Revelan primeros contenidos de telegramas que hacen referencia a Chile
Se trata de un documento en que la ex presidenta, Michelle Bachelet, entrega su opinión sobre la política latinoamericana y, en especial, respecto a la situación de Argentina, al secretario adjunto de Washington para Latinoamérica, Arturo Valenzuela.
Luego de 48 horas de que Wikileaks revelara telegramas confidenciales de la diplomacia estadounidense, enviados por varias embajadas de Estados Unidos al Departamento de Estado, el diario El País de España hace la primera mención directa a uno de los cables referidos a Chile.
El informe recoge la opinión de la ex presidenta Michelle Bachelet sobre la actualidad de la región, y su preocupación por la política argentina. Esta fue entregada por la ex mandataria al secretario adjunto de Washington para Latinoamérica, Arturo Valenzuela, cuando éste estuvo en Chile en enero de 2010.
Según se lee en el sitio web de ese medio, “la presidenta chilena pasa revista a la actualidad latinoamericana en su conjunto y, en el caso de Argentina, afirma el documento, 'expresa francamente los retos que enfrenta ese país, desde sus débiles instituciones y su falta de una democracia robusta a su inestable presidente", en alusión al ex mandatario transandino Néstor Kirchner
De acuerdo a lo expresado en El País, el texto no atribuye palabras exactas a Bachelet, “sino que resume una conversación”.
Varios de los telegramas filtrados hablan del “difícil trato personal” de los embajadores y diplomáticos estadounideneses presentes en la región con Néstor Kirchner y Cristina Fernández, la actual presidenta de ese país. Asimismo, se reveló que el Departamento de Estado ordenó indagar sobre la salud mental de la Señora "K".
vNominated for Favorite World Artist at 2010 Independent Music Awards!
vNominated for 4 Canadian Reggae Music Awards! (Top Newcomer, Top Singer, Top Album, Top Producer) -- Feb, 2009
vSpotlighted “Artist of the Week” on CBC Radio 1, Home Run, 12-12-08
“If there ever was a time, since Bob Marley, where Reggae could actually penetrate popular music, Auresia definitely has the potential to do it”, Duke Eatmon, CBC Radio 1, Home Run.
“…it's obvious that Auresia is a talent worth watching”--- David Dacks, Exclaim!
BIOGRAPHY
Focusing on the positive in a musical style that has had its share of occupational hazards, Auresia is unfazed by the chaos often associated with her genre, such as having to cancel a show in Calgary due to a shooting between local reggae DJs. A singer, song writer and guitarist out of Montreal, she was nominated for Favorite World Artist at the 2010 Independent Music Awards and for 4 Awards at the 2009 Canadian Reggae Music Awards.
Born in Edmonton of Ukrainian decent, Auresia has been singing and charming audiences from the age of three. Her style is a new breed of Reggae for the urban soul; deep roots riddims swathed by the melodies of Auresia’s sweet and haunting voice. Through her intricate melodies, beautiful harmonies and combination of world, soul, r&b and conscious lyrics it’s evident that Auresia’s sound is diverse.
Auresia show is high-energy and positive vibes while still captivating the audience with her meditative vocals. After years of performing in Europe, the US, Jamaica, and after touring Canada from East to West(26 dates in 2009 Canada Roots Tour and 24 dates on her 2010 SummerCanada Love Tour), Auresia has developed a strong fan base. She is scheduled to perform more internationally later this Fall and Winter in Jamaica, Colombia, Brazil, Chile and Argentina with the release of new singles and videos: “Fuel Up ( On Love)” and “Rising Smile”in late 2010/ early 2011, leading up to her sophomore albumto be released Summer 2011.
(Auresia Bio Cont… Pg 2.)
Auresia has played Montreal and Ottawa Int’l Reggae Fests, Toronto Rastafest and Sistah Fest, Koots Roots, Cortes Arts Festivals in BC, the Queens of Reggae series and also has graced the stage at various Clubs in Western Europe and in Jamaica. She has shared the stage with Kymani Marley, Sister Nancy, Tanya Stephens, Sugar Minott, Sanchez, Shaggy, Queen Ifrica, Tony Rebel, Clinton Fearon, and Canadian favorites’ Ibo & Kindread and Kali & Dub Inc.
Releasing her self- titled debut in 2008, she has been writing new material, releasing her 1st single:” Fuel Up (On Love)” on November 12, 2010.She is also working on her sophomore album - “Dangerous in Love” ( working title), to be recorded this Winter and Spring 2011 and released late Summer 2011.
