Bipolar Disorder: Sharma V

Yatham LN, Kennedy SH, O'Donovan C, Parikh SV, MacQueen G, McIntyre RS, Sharma V, Beaulieu S, Anonymous00162. · Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada. · Bipolar Disord. · Pubmed #17156158 No free full text.

Abstract: In 2005, the Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder. This update reviews new evidence since the previous publication and incorporates recommendations based on the most current evidence for treatment of various phases of bipolar disorder. It is designed to be used in conjunction with the 2005 CANMAT Guidelines. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate and several atypical antipsychotics continue to be recommended as first-line treatments for acute mania. For the management of bipolar depression, new data support quetiapine monotherapy as a first-line option. Lithium and lamotrigine monotherapy, olanzapine plus selective serotonin reuptake inhibitors (SSRI), and lithium or divalproex plus SSRI/bupropion continue to remain the other first-line options. First-line options in the maintenance treatment of bipolar disorder continue to be lithium, lamotrigine, valproate and olanzapine. There is recent evidence to support the combination of olanzapine and fluoxetine as a second-line maintenance therapy for bipolar depression. New data also support quetiapine monotherapy as a second-line option for the management of acute bipolar II depression. The importance of comorbid psychiatric and medical conditions cannot be understated, and this update provides an expanded look at the prevalence, impact and management of comorbid conditions in patients with bipolar disorder.

Yatham LN, Kennedy SH, O'Donovan C, Parikh S, MacQueen G, McIntyre R, Sharma V, Silverstone P, Alda M, Baruch P, Beaulieu S, Daigneault A, Milev R, Young LT, Ravindran A, Schaffer A, Connolly M, Gorman CP, Anonymous00076. · Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. · Bipolar Disord. · Pubmed #15952957 No free full text.

Abstract: Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring.

Sharma V. · Mood and Anxiety Program, Regional Mental Health Care, London, Ontario, Canada. · Can J Clin Pharmacol. · Pubmed #19164845 links to  free full text

Abstract: The spectrum of bipolar disorder (BPD) includes BP I, BP II, and BP not otherwise specified(NOS). The latter two conditions are thought to have a combined lifetime prevalence of 3.5%compared to a prevalence rate of 1.0% for BP I.Despite the combined high prevalence of BP II and BP NOS, surprisingly little is known about the course and treatment of these disorders during pregnancy and the postpartum period. Brief hypomanic symptoms occur in the early puerperium in as many as 15% of women, and there is preliminary evidence that postpartum depression in some patients may be related to BP II or BP NOS. Yet there is paucity of data on the acute, and maintenance treatment of major depressive episodes during pregnancy in women with BP II and BP NOS. And there are no psychopharmacological studies on the acute or maintenance treatment of bipolar postpartum depression to guide clinical decision making. Also, there is a lack of screening instruments designed specifically for use before or after delivery in women with suspected bipolar disorder. This paper reviews the current literature on the diagnosis, and treatment of BP II and BP NOS during pregnancy and in the postpartum period and makes recommendations for the detection and treatment of these disorders.

Sharma V. · University of Western Ontario, London, Ontario, Canada. · Curr Drug Saf. · Pubmed #18690984 No free full text.

Abstract: Postpartum psychosis is a rare but serious psychiatric illness that follows delivery. Although controversy continues to surround its diagnostic status, it is generally considered an episode of bipolar disorder with accompanying psychotic features. The consequences of untreated postpartum psychosis can be serious due to the associated risk of suicide and infanticide; however, its close temporal association with childbirth should provide an opportunity to undertake prophylactic measures in women at risk for developing postpartum psychosis. This article reviews the literature concerning acute and prophylactic pharmacological treatment and suggests a comprehensive approach for management of postpartum psychosis.

Sharma V. · Mood Disorders Program, Regional Mental Health Care London, Department of Psychiatry, University of Western Ontario, London, Ontario, Canada. · Bipolar Disord. · Pubmed #14700012 No free full text.

