Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. 
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. 
Bipolar Disord 2012: 00: 000–000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd.The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first‐line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first‐line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first‐line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second‐line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not‐recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long‐acting injection, and adjunctive ziprasidone continue to be first‐line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third‐line options.

No abstract

Accruing data suggest that oxidative stress may be a factor underlying the pathophysiology of bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SCZ). Glutathione (GSH) is the major free radical scavenger in the brain. Diminished GSH levels elevate cellular vulnerability towards oxidative stress; characterized by accumulating reactive oxygen species. The aim of this study was to determine if mood disorders and SCZ are associated with abnormal GSH and its functionally related enzymes. Post-mortem prefrontal cortex from patients with BD, MDD, SCZ, and from non-psychiatric comparison controls were provided by the Stanley Foundation Neuropathology Consortium. Spectrophotometric analysis was utilized for the quantitative determination of GSH, while immunoblotting analyses were used to examine expression of glutamyl-cysteine ligase (GCL), GSH reductase (GR), and GSH peroxidase (GPx). We found that the levels of reduced, oxidized, and total GSH were significantly decreased in all psychiatric conditions compared to the control group. Although GCL and GR levels did not differ between groups, the levels of GPx were reduced in MDD and SCZ compared to control subjects. Since oxidative damage has been demonstrated in MDD, BD, and SCZ, our finding that GSH levels are reduced in post-mortem prefrontal cortex suggests that these patient groups may be more susceptible to oxidative stress.

Bipolar I disorder (BD) has a poorer longer-term outcome than previously thought, with persistent cognitive impairment and functional decline. The neurobiological underpinnings that might underlie these changes remain unknown. Changes in brain-derived neurotrophic factor (BDNF) levels and cytokines are potential candidates. The aim of this study was to examine both cytokine and BDNF levels and their relationship in BD patients in the early and late stages of the disorder. We measured serum BDNF, TNF-alpha, IL-6 and IL-10 levels in a total of 60 patients with BD I and we compared those in early stages of illness with those in late stages of illness and also compared both groups with 60 matched healthy controls. BDNF was decreased only in those patients in the late stage of bipolar disorder. Moreover, BDNF levels were negatively correlated with length of illness. In contrast, all interleukins and TNF-alpha were increased in the early stages of BD, compared to controls. While TNF-alpha and IL-6 continued to be significantly higher than controls at late stages of BD, IL-10 did not. When levels were compared between patients at early and late stages of illness, there was a significant decrease in BDNF and IL-6 in the later stage of BD compared to the early stage. Inversely, TNF-alpha showed a significant increase at the later stage. Failure of inflammatory defences in the late stage of the disorder may account for reduction in BDNF and continued elevations in cytokines; thus these may have the potential to serve as markers of illness progression in BD.

Rev Bras Psiquiatr. 2006;28(1):80-5 83 Cartas aos editores consagram o lítio como primeira escolha terapêutica em pra-ticamente todas as fases e apresentações do TB. 5 Conclui-se que os psiquiatras (principalmente aqueles em formação) de-vem ser estimulados a conhecer de forma precisa as indica-ções do lítio e aprenderem a utilizar esta medicação, que tem auxiliado tantos pacientes. O legado do brilhante professor e pesquisador Mogens Schou, falecido recentemente, permanece mais atual do que nunca. Alegre (RS), Brasil Referências 1. Fieve RR. Lithium therapy at the millennium: a revolutionary drug used for 50 years faces competing options and possible demise. Bipolar Disord. 1999;1(2):67-70. 2. Schou M, Juel-Nielsen N, Stromgren E, Voldby H. The treatment of manic psychoses by the administration of lithium salts. J Neurol Neurosurg Psychiatry. 1954;17(4):250-60. 3. Schlagenhauf G, Tupin J, White RB. The use of lithium carbonate in the treatment of manic psychoses. Am J Psychiatry. 1966;123(2):199-207. 4. Sr. Editor, Nos últimos anos, a psiquiatria brasileira avançou muito no sentido de declarar todo e qualquer potencial conflito de interesse. No último congresso da Associação Brasileira de Psiquiatria (ABP), em Belo Horizonte (MG), todos os partici-pantes foram solicitados a declarar qualquer envolvimento comercial que pudesse, mesmo que remotamente, influen-ciar as suas apresentações. A própria Revista Brasileira de Psiquiatria (RBP) tem orientações muito claras para os auto-res quando da submissão dos artigos. Por isso, foi com grande surpresa que li, na última edição da RBP, o artigo do grupo do GREA-USP, 1 no qual não consta o reconhecimento de conflitos de interesse. É fato público que pelo menos dois dos autores desse artigo trabalham ou trabalharam na época da submissão do artigo numa ONG com financiamento da indústria do álcool (CISA). Na área da dependência química, várias das principais re-vistas internacionais têm códigos muito bem definidos sobre fontes de potencial conflitos de interesse, especialmente quan-do se trata de profissionais que aceitam financiamento da in-dústria do cigarro e do álcool. A declaração de haver, por parte dos profissionais, o envolvimento com a indústria do álcool ou do cigarro, lógico que não coloca necessariamente sob suspeita todo o eventual trabalho sério do ponto de vista científico. No entanto, acho que é um direito dos leitores da RBP saberem as eventuais fontes de conflitos de interesse para desenvolverem a sua própria opinião sobre a influência dessas indústrias na qualidade dos artigos publicados. Espero que os editores da RBP possam corrigir essa falta de informação.