REVIEWS of AURESIA’s DEBUT ALBUM:
‘Auresia’-self-titled album, released November, 2008
"This Montreal singer's debut is a thoroughly captivating disc, with more inventive hooks and melodic touches than most roots albums. When it all comes together on majestic tracks like the Augustus Pablo-flavoured "Jah Goddess" and the heartfelt and focused tribute to her mother, "Echoes of Fall," it's obvious that Auresia is a talent worth watching. Every track on this album is deep and delicious, with bass sweetness and dub-informed production." -- David Dacks, Exclaim! Feb/March 2009
“Montreal has produced an artist who can run the range of Jamaician influence- Auresia. Tunes like “Give a Little Time” and “Jah Goddess” are emblematic of Auresia’s golden-era styled reggae, reaching back to the 1970’s, melodica and all- though she adds in a little contemporary influence, her sweet, soft voice becoming a little less so on a track like “What is Right.” A competent debut from a talented artist who knows how to combine a folk-driven style with the roots of reggae.”8/10– Erin MacLeod, Montreal Mirror, January 15-21, 2009.
"One of the most distinctive things about Auresia's music is that although like many singers here and abroad, she writes good and meaningful lyrics, she also has the very rare (at least in reggae) ability to compose and play the music beautifully as well. She is a consummate musician, a skillful singer and deftly uses her voice as one of the instruments in the mix. Auresia is one of the few people left who truly understands the value of non-synthesized sounds and is the first female reggae producer from Quebec I have ever heard, and one of the first Canadians this year to properly orchestrate/arrange a horn section, complete with melodica; Proper!"- DJ Chocolate, Radio DJ CKLN, Toronto, ONT
"Auresia is Montreal's own Queen of Reggae! Her combination of reggae, RnB and roots own her a style that is uniquely her own."- Empress Soul, Positive Creations Music Collective, Canada
“… a stylish and smooth reggae recording that speaks both a personal and universal truth. Auresia's passionate approach to music and life helps explain why the album garnered four nominations at this year's Canadian Reggae Music Awards…”—Francois Marchand, Edmonton Journal, Edmonton, AB
Montreal Reggae Artist AURESIARaises the “Green” Bar with Eco-Dancehall Release
In the 2 years since she dropped her critically acclaimed eponymous, self-titled album in Nov. 2008, Auresia has been one of the busiest independent artists on the Canadian musical landscape, reggae stylings or not. With 2 cross country tours behind her, dozens of festivals and home-town shows, a “Favorite World Artist” nomination at the 2010 Canadian Independent Music Awards, and 4 nominations at the 2009 Canadian Reggae Music Awards, she is becoming a familiar artistic entity throughout Canada to both audiences and industry types. Now she takes her unique blend of Caribbean flavors and Urban soul to new heights of social consciousness with the release of her latest single (and first official dancehall track)“Fuel Up (On Love)”.
Co-produced by Auresia and David Lines (using the Accopocco “riddim” from Smokey House Productionz in Toronto, mixed in Jamaica by world-renowned dancehall engineer Tandra Tjahgroo), Fuel Up (On Love) is a musical statement which recognizes the fact the we are aware of the situation with our environment and natural resources, yet most of us are too preoccupied or feel too powerless to affect any real change.Loaded with unforgettable hooks, and a rhythm that will not let you sit still, Fuel Up (On Love) shows us that the answers to the ecological issue lie within each of us.Based on immediate reaction from test audiences, many feel this could be a contender for this year’s Juno awards.
Auresia is currently setting plans in motion for tours in Jamaica, Colombia, Brazil, Chile and Argentina for 2011 and has an upcoming music video release for her song “Jah Goddess” on December 4th.Her sophomore album (working title “Dangerous in Love” ) to be released Summer 2011.
Auresia has played Montreal and Ottawa Int’l Reggae Fests, Toronto Rastafest and Sistah Fest, Koots Roots, Cortes Arts Festivals in BC, the Queens of Reggae series and also has graced the stage at various Clubs in Western Europe and in Jamaica. She has shared the stage with Kymani Marley, Sister Nancy, Tanya Stephens, Sugar Minott, Sanchez, Shaggy, Queen Ifrica, Tony Rebel, Clinton Fearon, and Canadian favorites’ Ibo & Kindread and Kali & Dub Inc.