Abstract: Globally, a million people commit suicide every year, and 10-20 million attempt it. Mood disorders, especially major depressive disorder (MDD) and bipolar disorder, are the most common psychiatric conditions associated with suicide. Primary (psychiatric and physical illness), secondary (psychosocial), and tertiary (demographic) risk factors for suicide have been identified. Comorbid psychiatric illness, particularly anxiety symptoms or disorders, significantly increase the risk of suicidal behavior. Current standard risk assessments and precautions may be of limited value, while assessing the severity of anxiety and agitation may be more effective in identifying patients at risk. Lithium is the medication that has most consistently demonstrated an antisuicidal effect. The effects of antidepressants and conventional antipsychotics on suicide risk are uncertain, but atypical antipsychotics appear promising. Atypical antipsychotics have beneficial effects on depressed mood both in patients with MDD and in patients with bipolar disorder. In addition, data in patients with schizophrenia have demonstrated a significant improvement in the incidence of suicidal behavior with clozapine compared with olanzapine. Electroconvulsive therapy appears to have an acute benefit on suicidality.

Sharma V, Mazmanian D. · Mood Disorders Program, Regional Mental Health Care-London, London, Canada. · Bipolar Disord. · Pubmed #12680898 No free full text.

Abstract: Postpartum psychosis is a rare but severe psychiatric disorder. Its diagnostic status remains controversial, but several studies have shown that the majority of patients who develop psychosis immediately following childbirth suffer from bipolar disorder. The pathophysiology of postpartum psychosis is poorly understood, but factors such as primiparity, difficult labor, genetic predisposition, and hormonal changes have been suggested as etiological factors. This paper reviews the literature on the relationship of sleep disruption and postpartum psychosis. It is argued that sleep loss resulting from the interaction of various putative causal factors may be the final common pathway in the development of psychosis in susceptible women. Clinical significance of these findings, including strategies to prevent postpartum psychosis, are discussed and suggestions are made for future research directions.

Sharma V. · Mood Disorders Program, Regional Mental Healthcare London, London, Ontario, Canada. · Expert Opin Pharmacother. · Pubmed #12387688 No free full text.

Abstract: The postpartum period is an exceptionally high-risk time for the occurrence of episodes of depression in women with major depressive disorder or bipolar disorder. There is accumulating evidence that major depressive disorder with postpartum onset in some patients has a bipolar diathesis. This article reviews the pharmacological treatment of postpartum depression. Although the data are limited, studies have focused exclusively on the acute and prophylactic treatment of major depressive disorder. To date, there are no studies of bipolar depression with postpartum onset. A careful assessment of maternal and infant risks and benefits is required prior to initiation of pharmacological treatment. Strategies to reduce misdiagnosis of subtle forms of bipolar disorder are discussed and suggestions are made regarding possible treatment interventions. The urgent need to conduct further studies comparing the symptom patterns, response to treatment and illness course in women with major depressive disorders and bipolar depression with postpartum onset is highlighted.

Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S, O'Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Young AH, Alda M, Milev R, Vieta E, Calabrese JR, Berk M, Ha K, Kapczinski F. · Department of Psychiatry, University of British Columbia,2255 Wesbrook Mall, Vancouver, BC V6T 2A1, , Canada. · Bipolar Disord. · Pubmed #19419382 No free full text.

Abstract: The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.

Sharma V, Smith A, Mazmanian D. · Department of Psychiatry and Obstetrics & Gynecology, University of Western Ontario, Ontario, Canada. · Bipolar Disord. · Pubmed #16879140 No free full text.

Abstract: OBJECTIVES: The use of olanzapine (OLZ) in the prevention of postpartum psychosis (PP) and mood episodes in women with bipolar disorder was investigated in a naturalistic, prospective study. METHODS: Eleven women received OLZ alone or in combination with an antidepressant or mood stabilizer, and 14 women received either antidepressants, mood stabilizers, or no medication for a minimum of 4 weeks after delivery. RESULTS: Two (18.2%) of the women in the OLZ group experienced a postpartum mood episode, whereas eight (57.1%) of the women in the No-OLZ group did. CONCLUSIONS: The role of OLZ in the prophylaxis of PP and mood episodes, particularly in women at high risk, clearly warrants further investigation.

Nguyen HT, Sharma V, McIntyre RS. · Department of Psychiatry, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada. · Adv Ther. · Pubmed #19330496 No free full text.

