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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by floatingbridge on December 27, 2011, at 10:49:18
Are there negative symptoms for bipolar? I know there are symptoms identified for schizophrenia and schizoaffective disorder, but does bipolar have it's own subtle categories?
If so, can these remit over time or with the proper treatment?
Posted by SLS on December 27, 2011, at 12:14:25
In reply to Bipolar negative symptoms?, posted by floatingbridge on December 27, 2011, at 10:49:18
> Are there negative symptoms for bipolar? I know there are symptoms identified for schizophrenia and schizoaffective disorder, but does bipolar have it's own subtle categories?
>
> If so, can these remit over time or with the proper treatment?Check out the "deficit syndrome" as it applies to schizophrenia. I think you'll find that it bears a resemblance to anergic, anhedonic bipolar depression. Dopamine?
- Scott
Posted by floatingbridge on December 27, 2011, at 13:03:25
In reply to Re: Bipolar negative symptoms? » floatingbridge, posted by SLS on December 27, 2011, at 12:14:25
Thanks, that term is helpful.
I found this if anyone is interested in this abstract:
Posted by Christ_empowered on December 27, 2011, at 15:17:15
In reply to Re: Bipolar negative symptoms? » SLS, posted by floatingbridge on December 27, 2011, at 13:03:25
Bipolar and schizophrenia overlap considerably. In my life, for instance, I've been diagnosed by different doctors as different flavors of schizophrenia and then as bipolar I. A lot of it is pure BS if you ask me, but whatever.
Anyway, now that I'm "bipolar," I will say that there's something aside from/in addition to depression that can cause problems. You also have to watch out for the meds--they're great when dosed appropriately, but heavy medication, crazy cocktails, etc. will slow you down and might cause cognitive and mood problems.
Posted by Phillipa on December 27, 2011, at 17:50:11
In reply to Re: Bipolar negative symptoms?, posted by Christ_empowered on December 27, 2011, at 15:17:15
CE was a time when both were thought to be the same. Didn't lithium separate the bipolar from schizophrenia? Today a lot more meds of course. And wouldn't also bipolar usually follow cycles of wellness and the ups and downs? Phillipa
Posted by Toph on December 27, 2011, at 18:01:23
In reply to Bipolar negative symptoms?, posted by floatingbridge on December 27, 2011, at 10:49:18
> Are there negative symptoms for bipolar?...
> If so, can these remit over time or with the proper treatment?My manic symptoms include insomnia, racing thoughts, meglomania, hypersexuality, and psychotic delusions mainly involving paranoia and ideas of reference. Every episode has required hospitalization. My depressive episodes involve suicidal ideation, immense self-doubt and complete cessation of functioning.
True BPI has no remission other than through chemical maintenance. I am fortunate that lithium has kept me mostly symptom free for 40 years (except for one manic relapse 3 years ago).
Posted by Phillipa on December 27, 2011, at 20:55:20
In reply to Re: Bipolar negative symptoms?, posted by Toph on December 27, 2011, at 18:01:23
Toph yes you are. Too often like my deceased ex father in law he would quit his lithium and bingo mania and then severe vegetative depression. Only the lithium restored him to his previous level of "normal behavior". Phillipa
Posted by bleauberry on December 28, 2011, at 16:04:15
In reply to Bipolar negative symptoms?, posted by floatingbridge on December 27, 2011, at 10:49:18
I don't put much weight on the subtle names used in psychiatry because there is so much overlap between them and so much varying subjectivity in determining which name to use. Also, they are not very helpful in directing treatment. I think if anything they give us a rough place to start. I think a big mistake that is made throughout the industry is staying in that same vein they started in even when it isn't working For example assume we get a rough starting point by declaring something "bipolar"....but if 5 or 10 years later we have not made progress treating this monster as bipolar, then clearly it is not bipolar even though it looks like it....by staying married to the word "bipolar" in this example, the patient NEVER gets an opportunity to find out what it really is or what really works.
The whole topic of "negative" symptoms or "deficit" symptoms however offer some good clues. For example, we know right away that this is probably not a serotonin or GABA issue, and that either of those can worsen the symptoms. Once in a while we see paradoxical reactions where indeed a serotonin med or a gaba med perk someone right up into being reborn again, but that isn't very often. We know it is related to the circuits of norepinephrine and dopamine, and even to a greater extent the endorphins. We know this is a common thing that happens when the neurons are competing with toxins from pathogenic organisms or heavy metals. It is common in stressed adrenals.
So while maybe we can't know what exactly causes the negative symptoms or what treats them, we at least know the right doors to knock on when we go exploring. Bottom line, gotta look under all rocks even the ones not suspected, but the first line place to start includes ne, dopamine, and endorphins. We cannot predict the exact mechanism, for example whether it be agonism or antagonism or reuptake inhibition or maoi or stimulant or what. No way to know. Have to try them. But don't waste any time on anything that is primarily serotonin or gaba. Look into blood cleansing herbs and wide spectrum antimicrobial herbs. There are a lot of choices but you have to start somewhere and then keep going because sooner or later you will either purposefully or accidentally stumble onto something....but only if you are actually trying new stuff. Staying with the old stuff and the old strategy that aren't working robs one of their future by making many opportunities off limits.
That's how I see it anyway.
Posted by alchemy on December 28, 2011, at 20:57:43
In reply to Re: Bipolar negative symptoms?, posted by bleauberry on December 28, 2011, at 16:04:15
Although symptoms overlap & vary, at least they have expanded/included "Bipolar" to include I, II, and III. As well as the "rapid cycling", "cyclothymia", etc.
