New anticonvulsant medication uses in bipolar disorder

Therapy of bipolar disorders is a rapidly evolving field. Lithium has efficacy in classic bipolar disorders whereas divalproex sodium and carbamazepine may have broader spectrum efficacy that includes non-classic bipolar disorder. In the last 10 years, a series of anticonvulsants have been approved for marketing in the United States. Gabapentin has indirect g-aminobuytric acid-ergic actions, is generally well tolerated, and appears to have anxiolytic, analgesic, and hypnotic effects. Lamotrigine has antiglutamatergic actions and is generally well tolerated (aside from rash in 1 in 10, and serious rash in 1 in 1,000 patients). Lamotrigine is indicated for maintenance treatment in bipolar disorder. Emerging evidence suggests lamotrigine may have utility in bipolar disorder patients with depression and treatment-refractory rapid cycling, as well as analgesic effects. Topiramate and zonisamide may allow both weight loss, while topiramate may have specific efficacy in bulimia, binge eating disorder, and alcohol dependence. Two small studies found oxcarbazepine had similar efficacy to lithium and haloperidol in acute mania. Phenytoin, an older anticonvulsant, may have adjunctive acute mania efficacy. Levetiracetam, a newer anticonvulsant, may be worth exploring and has minimal drug-drug interactions. None of these newer agents has been shown effective in a large placebo controlled trial for acute mania. Although the clinical profiles of these newer anticonvulsants do not appear to overlap markedly with divalproex and carbamazepine (except perhaps for oxcarbazepine), these novel agents may still offer important new options in relieving a variety of specific target symptoms in patients with bipolar disorder.     

The use of antiepileptic drugs in bipolar disorders: a review based on evidence from controlled trials

Antiepileptic drugs (AEDs) have diverse psychotropic profiles. Some AEDs have proven to be efficacious in the treatment of mood disorders, especially bipolar disorder. Others are ineffective as primary treatments but may be useful adjuncts for mood disorders or comorbid conditions. Valproate (acute mania and mixed episodes), carbamazepine (acute mania and mixed episodes), and lamotrigine (maintenance to delay recurrence) have United States Food and Drug Administration indications for the treatment of bipolar disorder. This article provides an overview of data on the use of AEDs in bipolar disorder, including acute mania and depression, prophylaxis, and rapid cycling.     

Reassessing carbamazepine in the treatment of bipolar disorder: clinical implications of new data

This monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions. Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight.) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.     

Group process in short-term outpatient therapy groups for schizophrenics

The short form of the group climate questionnaire (GCQ-S) was used to evaluate process in three 12-session therapy groups for outpatient schizophrenics. Results showed no difference on the Engaged dimension between the short-term schizophrenic groups and either a normative sample of outpatient neurotic groups or the first 26 sessions of a long-term outpatient schizophrenic group. However, the short-term groups scored significantly lower (p<.001) on the Avoiding and Conflict dimensions as compared with either long-term sample. The session-to-session GCQ-S dimension pattern did not support the presence of sequential group stages, but there was a tendency for the Engaged scores to increase and the Avoiding and Conflict scores to decrease as time went on.The authors gratefully acknowledge K. Roy MacKenzie, M.D., and Don Brown, M.D., for their helpful comments regarding this paper. Parts of this paper were presented in a poster session at the American Group Psychotherapy Association Annual Meeting in New York, February 8–12, 1988.     

生活医学化与健康恐慌的关系及其反思*--论Michael Fitzpatrick《健康的暴政：医生及生活方式的控制》

迈克尔·菲茨帕特里克的《健康的暴政：医生及生活方式的控制》一书,以健康干预为主线,以健康政治化、生活医学化、疾病道德化为主题,论述了生活医学化的不同方面和形成过程,并力图揭示医学化背后隐含着的医学对社会的干预和控制。其中作者关于生活医学化和健康恐慌的一些哲学思考,尤其是生活医学化与健康恐慌的内涵及特点、生活医学化与健康恐慌的关系以及对生活医学化的审视与反思,在一定程度上蕴涵着对当今社会发展的启示。     

Situation awareness as a function of frame of reference, computer-graphics eyepoint elevation, and geometric field of view

The purpose of this study was to determine how 3 variables for the design of a "heads-down" spatial display--the frame of reference (pilot's eye vs. God's eye), geometric field of view, and elevation of the computer graphics eyepoint--influenced situation awareness. Thirteen flight-naive subjects each flew a simulated F-16 over a computer-generated flight environment to lock onto and intercept a series of sequentially appearing targets. The flight scene consisted of both an "out-the-window" view and a computer-generated heads-down spatial display showing an airplane symbol superimposed on a perspective view of the flight environment. During the interactive phase of the experiment, root mean square flight-path error, target lock-on time, and target acquisition time were measured. After the interactive phase of the study was completed, subjects were required to mark the location of the targets from memory on a computer-generated top-down view of the flight scene in an attempt to reconstruct the spatial mental model which subjects formed of the flight environment. The results for the interactive phase of the study indicated that performance was superior using the pilot's-eye display. However, for the spatial reconstruction task, performance was better using the God's-eye display. It was also shown that the ability to maintain the optimal flight-path using the more top-down view of the scene (600 eyepoint) was superior to the 300 eyepoint elevation. Implications of the results for the design of spatial instruments are discussed.