Bipolar Disorder: Vázquez GH

Vázquez GH, Strejilevich S, García Bonetto G, Cetkovich-Bakmas M, Zaratiegui R, Lagomarsino A, Goldchluk A, Kalina E, Herbst L, Gutiérrez B, Anonymous00416. · Departamento de Neurociencias, Universidad de Palermo, Buenos Aires, Argentina. · Vertex. · Pubmed #16601825 No free full text.

Abstract: The consensus guidelines of argentine experts in the treatment of bipolar disorders are the result of three days of work of the 10 main local experts under the organization of the Argentine Association of Biological Psychiatry (AAPB). It was adopted a mixed criterion for its preparation: all the recent data of the evidence medicine based published until now were discussed and were balanced with the knowledge acquired from clinical experience of the local experts on the bipolar field. It presents general recommendations and suggested therapeutic sequences for the phase of maintenance, the manic/hypomanic or mixed episode and the depressive episode. These have been divided according to the classification in type I and II; with or without rapid cycling. Since the group of experts identified the delay and miss-diagnoses like the most important barrier for a suitable treatment enclosed a series of recommendations for differential diagnosis of bipolar disorders.

Vázquez GH, Kahn C, Schiavo CE, Goldchluk A, Herbst L, Piccione M, Saidman N, Ruggeri H, Silva A, Leal J, Bonetto GG, Zaratiegui R, Padilla E, Vilapriño JJ, Calvó M, Guerrero G, Strejilevich SA, Cetkovich-Bakmas MG, Akiskal KK, Akiskal HS. · Department of Neuroscience, University of Palermo, Buenos Aires, Argentina. · J Affect Disord. · Pubmed #18006072 No free full text.

Abstract: BACKGROUND: The purpose of this study is to examine the prevalence of affective temperaments between clinically unaffected relatives of bipolar patients and secondarily to investigate the impact of these "subaffective" forms on their quality of life (QoL). METHODS: The study was performed in seven sites across Argentina. We administered the scales TEMPS-A and Quality of Life Index to a sample of 114 non-ill first degree relatives of bipolar disorder patients ("cases") and 115 comparison subjects without family history of affective illness ("controls"). We used The Mood Disorder Questionnaire to rule out clinical bipolarity. RESULTS: Mean scores on all TEMPS-A subscales were significantly higher in cases, except for hyperthymia. The prevalence of affective temperaments, according to Argentinean cut-off points, was also higher, with statistical significance for cyclothymic and anxious temperaments. Regarding QoL, we found no significant differences between both groups, except for interpersonal functioning, which was better in controls. A detailed subanalysis showed significant effects of QoL domains for all temperaments, except for the hyperthymic. LIMITATIONS: We used self-report measures. A larger sample size would have provided us greater statistical power for certain analyses. CONCLUSIONS: Our findings support the concept of a spectrum of subthreshold affective traits or temperaments - especially for the cyclothymic and anxious - in bipolar pedigrees. We further demonstrated that, except for the hyperthymic, quality of life was affected by these temperaments in "clinically well" relatives. Overall, our data are compatible with the "endophenotype" and "subaffective" theses for affective temperaments.

Akiskal HS, Vázquez GH. · International Mood Center, Department of Psychiatry, University of California at San Diego, San Diego, CA, USA. · Vertex. · Pubmed #17088954 No free full text.

Abstract: It was commonly believed that no more than 1% of the general population has bipolar disorder. New data are beginning to provide confirming evidence for a higher prevalence of up to at least 5%. Several overlapping subtypes of bipolar disorder with hypomanic (rather than manic) features have been described, and more complex evolutive forms of the illness have also received greater clinical attention. The recognition of the entire clinical spectrum of bipolar disorders is of major public health concern because, despite the increasing availability of new treatments, under diagnosis or long delay in diagnosis, and gross under treatment continue to plague our field. Lesser manifestations and subaffective forms usually precede the overt manifestations of the illness in the offspring and biological kin of adult bipolars. In the last decades, a great body of data justifies considerable widening beyond the conservative positions of current nosological classifications, such as DSM IV and ICD10.