Abstract: OBJECTIVE: To review the teratogenic effects associated with the use of Food and Drug Administration-approved agents for bipolar disorder. METHODS: A PubMed search of all English language articles published from January 1966 to December 2008 was conducted. The key search terms included all major bipolar agents, cross-referenced with: teratogenicity, teratogen, safety, pregnancy, fetus, bipolar disorder, and malformation. The search was augmented with manual reviews of relevant article reference lists as well as http://clinicaltrials.gov and http://www.fda.gov (both last accessed in April 2008). Several pregnancy registries were also reviewed to determine malformation rates as well as teratogenesis attributable to each agent. Articles selected for review were based on author consensus, adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality. RESULTS: Valproate is associated with the highest rate of major congenital malformations (6.2%-16%). The relative risk of neural tube defects with valproate and carbamazepine is reported as approximately 1%-5% and 0.5%-1%, respectively. Preliminary evidence suggests that the relative risk for oral clefts (cleft lip or palate) is increased with lamotrigine relative to other antiepileptic drugs (AED) (ie, approximately 0.4%). The rate of major congenital malformations is higher in fetuses exposed to AED polytherapy (ie, >/=2 drugs) in comparison with AED monotherapy. Adverse neurobehavioral effects are insufficiently reported for most agents. In-utero exposure to valproate is associated with a greater risk of developmental difficulty requiring special education interventions as well as decreased verbal IQ scores. The risk of Ebstein's anomaly associated with lithium use is increased relative to the general population. The major congenital malformation rate with chlorpromazine and atypical antipsychotics is not established as being higher than a non-exposed group; the teratogenic risks associated with the olanzapine-fluoxetine combination are unknown. CONCLUSIONS: Well-characterized risks are associated with valproate, carbamazepine, lamotrigine, and lithium. The risks associated with psychotropic drug use need to be understood in the context of significant rates of relapse and associated morbidity when discontinuing bipolar treatment during pregnancy.

Sharma V, Khan M, Corpse C, Sharma P. · Specialized Adult Ambulatory Care Program, London, ON, Canada. · Bipolar Disord. · Pubmed #18837870 No free full text.

Abstract: OBJECTIVE: To investigate the diagnostic profile of women referred for postpartum depression. METHODS: Fifty-six women seen consecutively with the referral diagnosis of postpartum depression were administered structured instruments to gather information about their DSM-IV Axis I diagnoses. RESULTS: In terms of frequency of occurrence, the primary diagnoses in this sample were: major depressive disorder (46%), bipolar disorder not otherwise specified (29%), bipolar II disorder (23%), and bipolar I disorder (2%). A current comorbid disorder, with no lifetime comorbidity, occurred among 32% of the sample; by contrast, lifetime comorbidity alone (i.e., with no currently comorbid disorder) was found among 27%. Both a lifetime and a current comorbidity were found among 18% of the women, and 23% had no comorbid disorder. The most frequently occurring current comorbid disorder was an anxiety disorder (46%), with obsessive-compulsive disorder (62%) being the most common type of anxiety disorder. For lifetime comorbidity, substance use (20%) and anxiety disorders (12%) were the two most common. Over 80% of patients who scored positive on either the Highs Scale or the Mood Disorder Questionnaire met the diagnostic criteria for a bipolar disorder. CONCLUSION: The results suggest that postpartum depression is a heterogeneous entity and that misdiagnosis of bipolar disorder in the postpartum period may be quite common. The findings have important clinical implications, which include the need for early detection of bipolarity through the use of reliable and valid assessment instruments, and implementation of appropriate prevention and treatment strategies.

Sharma V, Khan M, Corpse C. · Specialized Adult Ambulatory Care Program, Regional Mental Health Care London, Ontario, Canada. · J Affect Disord. · Pubmed #18314200 No free full text.

Abstract: OBJECTIVES: We report the results of a retrospective, naturalistic study of lamotrigine in the management of treatment-resistant bipolar II depression. METHODS: Hospital charts of 31 patients treated at a mood disorders clinic, who had been on lamotrigine for at least six months after failing to show an adequate response to a combination of two mood stabilizers or a mood stabilizer and an antidepressant, were reviewed using the Clinical Global Impression-Improvement (CGI) rating scale. RESULTS: Patients were seen for an average of 19.4 months following the introduction of lamotrigine. The lamotrigine daily dose ranged from 50-400 mg (mean dose 199.2 mg) as monotherapy or in combination with a mood stabilizer, an atypical antipsychotic, or a sedative/hypnotic drug. Very much improvement was seen in 52% of patients and 32% were considered much improved. CONCLUSIONS: These naturalistic data suggest that lamotrigine alone or in combination with other psychotropic drugs was well tolerated and effective in the management treatment-resistant bipolar II depression. LIMITATIONS: Retrospective design, small sample size, and lack of a control group.