HEAR & BUY THE TRACK on WWW.MYSPACE.COM/AURESIAand at WWW.AURESIA.COM
For more info:
--
***Nominated for Favorite World Artist at The 2010 Annual Independent Music Awards!~
and 4 Awards at the 2009 Canadian Reggae Music Awards ***
En Seúl, Presidenta Cristina Fernández pidió que el mundo tome de ejemplo a la Argentina
Ante un grupo de empresarios, afirmó que la crisis global debe ser abordada "con un concepto de cooperación internacional".
Antes de iniciar su participación en las actividades oficiales de la cumbre del G-20, que arrancaron esta tarde (de Seúl, primera hora de la mañana en la Argentina) con una recepción que ofreció el presidente surcoreano Lee Myung-bak, la presidenta Cristina Fernández de Kirchner sugirió ante un grupo de empresarios que, para superar la crisis global, el mundo tome como ejemplo a la Argentina.
La mandataria inició sus actividades en Corea del Sur con una exposición en un seminario de la Cumbre de Negocios del G-20 ante más de treinta ejecutivos de multinacionales que tienen intereses en la Argentina. A ellos les dijo que las políticas de crecimiento del kirchnerismo pueden ser un ejemplo de "lo que se puede aplicar a escala global" partiendo del criterio de que "no puede crecer un sector a costa de que se derrumbe el resto de la sociedad".
La mandataria rechazó además que la actual crisis global haya sido solo financiera. "Como todos sabemos –aseveró-, esconde causas mucho más profundas que deben ser abordadas con mucha seriedad y fundamentalmente con un concepto de cooperación internacional", remarcó, tras lo cual aseguró que la mayor responsabilidad debe ser de "los países desarrollados, porque el nivel de vida de sus habitantes es sustancialmente superior al de las economías en desarrollo".
También advirtió que "es importante tener un correcto diagnóstico de la enfermedad porque si no se corre el riesgo de darles distintos remedios al enfermo y enfermarlo aun más". E insistió en que "la cooperación internacional con seriedad, responsabilidad y racionalidad es la clave para abordar los problemas".
Antes de entrar al encuentro con los empresarios, en el que estuvo acompañada por el ministro de Economía Amado Boudou y el canciller Héctor Timerman, la Presidenta se reunió cinco minutos con su par de España, José Luis Rodríguez Zapatero, quien le transmitió sus condolencias por el fallecimiento del ex presidente Néstor Kirchner. En la audiencia estaban, entre otros, el titular y el secretario general de la UIA, Héctor Méndez y José Ignacio de Mendiguren, respectivamente, quienes ayer salieron a responder duramente al Gobierno por sus denuncias de que la inflación es ocasionada básicamente por los empresarios.
Más tarde, y antes de la reunión con el resto de los mandatarios del G-20 en la recepción que ofreció Lee Myung-bak, Fernández de Kirchner mantuvo un encuentro con el primer ministro de Canadá, Stephen Harper, con quien analizó las inversiones de la minera Barrick Gold en la Argentina. Los dos mandatarios ya se habían reunido en la última reunión del G20, en Toronto, en junio de este año, aunque en esa oportunidad también fue parte del encuentro el CEO de Barrick Gold, Peter Munk.
Tras la recepción, la agenda de la Presidenta continuará en las primeras horas de la mañana del viernes en Corea (esta noche en la Argentina) con las sesiones de la Cumbre del G-20, que se realizarán en el Centro de Convenciones y Exhibiciones de Seúl (COEX). Su última actividad Cristina en Seúl será la cena de gala de mañana, desde donde se dirigirá al aeropuerto internacional de Incheon para emprender el regreso hacia Buenos Aires.
Paul McCartney hizo vibrar a 45 mil personas en Buenos Aires
El show del ex beatle en Argentina contó con homenaje a sus ex compañeros John Lennon y George Harrison.
Paul McCartney dio vida esta noche a un concierto vibrante y nostálgico para las 45.000 personas que asistieron al estadio de River Plate de la Ciudad de Buenos Aires.
El ex beatle habló en español, flameó una bandera argentina y recurrió a los fuegos artificiales.
El músico británico comenzó el recital a las 21 horas locales (00:00 GMT) con un "Hola Buenos Aires" y los primeros acordes de "Venus and Mars", de su época de Wings, el primer grupo que formó tras la separación de Los Beatles.
El tiempo parece no pasar para McCartney, dueño de una voz privilegiada, intacta pese a los años, y una plenitud física que le permitió bailar y saltar en diferentes pasajes del concierto.
