PubMed Health⌕ Search

Biomedical subjects

S M Strakowski

Publications and source records attributed to S M Strakowski.

At least 73 records · Page 4Linked to original sources
PubMed1998

Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization.

BACKGROUND: Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization. METHOD: Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded. RESULTS: The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated. CONCLUSION: The obsessive-compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted.

Adult↗
PubMed1998

Anticonvulsants and antipsychotics in the treatment of bipolar disorder.

A number of recent advances in clinical psychopharmacology regarding anticonvulsant and new antipsychotic medications have important implications with respect to the treatment of patients who have bipolar disorder. The authors reviewed the available literature on the efficacy of the anticonvulsants valproate, carbamazepine, gabapentin, and lamotrigine for the treatment of bipolar disorder. They also reviewed the use of standard and new antipsychotic medications for the treatment of various aspects of the illness. Valproate and carbamazepine have been shown to be effective in the treatment of acute mania in controlled trials. Preliminary data suggest that these agents may differ in their time course of antimanic activity and predictors of response. Neither agent has been extensively studied in controlled trials in bipolar depression or as maintenance therapy, although carbamazepine has received the most systematic study in these areas. Gabapentin and lamotrigine are only now being evaluated in controlled trials in patients who have bipolar disorder. Antipsychotics are commonly used in the treatment of patients with acute mania and as maintenance treatment. However, the use of standard antipsychotics in acute mania is associated with a number of limitations. New antipsychotic agents may possess thymoleptic as well as antipsychotic activity, but they have not been studied in controlled trials in bipolar disorder.

Acetates↗
PubMed1997

Lack of enhanced response to repeated d-amphetamine challenge in first-episode psychosis: implications for a sensitization model of psychosis in humans.

Behavioral sensitization is the process whereby intermittent stimulant exposure produces a time-dependent, enduring, and progressively more robust behavioral response. This process serves as a model for the development of psychosis, but has been little studied in humans. The authors report results from a double-blind, placebo-controlled study of repeated d-amphetamine challenges in 13 patients with first-episode manic or schizophrenic psychosis. Each patient received two daily doses of d-amphetamine (0.25 mg/kg) separated by 48 hours that alternated with two daily doses of matched placebo. Symptoms (activity/energy level, mood, rate and amount of speech, and severity of psychosis) and eye-blink rates were measured hourly for 5 hours following drug administration. In contrast to results from previous work in normal volunteers, none of the measures demonstrated the progressive increase following the second amphetamine dose as compared to the first dose that characterizes sensitization. These results suggest that patients with psychosis are already maximally sensitized, so cannot exhibit progressive behavioral enhancement following repeated stimulant challenges, or that patients with psychosis do not sensitize.

Adult↗
PubMed1997

Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder.

OBJECTIVE: Although available data suggest that bipolar disorder most commonly begins in adolescence, it has often been underrecognized and misdiagnosed in this age group. The authors hypothesized that this might in part be because adolescent mania is phenomenologically different from adult mania. To test this hypothesis, they compared a cohort of adolescents hospitalized for acute mania with a group of hospitalized acutely manic adults. METHOD: The authors compared symptomatic differences between 40 adolescent (ages 12-18 years) and 88 adult (ages 19-45 years) bipolar patients hospitalized for acute mania. They also compared the two groups with respect to demographic characteristics, psychiatric comorbidity, family history, and short-term outcome. RESULTS: Compared with adults, adolescent patients displayed a significantly higher rate of mixed bipolar disorder and a significantly lower rate of psychotic features (by DSM-III-R criteria), as well as higher ratings for many depressive symptoms (including suicidality and depressed mood) and lower ratings for thought disorder and delusions. Adolescents also displayed a significantly lower rate of substance abuse and significantly higher rates of familial mood disorder and drug abuse or dependence. CONCLUSIONS: Significant differences were found in the phenomenology of adolescent and adult mania in this study. The reasons for these differences are not known. Possible explanations include artifact due to methodological limitations and differences between adolescents and adults in familial loading for mood or substance use disorders or in developmental or maturational stage.

Acute Disease↗
PubMed1997

Comparison of patients with early-, typical-, and late-onset affective psychosis.