Balachandra K, Sharma V, Dozois D, Bhayana B. · Department of Psychiatry, University of Western Ontario, London. · Can Fam Physician. · Pubmed #16926928 links to  free full text

Abstract: OBJECTIVE: To investigate family physicians' experience in diagnosing and managing bipolar disorder, how they rate their undergraduate and postgraduate training in this area, and what they think they need to learn in the future. DESIGN: Survey questionnaire. SETTING: Family practices in London, Ont. PARTICIPANTS: Random sample of 297 family physicians. MAIN OUTCOME MEASURES: Physicians' experience in diagnosing and managing patients with bipolar disorder, rating of their undergraduate and postgraduate training in this area, and thoughts about what they need to learn in the future. RESULTS: Of 297 surveys sent out, 147 (49.5%) were returned. Male respondents accounted for 62%, and female respondents 37%, of completed surveys. Average year of graduation from medical school was 1979. The most common response for level of experience in diagnosing and treating bipolar disorders was "somewhat comfortable." Physicians frequently reported screening for symptoms of mood disorders (42%), and most of them were sharing care with other professionals (88%). Undergraduate training was rated as poor (42%) or satisfactory (46%), and postgraduate training was rated as poor (42%) or satisfactory (44%). Physicians thought they needed more education in issues of diagnosis and pharmacotherapy. CONCLUSION: Family physicians were only somewhat comfortable with diagnosing and managing bipolar disorders, and most thought their undergraduate and graduate training in this area had been, at best, satisfactory. They expressed a need for more education in the areas of diagnosis and pharmacotherapy.

Sharma V. · Department of Psychiatry and Obstetrics & Gynecology, University of Western Ontario and Mood Disorders Program, Regional Mental Health Care London, ON, Canada. · Bipolar Disord. · Pubmed #16879142 No free full text.

Abstract: OBJECTIVES: This paper discusses the effect of antidepressant use on the illness course in three women who were treated for first-onset postpartum depression (PPD) following childbirth. METHODS: A report of three cases of early-onset PPD in which bipolarity manifested following antidepressant treatment. RESULTS: There was no past history of psychiatric disturbance but in each case there was a family history of bipolar (BP) disorder. Treatment with antidepressants resulted in a highly unstable illness course characterized by a mixed episode, cycle acceleration, and a postpartum psychosis. However, discontinuation of antidepressants and institution of treatment with mood stabilizers and atypical neuroleptics resulted in sustained improvement and symptom remission. CONCLUSIONS: Caution is urged in the use of antidepressants to treat early-onset PPD in women at risk for developing BP disorder due to a family history of bipolar illness.

Sharma V. · Psychiatry and Obstetrics & Gynecology, University of Western Ontario, London, Canada; Mood Disorders Program, Regional Mental Health Care London, 850 Highbury Avenue North, P.O. Box 5532, Station B, London, Ont., Canada N6A 4H1. · Med Hypotheses. · Pubmed #16797856 No free full text.

Abstract: Major depressive disorder is a common psychiatric illness that is considered generally treatable; however, there are some patients who fail to respond in spite of adequate trials of antidepressants. Clinical factors known to contribute to treatment resistance include psychiatric and physical comorbidity, undiagnosed bipolarity, and treatment non-adherence. There is also emerging evidence that the use of antidepressants in some 'unipolar' patients may lead to a pattern of progressive diminution of therapeutic response and ultimately treatment resistance. A large number of these patients may have a bipolar diathesis even though there are no symptoms of hypomanic, manic or mixed episodes. It is hypothesized that the widespread and injudicious use of antidepressants in patients with a bipolar diathesis might result in treatment-induced resistant depression. Furthermore, attempts to manage the antidepressant-led mood instability might cause increased utilisation of other psychotropic drugs including sedative/hypnotics, neuroleptics and mood stabilisers and contribute to polypharmacotherapy.