La noche tuvo varios homenajes, especialmente a John Lennon y George Harrison cuando cantó "A Day in the Life" y "Give Peace A Chance", en forma enganchada, y "Something", que provocó la emoción del público.
McCartney durante el show utilizó bajo (el que tiene la forma de violín), guitarra, y piano, aunque también alternó con mandolina y ukelele en algunas de sus canciones.
Margaret Trudeau and her advocacy work for people with mental illness at The Star Talks series
TORONTO, by JUAN CARLOS CORDERO, UNO International News Service.-Margaret Trudeau, the former wife of the late Prime Minister Pierre Trudeau and a mental health advocate, discussed her struggles with mental illness on Wednesday November 10 with Susan Delacourt, a member of the Toronto Star’s Ottawa bureau in the latest event in the Star Talks series presented by the Toronto Public Library and the The Toronto Star newspaper.
Trudeau also signed copies of her new book, Changing My Mind, which tells of the bipolar condition she has struggled with all her life and the medical treatment that has given her new happiness and balance.
The event took place at , Wednesday, Nov. 10, at the Appel Salon at the Toronto Reference Library, 789 Yonge St. , located one block north of Bloor St. Doors opened at , but it was completely full in minutes. 498 seated people, plus about a hundred listening in the internal video screen. It could be said sold out, because admission was free (usually there is some empty seats in other Talks in the same room). But certainly, the former First Lady of Canada got a great respect for her advocacy work and remembrances from the past that now are clear due to her diagnosed illness.
From dancing and partying with Rolling Stone’s frontman Mick Jagger to other behaviours, maybe the most touching part was rememebering when her daughterAlicia Mary Rose Kemper offered tea to her seeing hermoods. She simply said to her: “Mommy is sick”. A child is a child and has to grow, we parents do need to worry them with this. But then, when she was 10 year old, she needed to talk about a subject, she chooses Mental Health, and even brought me as a Guest Speaker, saying proudly: “Here, my mommy”
To all those who has family members and friends who have suffered or currently suffer from the Bipolar Disorder (usually known as Manic Depression), it was a touching moment that brought some tears. Her book dedication is explicit: “To Alicia Mary Rose Kemper and to all daughters of mothers who struggle with a mental illness”.
Bipolar, or manic-depressive disorder, is a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression.
Description
In the United States alone, more than two million people are diagnosed with bipolar disorder. Research shows that as many as 10 million people might be affected by bipolar disorder, which is the sixth-leading cause of disability worldwide. The average age of onset of bipolar disorder is from adolescence through the early twenties. However, because of the complexity of the disorder, a correct diagnosis can be delayed for several years or more. In a survey of bipolar patients conducted by the National Depressive and Manic Depressive Association (MDMDA), one-half of respondents reported visiting three or more professionals before receiving a correct diagnosis, and over one-third reported a wait of ten years or more before they were correctly diagnosed.
Bipolar I disorder is characterized by manic episodes, the "high" of the manic-depressive cycle. A person with bipolar disorder experiencing mania often has feelings of self-importance, elation, talkativeness, increased sociability, and a desire to embark on goal-oriented activities, coupled with the characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. Usually this manic period is followed by a period of depression, although a few bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common (mania characterized by anger and irritability).
Bipolar II disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. Bipolar depression may be difficult to distinguish from a unipolar major depressive episode. Patients with bipolar depression tend to have extremely low energy, retarded mental and physical processes, and more profound fatigue (for example, hypersomnia; a sleep disorder marked by a need for excessive sleep or sleepiness when awake) than unipolar depressives.
Cyclothymia refers to the cycling of hypomanic episodes with depression that does not reach major depressive proportions. One-third of patients with cyclothymia will develop bipolar I or II disorder later in life.
A phenomenon known as rapid cycling occurs in up to 20% of bipolar I and II patients. In rapid cycling, manic and depressive episodes must alternate frequently; at least four times in 12 months; to meet the diagnostic definition. In some cases of "ultra-rapid cycling," the patient may bounce between manic and depressive states several times within a 24-hour period. This condition is very hard to distinguish from mixed states.
Bipolar NOS is a category for bipolar states that do not clearly fit into the bipolar I, II, or cyclothymia diagnoses.