OBJECTIVE: The authors compared the clinical characteristics and family history of patients with early-onset (before age 18), typical-onset (at 20-25 years), and late-onset (after age 35) affective psychosis at the time of first hospitalization. METHOD: Diagnostic, symptom, and family history information was obtained from 88 consecutively hospitalized patients. RESULTS: Major depression was more common in the late-onset group, and a family history of affective and substance abuse disorders was more common among the early-onset patients. Affective symptoms differed significantly among groups; specifically, early-onset patients had more energy, minimal sleep disruption, and greater suicidality, while typical-onset patients had more severe abnormal thought content. CONCLUSIONS: Among patients with affective psychosis, there may be heterogeneity of symptoms and family history associated with age at first hospitalization.

Adolescent↗
PubMed1997

The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis.

BACKGROUND: Previously, we reported that patient race was associated with disagreement between research and clinical diagnoses. To extend this work, we studied whether disagreement was specifically due to associations of patient race with information or criterion variance. METHOD: Ninety-nine patients consecutively admitted through the University of Cincinnati Psychiatric Emergency Service (PES) for a first hospitalization for psychosis were evaluated using the Structured Clinical Interview for DSM-III-R. Diagnoses made in the PES were compared with those obtained from the structured interview. We examined the contributions of information variance and criterion variance to the association between race and diagnostic agreement of PES and research diagnoses. RESULTS: Agreement in PES and research diagnoses was present in only 42% of patients. Diagnostic agreement was less common in non-white patients than white patients, even after controlling for other sociodemographic and clinical variables. Information variance was the cause of diagnostic disagreement in 58% of cases and was associated with patient race. Criterion variance, occurring in 42% of cases, was not associated with race. CONCLUSION: Patient race may contribute to the diagnostic process in the psychiatric emergency service by influencing the information obtained from patients during clinical evaluations.

Emergency Services, Psychiatric↗
PubMed1997

Compliance with maintenance treatment in bipolar disorder.

Studies of compliance with pharmacologic treatment in patients with bipolar disorder have primarily involved outpatients receiving lithium. To date, very little data addresses the rates of noncompliance in patients with bipolar disorder treated with other available mood stabilizers (e.g. divalproex, carbamazepine). One hundred and forty patients initially hospitalized for a bipolar disorder, manic or mixed episode, were evaluated prospectively over 1 year to assess their compliance with pharmacotherapy. Compliance was assessed by a clinician-administered questionnaire, using information from the patient, treaters, and significant others. Seventy-one patients (51%) were partially or totally noncompliant with pharmacologic treatment during the 1-year followup period. Noncompliance was significantly associated with the presence of a comorbid substance use disorder. Denial of need was the most common reason cited for noncompliance. Compliance was associated with being male and Caucasian and with treatment with combined lithium and divalproex or with this combination and an antipsychotic. Noncompliance with pharmacotherapy remains a substantial problem in the treatment of patients with bipolar disorder.

Adult↗
PubMed1996

Enhanced response to repeated d-amphetamine challenge: evidence for behavioral sensitization in humans.

Behavioral sensitization is the process whereby intermittent stimulant exposure produces a time-dependent, enduring, and progressively more robust behavioral response. This process serves as an important model of neural plasticity and has also been proposed as a model for a variety of psychiatric syndromes; however, there are no published controlled studies of behavioral sensitization in human subjects. The authors report results from a double-blind, placebo-controlled study of repeated d-amphetamine challenges in a sample of normal human volunteers. Eleven consecutively recruited normal volunteers participated in this 4-day protocol. Each subject received two daily doses of d-amphetamine (0.25 mg/kg) separated by 48 hours that alternated with two daily doses of matched placebo. Symptoms (activity/energy level, mood, rate, and amount of speech) and eye-blink rates were measured hourly for 5 hours following drug administration. All four measures demonstrated significantly enhanced increases following the second amphetamine dose as compared to the first amphetamine dose and both placebo conditions. These findings suggest that behavioral sensitization is measurable in human subjects.

Administration, Oral↗
PubMed1996

Personality disorders in first- and multiple-episode mania.

We compared rates of DSM-III-R personality disorders in 33 first-episode and 26 multiple-episode bipolar patients. Patients were evaluated with the patient and personality disorders versions of the Structured Clinical Interview for DSM-III-R. Significantly more multiple-episode patients (65%) met DSM-III-R criteria for a personality disorder than did first-episode patients (33%). Race was also associated with a diagnosis of a personality disorder. Personality disorders may be associated with multiple affective episodes in bipolar patients.

