treatment for all phases of bipolar disorder, including mania, depression, and prevention of recurrence. While not examined in a controlled trial, abundant evidence supports a role for lithium in decreasing the risk of suicide.…
Key Points All antipsychotics share dopamine 2 blockade as the presumed main mechanism of action. Primary symptom targets of antipsychotics are positive symptoms (disorganization, delusions, and hallucinations) and agitation; their efficacy for negative symptoms and cognitive deficits of schizophrenia is…
Key Points A variety of pharmacological agents are effective for the treatment of anxiety disorders. The SSRIs and SNRIs are first-line pharmacological agents for the treatment of anxiety disorders. Benzodiazepines are effective, rapidly acting and well-tolerated, but are associated with…
Key Points Incidence The lifetime prevalence of bipolar disorders is approximately 2%. Epidemiology Bipolar disorder is associated with significant morbidity, including functional impairment, as well as significant risk for suicide. Clinical Findings Diagnosis of bipolar disorder rests on establishing current…
Key Points Background Treatment-resistant depression (TRD) refers to an inadequate response to at least one antidepressant given in sufficient doses and for an appropriate duration. History Despite the recent advances in treatment of depression, only 30%–40% of patients achieve remission…
Key Points The immediate mechanism of action of modern antidepressants (“immediate effects”) involves influencing the function of one or more monoamine neurotransmitter systems (serotonin, norepinephrine [noradrenaline], or dopamine). Influencing monoaminergic function has been shown to result in several changes in…
Key Points Background Among patients with a psychiatric illness, treatment adherence is associated with better treatment outcomes, a lower risk of relapse and hospitalization, and better adherence to treatments for co-morbid medical illnesses. However, barriers to adherence are common and…
Key Points One can approach the study of the brain and its pathophysiology from various perspectives with different levels of resolution: molecular, genetic, cellular, synaptic, systems, and behavioral. Pathological processes and therapeutic interventions can target one or more of these…