Causes and symptoms
The source of bipolar disorder has not been clearly defined. Because two-thirds of bipolar patients have a family history of affective or emotional disorders, researchers have searched for a genetic link to the disorder. Several studies have uncovered a number of possible genetic connections to the predisposition for bipolar disorder. A 2003 study found that schizophrenia and bipolar disorder could have similar genetic causes that arise from certain problems with genes associated with myelin development in the central nervous system. (Myelin is a white, fat-like substance that forms a sort of layer or sheath around nerve fibers.) Another possible biological cause under investigation is the presence of an excessive calcium build-up in the cells of bipolar patients. Also, dopamine and other neurochemical transmitters appear to be implicated in bipolar disorder and these are under intense investigation.
Key terms
Affective disorder — An emotional disorder involving abnormal highs and/or lows in mood. Now termed mood disorder.
Anticonvulsant medication — A drug used to prevent convulsions or seizures; often prescribed in the treatment of epilepsy. Several anticonvulsant medications have been found effective in the treatment of bipolar disorder.
Antipsychotic medication — A drug used to treat psychotic symptoms, such as delusions or hallucinations, in which patients are unable to distinguish fantasy from reality.
Benzodiazpines — A group of tranquilizers having sedative, hypnotic, antianxiety, amnestic, anticonvulsant, and muscle relaxant effects.
DSM-IV — Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This reference book, published by the American Psychiatric Association, is the diagnostic standard for most mental health professionals in the United States.
ECT — Electroconvulsive therapy sometimes is used to treat depression or mania when pharmaceutical treatment fails.
Hypomania — A milder form of mania which is characteristic of bipolar II disorder.
Mania — An elevated or euphoric mood or irritable state that is characteristic of bipolar I disorder.
Mixed mania/mixed state — A mental state in which symptoms of both depression and mania occur simultaneously.
Neurotransmitter — A chemical in the brain that transmits messages between neurons, or nerve cells. Changes in the levels of certain neurotransmitters, such as serotonin, norepinephrine, and dopamine, are thought to be related to bipolar disorder.
Psychomotor retardation — Slowed mental and physical processes characteristic of a bipolar depressive episode.
Over one-half of patients diagnosed with bipolar disorder have a history of substance abuse. There is a high rate of association between cocaine abuse and bipolar disorder. Some studies have shown up to 30% of abusers meeting the criteria for bipolar disorder. The emotional and physical highs and lows of cocaine use correspond to the manic depression of the bipolar patient, making the disorder difficult to diagnosis.
For some bipolar patients, manic and depressive episodes coincide with seasonal changes. Depressive episodes are typical during winter and fall, and manic episodes are more probable in the spring and summer months.
Symptoms of bipolar depressive episodes include low energy levels, feelings of despair, difficulty concentrating, extreme fatigue, and psychomotor retardation (slowed mental and physical capabilities). Manic episodes are characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms such as grandiose illusions.
Diagnosis
Bipolar disorder usually is diagnosed and treated by a psychiatrist and/or a psychologist with medical assistance. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence of bipolar symptoms. These include the Millon Clinical Multiaxial Inventory III (MCMI-III), Minnesota Multiphasic Personality Inventory II (MMPI-2), the Internal State Scale (ISS), the Self-Report Manic Inventory (SRMI), and the Young Mania Rating Scale (YMRS). The tests are verbal and/or written and are administered in both hospital and outpatient settings.
Psychologists and psychiatrists typically use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a guideline for diagnosis of bipolar disorder and other mental illnesses. DSM-IV describes a manic episode as an abnormally elevated or irritable mood lasting a period of at least one week that is distinguished by at least three of the mania symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of the symptoms are required.
Although many clinicians find the criteria too rigid, a hypomanic diagnosis requires a duration of at least four days with at least three of the symptoms indicated for manic episodes (four if mood is irritable and not elevated). DSM-IV notes that unlike manic episodes, hypomanic episodes do not cause a marked impairment in social or occupational functioning, do not require hospitalization, and do not have psychotic features. In addition, because hypomanic episodes are characterized by high energy and goal directed activities and often result in a positive outcome, or are perceived in a positive manner by the patient, bipolar II disorder can go undiagnosed.
Bipolar symptoms often present differently in children and adolescents. Manic episodes in these age groups are typically characterized by more psychotic features than in adults, which may lead to a misdiagnosis of schizophrenia. Children and adolescents also tend toward irritability and aggressiveness instead of elation. Further, symptoms tend to be chronic, or ongoing, rather than acute, or episodic. Bipolar children are easily distracted, impulsive, and hyperactive, which can lead to a misdiagnosis of attention deficit hyperactivity disorder (ADHD). Furthermore, their aggression often leads to violence, which may be misdiagnosed as a conduct disorder.