I "cycle", but am no where near the description of the normal Bipolar definition.
They still have a long way to go though :)
Posted by Sailboat77 on December 29, 2011, at 17:33:19
In reply to Re: Bipolar negative symptoms?, posted by alchemy on December 28, 2011, at 20:57:43
In recent years doctors have been using what's called a "Bipolar Spectrum". This has gained traction in the psychiatric community because no person has exactly the same symptoms. When you place a person on a spectrum it allows a doctor to treat those exact symptoms, such as mania, anhedonia or depression, rather than treating a patient as though they fit into a broad category that may not accurately gauge their mental illness.
I for instance belong on the bipolar spectrum that emphasizes depressive states, limited cycling, and only rare bouts of mania. Knowing this, my doctor can treat me on a personalized basis instead of placing me in a large category that may not fit my mental illness.
-Best of luck
Posted by linkadge on December 29, 2011, at 17:49:32
In reply to Re: Bipolar negative symptoms?, posted by Sailboat77 on December 29, 2011, at 17:33:19
Yeah, I am probably somewhere on the 'bipolar spectrum'. However, I have had more sucess in treating just the depression than I have with encorperating any form of mood stabilizer or antipsychotic.
Linkadge
Posted by novelagent on January 5, 2012, at 19:18:27
In reply to Re: Bipolar negative symptoms? » floatingbridge, posted by SLS on December 27, 2011, at 12:14:25
thought this was interesting, given scott's mentioning of the dopaminergic pathways-- prefrontal dopamine is low in schizophrenia and bipolar, causing cognitive deficits
Positive Results from Shire's Vyvanse Clinical Trial in Schizophrenia
Shire plc (LSE: SHP, NASDAQ: SHPGY), the global specialty biopharmaceutical company, today announced positive results from a signal-finding study of Vyvanse(R) (lisdexamfetamine dimesylate) Capsules (CII) assessing its effect in a prospective examination of adults with negative symptom predominant schizophrenia. This study met its pre-defined primary end points. Vyvanse is a prescription medicine currently approved in the US, Canada, and Brazil for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). Vyvanse should only be used to treat ADHD.
This investigational, phase 2, 14-week, flexible dose, multi-center study consisted of a 10 week open-label (n = 92) and a 4 week double-blind component (n = 69). Vyvanse was administered orally as adjunctive therapy (20 to 70 mg per day, titrated over 7 weeks) to 92 clinically stable patients with predominant negative symptom schizophrenia (ages of 18 to 55), taking established maintenance doses of atypical antipsychotic medications. In the open-label, primary efficacy analysis, Vyvanse demonstrated significant improvement (p<0.0001) in negative symptoms after 10 weeks, compared to baseline, as measured by blinded-raters using the Scale for the Assessment of Negative Symptoms modified total score or SANS-18* [LOCF; mean change of -12.9 plus or minus 10.0 (95% CI -15.0 to -10.8)].
In order to assess the potential impact on positive symptom exacerbation, the Positive and Negative Syndrome Scale (PANSS) was administered as a secondary end point. This assessment documented the lack of positive symptom exacerbation, as Vyvanse demonstrated significant improvement from baseline to 10-week end point on both positive and overall psychiatric symptoms as measured by the PANSS positive subscale (LOCF; mean change -1.0 plus or minus 2.2; 95% CI -1.4 to -0.5; p<0.0001) and PANSS Total score (LOCF; mean change -9.8 plus or minus 9.0; 95% CI -11.7 to -8.0; p<0.0001). The PANSS is a commonly used measurement scale for the assessment of schizophrenia symptoms worldwide.
In the 10-week open-label phase, 23 subjects (out of 92) discontinued from the study. Five subjects discontinued due to an adverse event. Of these 5 subjects, 3 subjects discontinued due to serious adverse events. Two of the serious adverse event reports were of exacerbation of schizophrenia. The other 3 subjects discontinued due to involuntary jaw movements, elevated blood pressure or sleepiness.
Forced discontinuation criteria were also used to further ensure patient safety. These criteria included changes in positive symptoms, compliance, urine drug screen, caregiver relationship, and thoughts of self-harm or harm to others. By these criteria, 5 additional subjects were discontinued in the open-label phase (2 subjects with positive symptom change, 1 subject with non-compliance, 1 subject with self-harm thoughts, and 1 subject who terminated their caregiver relationship). The remaining subjects (n = 13) withdrew for various other reasons including: protocol violation, withdrawal by subject, or failure to meet randomization requirement.
In the double-blind phase, 13 subjects (out of 69) discontinued from the study. Two subjects withdrew due to a serious adverse event, reported as the exacerbation of schizophrenia (1 subject taking placebo and 1 subject taking Vyvanse). A third subject (taking placebo) experienced a serious adverse event of dyspepsia and was discontinued due to failure to take investigational product. Additionally, 2 subjects were discontinued because they met forced discontinuation criteria due to positive urine drug screens (1 taking placebo, 1 taking Vyvanse).
The adverse events (greater than or equal to 5%) reported in this study included headache (14.1%), insomnia and decreased appetite (10.9% each), dizziness (8.7%), dry mouth (6.5%) and diarrhea (5.4%). Mean changes in blood pressure and pulse were all consistent with the current product labeling in ADHD. There were no notable effects on ECG or clinical laboratory assessments.
This is the end of the thread.
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