Adult↗
PubMed1996

Racial differences in the diagnosis of psychosis.

In clinical populations, it has been reported that African-American patients are more likely to receive a diagnosis of schizophrenia than similar Caucasian patients. Factors contributing to this racial discrepancy are poorly defined. The authors examined the hypothesis that racial differences in severity of first-rank symptoms of schizophrenia contribute to this diagnostic difference. Patients were recruited as part of the DSM-IV Field Trial for Schizophrenia and Other Psychotic Disorders, and evaluated using a structured rating instrument. Symptom and diagnostic comparisons were performed between black and white patients. Black patients were significantly more likely than white patients to be diagnosed with schizophrenia and less likely with psychotic depression. Racial differences in symptom profiles were observed with black patients demonstrating more severe psychotic symptoms, in general, and first-rank symptoms, specifically. There were no racial differences in rates of affective syndromes or severity of affective symptoms. Racial disparity in diagnosis of psychotic patients may be in part secondary to more severe first-rank symptoms in black patients, causing clinicians to stray from DSM-III-R criteria.

Adult↗
PubMed1996

Racial influence on diagnosis in psychotic mania.

In a sample of 100 patients with psychotic mania, we examined whether African-Americans were more likely than Caucasians to present with Schneiderian first-rank symptoms, potentially contributing to a misdiagnosis of schizophrenia. In this sample, African-American patients were significantly more likely than Caucasian patients to have received a clinical diagnosis other than bipolar or schizoaffective disorder. There were no racial differences in affective symptoms, but there were differences in psychotic symptom profiles, primarily due to increased hallucinations in African-Americans and increased persecutory delusions in Caucasians. Racial differences in the clinical diagnosis of patients with mania were not due to differences in symptomatic expression, however.

Adolescent↗
PubMed1996

Suicidality among patients with mixed and manic bipolar disorder.

OBJECTIVE: Patients with mixed or manic bipolar disorder were studied to determine whether suicidality in mania is associated with increasing depression in general (i.e., a dimensional construct based on symptom severity) or with the presence of a mixed state per se (i.e., a categorical construct requiring the presence of a full depressive syndrome). METHOD: Diagnostic (categorical) assessments of 91 consecutively hospitalized patients with DSM-III-R mixed or manic bipolar disorder were made by using the Structural Clinical Interview for DSM-III-R. Symptom (dimensional) assessments were made by using the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Scale of the Assessment of Positive Symptoms. Logistic regression models were employed to test the relative associations between suicidality and dimensional and categorical depression measures. Receiver operating characteristics analysis was performed to identify a potential threshold depression rating that predicted suicidality. RESULTS: Suicidality was more common in mixed than manic bipolar disorder. However, when adjusted for total depression scores, this association with affective state did not persist, but the statistical model significantly improved. In the improved model, depressive symptom ratings were significantly associated with suicidality. Hamilton depression scale ratings greater than 18 identified over 90% of the patients with suicidality, although there was also a high rate of false positives (32%). CONCLUSIONS: It is the severity of concurrent depressive symptoms in mania, rather than the presence of a depressive syndrome per se (i.e., mixed state), that is associated with suicidality in bipolar patients.

Adolescent↗
PubMed1996

Relationships among negative, positive, and depressive symptoms in schizophrenia and psychotic depression.

BACKGROUND: We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis. METHOD: Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms. RESULTS: Analyses revealed the depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group. CONCLUSIONS: Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.

Adolescent↗
PubMed1996

A randomized comparison of divalproex oral loading versus haloperidol in the initial treatment of acute psychotic mania.