Sharma V, Khan M, Smith A. · Mood Disorders Program, Regional Mental Health Care London, 850 Highbury Avenue North, P.O. Box 5532, Station B, London, ON, Canada N6A 4H1. · J Affect Disord. · Pubmed #15708423 No free full text.

Abstract: BACKGROUND: Treatment resistant depression is a common clinical problem. Studies have shown that a large number of patients with depression do not have a satisfactory clinical outcome in spite of adequate trials of antidepressant drugs. In this study, we investigated demographic and clinical characteristics, diagnostic subtypes, and illness outcome of patients with resistant depression and a history of escape of response to adequate trials of at least two antidepressants for a previous episode. METHOD: Sixty-one patients who were seen consecutively at a mood disorders clinic with the diagnosis of "unipolar" treatment resistant depression, and followed up for at least one year, were interviewed using the Structured Clinical Interview for DSM-IV. Prospectively collected data including the occurrence of episodes of hypomania, and supplemental information from family members on illness course were also used for purposes of diagnostic re-evaluation. RESULTS: At intake, 35% of the patients were diagnosed as having a bipolar disorder. At follow-up, there was a 59% prevalence of bipolar disorder. Of the patients with major depressive disorder, 52% were subsequently classified as having bipolar spectrum disorder. The most important finding was that 80% of patients were found to show evidence of bipolarity. Moreover, the most common change in medication was a switch to mood stabilizers. CGI ratings showed significant improvement in functioning from the time of initial consultation. LIMITATIONS: This was a naturalistic study, and the data were collected in a non-blind fashion. CONCLUSIONS: The findings suggest that the majority of cases of unipolar treatment resistant depression, occurring in the context of loss of antidepressant response, have a bipolar diathesis.

Sharma V, Smith A, Khan M. · Mood Disorders Program, Regional Mental Health Care London, 850 Highbury Ave., PO Box 5532, Station B, Ontario, Canada, N6A 4H1. · J Affect Disord. · Pubmed #15555716 No free full text.

Abstract: BACKGROUND: Puerperal psychosis is the most serious psychiatric disorder after childbirth. Despite the ongoing debate regarding its diagnostic status, there is increasing evidence that it is related to bipolar or schizoaffective disorder. Although a well-recognized precipitant of mania, the role of sleep loss has not been systematically studied in the onset of puerperal psychosis. The aim of this study was to test the hypothesis that sleep disruption resulting from longer labour or nighttime delivery would be associated with the onset of puerperal psychosis. METHOD: Data on duration of labour and time of delivery were compared between a group of patients who were hospitalized with a diagnosis of puerperal psychosis and a group of controls from the same hospitals that were matched on age, parity, and on year of admission to the hospital. RESULTS: The most common DSM-IV diagnoses were bipolar disorder or schizoaffective disorder. The women in the puerperal psychosis group had a longer duration of labour and were more likely to have a nighttime delivery compared to women in the control group. Insomnia was the most frequent and usually the earliest symptom. LIMITATIONS: Small sample size, chart review, no direct measure of sleep, and use of a normal control rather than a comparison group of at-risk women. CONCLUSIONS: These preliminary findings provide indirect evidence that sleep loss may be a precipitant of puerperal psychosis in women who are biologically predisposed to this illness. DECLARATION OF INTEREST: This research was supported by the Ontario Mental Health Foundation.

Sharma V, Menon R, Carr TJ, Densmore M, Mazmanian D, Williamson PC. · Mood Disorders Program, Regional Mental Health Care London, 850 Highbury Avenue North, London, Ontario, Canada N6A 4H1. · J Affect Disord. · Pubmed #14607394 No free full text.

