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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


New Evidence-Based Approaches In Bipolar Disorder And Schizophrenia


GOAL
To update the practicing psychiatrist on the diagnostic complexity and current treatment advances in bipolar disorder.

TARGET AUDIENCE
This activity is designed for psychiatrists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Recognize proper diagnostic techniques in bipolar disorder.
  • Demonstrate the salient issues in medication selection and assess the impact of medications on patients with schizophrenia or bipolar disorder with a high risk of medical comorbidities or metabolic complications.
  • Evaluate ways to optimize pharmacologic interventions and translate switching strategies into improved patient functioning.
  • Critique the latest research on mania and mixed episodes in patients with and without psychotic features.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: November 15, 2004. Expiration date: November 15, 2006.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Pfizer Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Glenn Treisman, MD
Associate Professor
Department of Psychiatry and Behavioral Sciences
The Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Treisman reports having no financial or advisory relationships with corporate organizations related to this activity.

PARTICIPATING FACULTY

Paul E. Keck, Jr, MD
Professor of Psychiatry, Pharmacology, and Neuroscience
Vice Chairman of Research
University of Cincinnati College of Medicine
Chief, Division of Clinical Neuroscience
University of Cincinnati Medical Center
Associate Director of the General Clinical Research Center
Cinicinnati Veterans Affairs Medical Center
Cincinnati, Ohio
Dr Keck reports receiving grant and/or research support from Abbott Laboratories, the American Diabetes Association, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb Company, GlaxoSmithKline, Elan Corporation, Eli Lilly and Company, Janssen Pharmaceutica, Merck & Co, Inc, National Institute of Mental Health, National Institute of Drug Abuse, Organon, Ortho-McNeil Pharmaceutical, Pfizer Inc, the Stanley Medical Research Institute, and UCB Pharma; and serving as a consultant or a member of an advisory board for Abbott Laboratories, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb Company, Corcept Therapeutics Inc, GlaxoSmithKline, Janssen Pharmaceutica, Eli Lilly and Company, Novartis Corporation, Ortho-McNeil Pharmaceutical, Pfizer Inc,
Shire Pharmaceuticals Group, and Wyeth.

Jeffrey A. Lieberman, MD
Thad and Alice Eure Distinguished Professor of Psychiatry, Pharmacology, and Radiology
Vice Chairman for Research and Scientific Affairs
Department of Psychiatry
Director, Mental Health and Neurosciences Clinical Research Center
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina
Dr Lieberman reports receiving grant and/or research support from AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutica, Novartis Corporation, Organon, and Pfizer Inc; serving as a consultant to Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Novartis Corporation, Pfizer Inc, and Solvay Pharmaceuticals; and serving on the Advisory Board of Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Organon, Pfizer Inc, Sanofi-Synthelabo Inc, and Solvay Pharmaceuticals.

Charles B. Nemeroff, MD, PhD
Reunette W. Harris Professor and Chairman
Department of Psychiatry and Behavioral Sciences
Emory University School of Medicine
Atlanta, Georgia
Dr Nemeroff reports receiving grant and/or research support from Abbott Laboratories, American Foundation for Suicide Prevention, AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Merck & Co, Inc, National Alliance for Research on Schizophrenia and Depression, National Institutes for Mental Health, Pfizer Inc, Stanley Foundation/National Alliance for the Mentally Ill, and Wyeth; serving as a consultant to Abbott Laboratories, Acadia Pharmaceuticals, AstraZeneca LP, Bristol-Myers Squibb Company, Corcept Therapeutics Inc, Cyberonics, Cypress Biosciences Inc, Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Merck & Co, Inc, Neurocrine Biosciences, Novartis Corporation, Organon, Otsuka American Pharmaceutical, Inc, Sanofi-Synthelabo Inc, Scirex, Somerset Pharmaceuticals, and Wyeth; serving on the speakersÕ bureau for Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Organon, Otsuka America Pharmaceutical, Inc, Pfizer Inc, and Wyeth; serving on the Board of Directors for the American Foundation for Suicide Prevention, Cypress Biosciences Inc, the George West Mental Health Foundation, NovaDel Pharma Inc, and the Heinz C. Prechter Fund for Manic Depression; and holding stock in Corcept Therapeutics Inc and Neurocrine Biosciences, and he holds the patent for the method and devices for transdermal delivery of lithium (US 6 375 990 B1) and the method to estimate serotonin and norepinephrine transporter occupancy after drug treatment using patient or animal serum (provisional filing April 2001).

Notice: In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty members have disclosed that their articles have referenced the following unlabeled/unapproved uses of drugs or devices:

Dr Nemeroff—oxcarbazepine, carbamazepine, topiramate, liothyronine, inositol, pindolol, valproate, lamotrigine, and lithium.
Dr Lieberman—oxcarbazepine, carbamazepine, and topiramate.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

A New Look At An Evolving Disorder
Glenn Treisman, MD*

As psychiatry strives to improve the quality of treatment in patients diagnosed with serious and lifelong mental disorders, we look to the continuing advances in science to improve the recognition, diagnosis, and treatment of conditions such as bipolar disorder.

Global burden of disease statistics show clear evidence that we need to work toward better clinical interventions. In 1990, bipolar disorder was the sixth leading cause of disability worldwide and it was projected to remain a global health problem well into this century.1 Due to the complexity in the clinical presentation of conditions, such as bipolar disorder, there is evidence that there can be significant delays in making an accurate diagnosis.2 When untreated, this illness can pose high risks of morbidity and mortality; it impacts not only the individual and his/her family, but also society.

This issue of Advanced Studies in Medicine addresses some important changes in the understanding and treatment of bipolar disorder and schizophrenia. We are making strides in our clinical wisdom derived from an evolving evidence base of pivotal studies and clinical insights from our expert faculty.

Charles B. Nemeroff, MD, PhD, discusses bipolar disorder as a complex syndrome and offers an interesting perspective on the various clinical presentations of the disorder. He underscores the differential between unipolar depression and bipolar depression, and reviews the importance of comorbid medical and psychiatric disorders.

Paul E. Keck, Jr, MD, offers a valuable discussion on mania and reviews concepts that are important to the treating clinician, such as side-effect profile, tolerability, and efficacy.

Jeffrey A. Lieberman, MD, discusses first episode and acute psychosis in schizophrenia and mania, and reviews management and issues of early intervention.

In the following pages, clinicians will find a solid review of our current knowledge base and valuable new insights into the diagnosis and treatment of bipolar disorder.


REFERENCES
1. Murray CJ, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Global Burden of Disease and Injury Series. Cambridge, Mass: Harvard School of Public Health; 1996.
2. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161-174.

*Associate Professor, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Address correspondence to: Glenn Treisman, MD, Associate Professor, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 4-119, Baltimore, MD 21205. E-mail: glenn@jhem.jhmi.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.