BACKGROUND: Uncontrolled evidence suggests that divalproex administered via the oral loading strategy of 20 mg/kg/day may produce clinically significant antimanic response within 3 days of treatment in some patients. We conducted a prospective study to compare the antimanic response of divalproex oral loading with that of haloperidol in the initial treatment of acute psychotic mania. METHOD: After a < or = 1-day screening period, 36 consecutive hospitalized patients with bipolar disorder, manic or mixed phase and with psychotic features, were randomly assigned to receive either divalproex 20 mg/kg/day or haloperidol 0.2 mg/kg/day for 6 full days, without other psychotropic agents except lorazepam up to 4 mg/day for management of agitation. Serum valproate concentrations were measured after 1 day of treatment. Response was measured daily by a blind rater using the Young Mania Rating Scale and the Scale for Assessment of Positive Symptoms. RESULTS: Divalproex oral loading and haloperidol were equally effective in acutely reducing manic and psychotic symptoms. The greatest rate of improvement for both drug regimens occurred over the first 3 full days of treatment. Side effects were infrequent and minor for both treatments, except for extrapyramidal side effects which were significantly more common with haloperidol. CONCLUSION: Divalproex oral loading may produce rapid onset of antimanic and antipsychotic response comparable to that of haloperidol and with minimal side effects in the initial treatment of acute psychotic mania in a subset of bipolar patients.

Acute Disease↗
PubMed1996

Factors associated with maintenance antipsychotic treatment of patients with bipolar disorder.

BACKGROUND: Although recent surveys suggest that a substantial number of patients with bipolar disorder receive maintenance treatment with antipsychotic agents, little is known about the clinical factors associated with such treatment in this patient population. The purpose of this study was to identify clinical factors associated with maintenance antipsychotic treatment in patients with bipolar disorder. METHOD: Seventy-seven patients who had bipolar disorder and were hospitalized for acute manic or mixed episodes were evaluated according to demographic, diagnostic, illness severity, treatment, and compliance variables at admission and at follow-up 6 months after discharge to determine differences between patients receiving ongoing antipsychotic medications and those maintained on thymoleptics alone. RESULTS: Fifty-two patients (68%) continued to receive antipsychotics 6 months after discharge. Maintenance antipsychotic treatment at 6-month follow-up was associated with being male, medication noncompliance in the month prior to the index hospitalization, severity of manic symptoms, and prescription of antipsychotic medication at time of discharge. CONCLUSION: Despite the risks of neurologic and behavioral side effects associated with protracted antipsychotic treatment and the availability of agents with mood-stabilizing properties such as lithium, valproate, and carbamazepine, antipsychotic maintenance treatment of bipolar disorder is common and associated with several important clinical factors.

Adult↗
PubMed1996

Mania, psychosis, and antipsychotics.

Although psychotic symptoms often occur in the manic phase of bipolar disorder, psychotic mania has been and continues to be frequently misdiagnosed as schizophrenia or other psychotic illnesses. In addition, the role of antipsychotic agents in the acute and maintenance treatment of psychotic mania remains unclear. In this paper, we present an overview of studies of psychosis in mania. We also review studies of conventional and newer antipsychotic agents in the acute and maintenance treatment of psychotic mania to help clarify the role of these agents in treating this illness.

Adolescent↗
PubMed1996

Factors associated with pharmacologic noncompliance in patients with mania.

BACKGROUND: Studies of noncompliance with pharmacotherapy in bipolar disorder have primarily involved outpatients receiving lithium. There are limited data to date regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder hospitalized for recurrent mania. Similarly, the influence of race, illness phenomenology, and comorbid psychiatric and medical disorders and the treatment with antipsychotics, antidepressants, and mood-stabilizing agents other than lithium on noncompliance in this population have not been systematically examined. METHOD: Patients hospitalized for acute mania (N = 101) were evaluated by the Structured Clinical Interview for DSM-III-R to establish diagnosis and comorbidity and the Young Mania Rating Scale and Hamilton Rating Scale for Depression to assess severity of manic and depressive symptoms, respectively. Compliance was assessed by responses to a clinician-administered questionnaire administered to the patient, treaters, and significant others and by admission plasma concentrations of mood-stabilizing agents. RESULTS: Sixty-five patients (64%) were noncompliant with their pharmacologic regimen in the month prior to admission as defined by criteria for full compliance and partial or total noncompliance. Noncompliance was significantly associated with greater severity of mania upon admission (p = .02) and treatment with combinations of mood stabilizers (p = .01). CONCLUSION: Noncompliance with pharmacotherapy was present in the majority of patients admitted for acute mania and was associated with greater severity of mania upon admission and treatment with combinations of mood stabilizers.

Acute Disease↗