Bipolar Disorder: Walter G

Malhi GS, Adams D, Lampe L, Paton M, O'Connor N, Newton LA, Walter G, Taylor A, Porter R, Mulder RT, Berk M, Anonymous00020, Anonymous00021, Anonymous00022. · CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia. · Acta Psychiatr Scand Suppl. · Pubmed #19356155 No free full text.

Abstract: OBJECTIVE: To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making. METHOD: A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. RESULTS: The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. CONCLUSION: These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

Horsfall J, Cleary M, Hunt GE, Walter G. · Research Unit, Sydney South West Area Health Service, Concord Centre for Mental Health, Concord Hospital, New South Wales 2139, Australia. · Harv Rev Psychiatry. · Pubmed #19205964 No free full text.

Abstract: Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.

Walter G, Wiltshire C, Anderson J, Storm V. · Rivendell Unit, Child and Adolescent Mental Health Services, Central Sydney Area Health Service, Sydney, Australia. · Can J Psychiatry. · Pubmed #11761631 No free full text.

Abstract: OBJECTIVES: To summarize available knowledge about pharmacologic treatments that are used for first-onset (or early) psychosis in youths, with particular consideration of the prodromal stage and the effectiveness and safety of novel antipsychotic drugs and mood stabilizers. METHOD: A computerized search of medical databases (for example, Medline and Embase), a manual searching of articles and textbooks, and the use of vignettes to highlight treatment issues. RESULTS: There are limited data about the effectiveness and safety of psychotropic agents for youths with psychosis and scarce information about the drug treatment of the prodromal stage of early psychosis in all age groups. The available data are encouraging, although the newer agents are not without safety concerns. CONCLUSIONS: Despite the paucity of studies, there is a range of psychotropics that may be used in the early stages of psychotic illness in youths. Drug choice is influenced by several factors, including the clinical picture, side effect profile, and patient preference. In certain situations, the decision may be not to use medication.

Walter G, Tormos JM, Israel JA, Pascual-Leone A. · Department of Psychological Medicine, University of Sydney, Australia. · J Child Adolesc Psychopharmacol. · Pubmed #11322748 No free full text.

Abstract: There are no published data about transcranial magnetic stimulation (TMS) as a treatment for psychiatric disorders in young persons. The aim of this article is to collate available information about TMS in this population. Information was sought, by placing a message on the TMS Listserver, from investigators who had used TMS in patients 18 years of age or younger. Only one group reported experience in this area; it had treated seven patients, ages 16-18 years. Three patients had unipolar depression, three had schizophrenia, and one had bipolar disorder. Five of the seven patients had improved by the conclusion of the TMS course. Adverse events were reported in one patient. Further studies are needed first to investigate systematically the safety of TMS in children and adolescents and second to examine its potential therapeutic effects in this population.

Cahill C, Hanstock T, Jairam R, Hazell P, Walter G, Malhi GS. · University of Sydney Discipline of Psychological Medicine, Royal North Shore Hospital, Sydney, Australia. · Aust N Z J Psychiatry. · Pubmed #17508317 No free full text.

Abstract: The purpose of the present paper was to compare currently available diagnostic guidelines for juvenile bipolar disorder with respect to utility in research and clinical practice. A systematic search of psychiatric, medical and psychological databases was conducted using the terms 'juvenile bipolar disorder', 'paediatric bipolar disorder' and 'guidelines'. Three main sets of guidelines issued by the National Institute of Health and Clinical Excellence (UK), The National Institute of Mental Health (USA) and Child Psychiatric Workshop (USA) were found. There were key differences in the recommendations made by each regarding the diagnosis and symptomatic presentation of juvenile bipolar disorder. Although the diagnosis of juvenile bipolar disorder is gaining increased recognition, its definition remains controversial. It is recommended that clinicians and researchers need to develop diagnostic guidelines that have clinical salience and can be used for future research by incorporating key features of those that are currently available.

McShane G, Mihalich M, Walter G, Rey J. · St Joseph's College, Hunters Hill, NSW, Australia. · Australas Psychiatry. · Pubmed #16734650 No free full text.

Abstract: OBJECTIVES: To evaluate the outcome of adolescents with unipolar, bipolar and psychotic disorders admitted to a specialist child and adolescent mental health service in order to inform and enhance service delivery. METHODS: Young people treated over a 2 year period at the Rivendell Unit, Sydney, Australia, were identified. Information was gathered from the medical records, mailed questionnaires and follow-up telephone interviews. RESULTS: Of 114 patients eligible for inclusion in the study, outcome information was available for 85 (75%). After 3 years, there was improvement in mood and general level of functioning for all diagnostic groupings. Overall, suicidal thought, self-harm and suicide attempts were not significantly reduced at follow up and relapse rates were high. Patients with bipolar disorder seemed to have a better response to treatment than other diagnostic groups on general functioning, education and employment. CONCLUSIONS: The findings confirm the seriousness and adverse psychosocial consequences of psychotic, unipolar and bipolar mood disorders in this age group, highlighting the need for consistent and systematic follow up of young people after treatment.

Ghaziuddin N, Kaza M, Ghazi N, King C, Walter G, Rey JM. · Division of Child Adolescent Psychiatry, University of Michigan, Ann Arbor 48109-0390, USA. · J ECT. · Pubmed #11417921 No free full text.

Abstract: OBJECTIVE: To estimate knowledge, experience, and attitudes towards the use of electroconvulsive treatment in minors (patients < 18 years of age), among child and adolescent psychiatrists and psychologists. METHOD: 1,600 questionnaires were mailed to a group of child and adolescent psychiatrists and psychologists. RESULT: There were 625 (39%) respondents. 329 (53.8%) of the respondents stated that they possessed minimal knowledge about the use of ECT in children and adolescents. Lack of confidence in providing a second opinion was common and reported by 75%. Compared with those with minimal knowledge, respondents with advanced knowledge reported a higher perception of safety and efficacy. The majority (70%) of the respondents regarded ECT as a treatment of last resort. CONCLUSION: Many child and adolescent psychiatrists and psychologists have very little knowledge, training, or experience in this treatment. They seem to be ill equipped to appropriately consider or advise patients and families about ECT. Clinical and research implications of these findings are discussed.

Walter G. · No affiliation provided · Psychiatr Serv. · Pubmed #10402625 links to  free full text

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