Reply to Nutritional Approach to Bipolar Disorder
Bibliographic record
Abstract
Mania Associated With Initiation of ZiprasidoneSir: The efficacy of atypical antipsychotics in the treatment of psychotic disorders is well established.Although olanzapine carries an additional indication for bipolar disorder, there are cases of mania associated with risperidone 1,2 and olanzapine 3,4 treatment in some patients.We present a case report of mania that was apparently induced in a patient shortly after beginning therapy with another atypical antipsychotic, ziprasidone. Case report.Mr. A was a 20-year old man with a history of auditory hallucinations, paranoid delusions, flat affect, and social withdrawal.His symptoms worsened over several weeks, necessitating admission to our inpatient psychiatric unit.Haloperidol and risperidone trials had been attempted in the past, but he had refused treatment for 8 months prior to meeting us.Regarding this period, family members related waxing and waning of symptoms throughout, and they urged him to resume treatment.He had no history of drug/alcohol abuse, and his past medical/neurologic history was unremarkable.With the patient meeting DSM-IV-TR diagnostic criteria for schizophrenia, we began ziprasidone, 20 mg b.i.d., with 20-mg b.i.d.increases over 4 days to 80 mg b.i.d.Due to daytime sedation, his dose was changed to 160 mg h.s.That night, because he slept poorly but related no other symptoms, ziprasidone was decreased to 80 mg h.s.The following night, he displayed increased energy with elated mood.He had increased religiosity and jumped over chairs, danced, and sang on a table.Lorazepam (2 mg) was emergently administered twice over 36 hours for his agitation and manic behavior.The ziprasidone therapy was discontinued, and olanzapine therapy was initiated as he refused lithium and valproic acid.The manic symptoms resolved over 48 hours, and his psychotic symptoms resolved over 30 days.Follow-up at 3 months, during which time he was maintained on 20 mg of olanzapine daily, revealed no further symptoms of mania, although some paranoid delusions remained.On the basis of a recent literature search, this case represents the first report of mania associated with ziprasidone.Despite reports of the induction of mania by atypical antipsychotics, many authors find these agents (including ziprasidone 5 ) helpful in treating manic symptoms seen in bipolar and schizoaffective disorders.In a review of risperidone/olanzapine-induced mania, it was speculated the cause was due to 5-HT 2 /D 2 receptor occupancy.6 However, ziprasidone differs from the older atypicals in its profound 5-HT 1D and 5-HT/norepinephrine (NE) reuptake inhibition effect-similar to amitriptyline and imipramine.Perhaps the tricyclic-like antidepressant effect of ziprasidone precipitated our patient's mania.We acknowledge that this case could represent a manic break in a patient who suffers from schizoaffective disorder.However, when the criteria proposed by Aubry et al. 6 are ap-Dr.Nolan reports no financial or other relationship relevant to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.024 | 0.036 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".