Abstract: BACKGROUND: Over the past few years there has been an interest in the use of magnetic resonance imaging (MRI) to study specific brain regions in bipolar disorder. The present study compared the grey matter volume in the subgenual prefrontal cortex in patients with familial and non-familial bipolar disorder and normal control subjects. METHODS: MRI brain scans were performed on 12 patients with bipolar I disorder including six patients with a positive family history of bipolar disorder as well as eight control subjects. RESULTS: There was a significant reduction in the grey matter volume in the right subgenual prefrontal cortex, but not in the left subgenual prefrontal cortex. A family history x sex interaction with right prefrontal cortex volume was also observed as a trend. For females, a positive family history was associated with reduced right prefrontal cortex volumes; for males, a positive family history was associated with increased right prefrontal cortex volumes. LIMITATIONS: Small sample size, reduced statistical power. CONCLUSION: These data add to the emerging literature on structural changes in the subgenual prefrontal cortex in bipolar disorder, especially in patients with a positive family history.

Sharma V. · University of Western Ontario, Ontario, London, Canada. · Med Hypotheses. · Pubmed #13679016 No free full text.

Abstract: Puerperal psychosis is a rare but serious psychiatric disorder following delivery. Although controversy continues to surround its nosological status, puerperal psychosis is generally considered a mood episode with psychotic features occurring in the context of bipolar disorder or schizoaffective disorder. Due to the close temporal association with childbirth, the etiological role of gonadal steroids, particularly estrogen, has been considered. Familial factors have also been implicated in the triggering of episodes of puerperal psychosis. Sleep deprivation arising from an array of diverse factors is a common occurrence surrounding parturition. The author suggests that sleep loss plays a pivotal role in the causation of puerperal psychosis. Clinical implications of this hypothesis are discussed. Studies on the aetiology and pathogenesis of puerperal psychosis are urgently needed not only for prevention and better treatment strategies of puerperal psychosis but also for understanding the biological underpinnings of bipolar disorder.

Oluboka OJ, Stewart SL, Sharma V, Mazmanian D, Persad E. · Clinical Rehabilitation Evaluation Unit (CREU), Acute Care Program, North Bay Psychiatric Hospital, PO Box 3010, HWY 11 N, North Bay, ON P1B 8L1. · Can J Psychiatry. · Pubmed #12025436 No free full text.

Abstract: OBJECTIVE: This study assessed the quantitative electroenchephalographic (QEEG) absolute power and coherence differences between a group of patients with bipolar I mood disorder (BMD I) and a group of patients with schizophrenia. We also examined the correlation between QEEG measures and family history of BMD. METHOD: Using the National Institutes of Mental Health (NIMH) Global Rating Scale, we rated 18 adult inpatients with a DSM-III-R diagnosis of BMD I for the severity of the current episode. We also collected data on the family history of the illness. This group was then matched for age, sex, and handedness with an equal number of inpatients with a DSM-III-R diagnosis of schizophrenia. QEEG absolute power and coherence was calculated for the alpha bandwidth (8.0 to 12.0 Hz), assessed at 18 pairs of electrodes in both hemispheres during resting, eyes-closed condition in all the patients. RESULTS: The patients with schizophrenia showed significantly higher coherence (P = 0.047) at 6 pairs of electrodes on the right side. The group with BMD showed significantly higher power (P = 0.042) at 2 pairs of electrodes on the right side. Correlational analysis showed that QEEG measures were significantly correlated (P = 0.01) with positive family history of BMD. CONCLUSION: These findings suggest that the patients with BMD are more disorganized in the right anterior hemisphere and that there is a significant positive correlation between the QEEG measures and the presence of family history of BMD. Further studies in a larger sample are required to confirm these preliminary findings.

Sharma V. · Mood Disorders Unit, London Psychiatric Hospital, 850 Highbury Avenue, P.O. Box 5532, Station B, London, Ontario, Canada. · J Affect Disord. · Pubmed #11292524 No free full text.

Abstract: BACKGROUND: The loss of response to antidepressant drugs is not an uncommon phenomenon. While some patients respond to changes in the drug regimen, others develop resistance to various treatment modalities. METHOD: I describe 15 cases who had a loss of response to repeated trials of antidepressants before developing a chronic and severe, refractory depression. RESULTS: These patients had failed to respond to various treatment strategies including substitution with other antidepressant drugs, augmentation with agents such as T3 and lithium; and finally electroconvulsive therapy (ECT). Following discontinuation of antidepressants and treatment with mood stabilizers, there was a sustained improvement. Notably some of the patients who had earlier failed to respond to mood stabilizers in combination with unimodal antidepressants improved upon discontinuation of antidepressants and continued treatment with mood stabilizers. LIMITATIONS: Open trial, retrospective design and small sample size. CONCLUSION: These clinical findings suggest that some refractory depressives represent cryptic bipolar disorders. Prospective validation is necessary to support this conclusion.

