Is seasonal affective disorder a bipolar variant?

Kathryn A. Roecklein, PhD, Assistant professor of psychology, The University of Pittsburgh, Pittsburgh, PA

Kelly J. Rohan, PhD, Associate professor of psychology, University of Vermont, Burlington, VT

Teodor T. Postolache, MD, Associate professor of psychiatry, Director, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD

Seasonal affective disorder (SAD) is an umbrella term for mood disorders that follow a seasonal pattern of recurrence. Bipolar I disorder (BD I) or bipolar II disorder (BD II) with seasonal pattern (BD SP) is the DSM-IV-TR diagnosis for persons with depressive episodes in the fall or winter and mania (BD I) or hypomania (BD II) in spring or summer.

This article compares BD SP with major depressive disorder with seasonal pattern (MDD SP), in which depressive episodes usually occur in fall or winter and fully remit in spring or summer. Rather than being categorically distinct from each other, BD SP and MDD SP may represent extreme variants on a seasonal depression continuum from unipolar to bipolar.

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Older patients and substance abuse

Shannon M. Drew, MD, Assistant clinical professor of psychiatry, Yale School of Medicine, New Haven, CT

Kirsten M. Wilkins, MD, Assistant professor of psychiatry, University of Oklahoma College of Medicine-Tulsa, Tulsa, OK

Louis A. Trevisan, MD, Assistant clinical professor of psychiatry, Yale School of Medicine, New Haven, CT

As the eldest post-World War II “baby boomers” turn 64 this year, relaxed social attitudes about substance use during their lifetimes may predict an increasing risk for substance use disorders (SUDs) in older Americans. This article describes screening and treatment approaches shown to be most effective for identifying and managing primary SUDs in older patients. Our goal is to help you ask the right questions and provide appropriate care.

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Psychosis in women

Mary V. Seeman, MD, Professor emerita, Department of psychiatry, University of Toronto

Psychoses of unknown cause usually begin in late adolescence or early adulthood. Less frequently the onset occurs in later adulthood (age ≥40). Late-onset psychosis is much more prevalent in women than in men for reasons that are imperfectly understood.

When you are evaluating a midlife woman with first onset of psychosis, don’t assume an illness of unknown cause (bipolar disorder or schizophrenia) until after you have done a comprehensive search for triggers of her psychotic symptoms. After age 40, women are more likely than men to develop psychosis because of gender-specific medical and psychological precipitants.

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Treatment resistance is our greatest challenge

Henry A. Nasrallah, MD
Editor-in-Chief

We all have patients with thick charts, the mentally ill individuals who push our clinical skills to the limit. They respond poorly to the entire algorithm of approved medications for depression, anxiety, or psychosis. Their symptoms hardly budge despite multiple psychotherapeutic interventions. They lead lives of quiet desperation and suffer through many hospitalizations and outpatient visits. They are perennially at high risk for harm to self or others. They get many side effects yet meager benefits from pharmacotherapy. Their social and vocational functions often are minimal to nil. Their life has little meaning beyond doleful patienthood.

Treatment resistance in my long-suffering patients incites me to ask important questions that beg for answer.

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