Fetkewicz J, Sharma V, Merskey H. · False Memory Syndrome Foundation, Philadelphia, PA 19104-3315, USA. · J Affect Disord. · Pubmed #10781705 No free full text.

Abstract: BACKGROUND: Many patients who have been told they have Multiple Personality/Dissociative Identity Disorder (MPD/DID) seem to have deteriorated clinically after being so diagnosed. We report here the results of a survey of suicide attempts in patients diagnosed as having MPD and a comparison group hospitalized with a mood disorder. METHODS: Twenty individuals who had been diagnosed as having MPD, had developed false memories, and had relinquished them, were surveyed with respect to suicide attempts before and after the diagnosis. Twelve of those approached agreed to provide data and were compared with 12 patients from an in-patient mood disorders unit, matched for age and sex. RESULTS: In the MPD group more patients attempted suicide after being diagnosed than before and they made more separate attempts at suicide than before. The reverse was true in the comparison group with patients and suicide attempts before and after hospitalization. Comparing the numbers of attempts in the groups before diagnosis/hospitalization and afterward Chi(2)=20.177, DF=1, P<0.001. LIMITATIONS AND CONCLUSIONS: Both samples were highly selected, and the comparison group does not provide an exact control. Nevertheless, the results support a trend in the literature that finds the diagnosis of multiple personality disorder and the use of recovered memory treatment are harmful.

Whitney DK, Sharma V, Kueneman K. · Division of Society, Women and Health, Centre for Addiction and Mental Health, Toronto, ON, Canada. · J Affect Disord. · Pubmed #10628878 No free full text.

Abstract: OBJECTIVE: The objective of the study was to determine if a seasonal pattern existed for hospital admissions of manic depressive illness to a Ontario provincial psychiatric hospital. METHOD: Admission records were reviewed for the 75 year period of the study. In the analysis factors including: mood state on admission, gender and the influence of psychotropic medications were considered. RESULTS: For mania and depression there was no statistically significant seasonal pattern of admissions. For mixed state admissions peaked in the summer. CONCLUSIONS: The results of this study contradict the seasonal pattern traditionally reported in the literature. The limitations of this study, which include changes in diagnostic criteria over time and admission date not identical to onset of affective episode, need to be acknowledged.

Sharma V, Pistor L. · Mood Disorders Unit, London Psychiatric Hospital, ON. · J Psychiatry Neurosci. · Pubmed #9987206 links to  free full text

Abstract: OBJECTIVE: An open trial was conducted to determine the efficacy of olanzapine in the treatment of bipolar mixed state. PARTICIPANTS: Nine inpatients at a provincial psychiatric hospital who met the DSM-IV criteria for bipolar I disorder, most recent episode mixed. INTERVENTION: Olanzapine was added to the existing drug regime in patients who had failed to respond to adequate trials of mood stabilizers used alone or in combination with neuroleptics. OUTCOME MEASURES: Patients were administered the Clinical Global Impression (CGI) Scale, the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) Scale before the initiation of olanzapine. These scales were repeated and patients were rated on the improvement subscale of the CGI at the time of discharge. RESULTS: Pretreatment means (and standard deviations [SD]) for the CGI scale, BPRS and GAF were 5.7 (1.1), 60.7 (13.7) and 17.8 (7.5), respectively. Post-treatment means and SD for the scales were 1.9 (0.6), 6.3 (3.3) and 71.7 (5.6), respectively. Paired t-tests on all measures indicated significant improvement in symptoms with t = 9.43, p < 0.001 for CGI; t = -13.28, p < 0.001 for BPRS; t = -21.83, p < 0.001 for GAF. The mean improvement subscale score of the CGI was 1.3 (SD 0.5) at discharge. CONCLUSIONS: Olanzapine was well-tolerated and was effective in the acute treatment of bipolar mixed state.

Sharma V, Corpse C. · No affiliation provided · Arch Womens Ment Health. · Pubmed #18677437 No free full text.

This publication has no abstract.