Substance abuse, thyroid disease, and use of prescription or over-the-counter medication can mask or mimic the presence of bipolar disorder. In cases of substance abuse, the patient must ordinarily undergo a period of detoxification and abstinence before a mood disorder is diagnosed and treatment begins.
Treatment
Treatment of bipolar disorder is usually achieved with medication. A combination of mood stabilizing agents with antidepressants, antipsychotics, and anticonvulsants is used to regulate manic and depressive episodes.
Mood stabilizing agents such as lithium, carbamazepine, and valproate are prescribed to regulate the manic highs and lows of bipolar disorder:
·Lithium (Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate, Lithotabs) is one of the oldest and most frequently prescribed drugs available for the treatment of bipolar mania and depression. Because the drug takes four to ten days to reach a therapeutic level in the bloodstream, it sometimes is prescribed in conjunction with neuroleptics and/or benzodiazepines to provide more immediate relief of a manic episode. Lithium also has been shown to be effective in regulating bipolar depression, but is not recommended for mixed mania. Lithium may not be an effective long-term treatment option for rapid cyclers, who typically develop a tolerance for it, or may not respond to it. Possible side effects of the drug include weight gain, thirst, nausea, and hand tremors. Prolonged lithium use also may cause hyperthyroidism (a disease of the thryoid that is marked by heart palpitations, nervousness, the presence of goiter, sweating, and a wide array of other symptoms.)
·Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood stabilizing agents. The drug often is used to treat bipolar patients who have not responded well to lithium therapy. Blurred vision and abnormal eye movement are two possible side effects of carbamazepine therapy.
·Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is one of the few drugs available that has been proven effective in treating rapid cycling bipolar and mixed states patients. Valproate is prescribed alone or in combination with carbamazepine and/or lithium. Stomach cramps, indigestion, diarrhea, hair loss, appetite loss, nausea, and unusual weight loss or gain are some of the common side effects of valproate. Note: valproate also is approved for the treatment of mania. A 2003 study found that the risk of death from suicide is about two and one-half times higher in people with bipolar disorder taking divalproex than those taking lithium.
Treating the depression associated with bipolar disorder has proven more challenging. In early 2004, the first drug to treat bipolar administration was approved by the U.S. Food and Drug Administration (FDA). It is called Symbyax, a combination of olanzipine and fluoxetine, the active ingredient in Prozac.
Because antidepressants may stimulate manic episodes in some bipolar patients, their use typically is short-term. Selective serotonin reuptake inhibitors (SSRIs) or, less often, monoamine oxidase inhibitors (MAO inhibitors) are prescribed for episodes of bipolar depression. Tricyclic antidepressants used to treat unipolar depression may trigger rapid cycling in bipolar patients and are, therefore, not a preferred treatment option for bipolar depression.
·SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), regulate depression by regulating levels of serotonin, a neurotransmitter. Anxiety, diarrhea, drowsiness, headache, sweating, nausea, sexual problems, and insomnia are all possible side effects of SSRIs.
·MAOIs such as tranylcypromine (Parnate) and phenelzine (Nardil) block the action of monoamine oxidase (MAO), an enzyme in the central nervous system. Patients taking MAOIs must cut foods high in tyramine (found in aged cheeses and meats) out of their diet to avoid hypotensive side effects.
·Bupropion (Wellbutrin) is a heterocyclic antidepressant. The exact neurochemical mechanism of the drug is not known, but it has been effective in regulating bipolar depression in some patients. Side effects of bupropion include agitation, anxiety, confusion, tremor, dry mouth, fast or irregular heartbeat, headache, and insomnia.
·ECT, or electroconvulsive therapy, has a high success rate for treating both unipolar and bipolar depression, and mania. However, because of the convenience of drug treatment and the stigma sometimes attached to ECT therapy, ECT usually is employed after all pharmaceutical treatment options have been explored. ECT is given under anesthesia and patients are given a muscle relaxant medication to prevent convulsions. The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that this electrical current alters the electrochemical processes of the brain, consequently relieving depression. Headaches, muscle soreness, nausea, and confusion are possible side effects immediately following an ECT procedure. Temporary memory loss has also been reported in ECT patients. In bipolar patients, ECT is often used in conjunction with drug therapy.
Adjunct treatments are used in conjunction with a long-term pharmaceutical treatment plan:
·Long-acting benzodiazepines such as clonazepam (Klonapin) and alprazolam (Xanax) are used for rapid treatment of manic symptoms to calm and sedate patients until mania or hypomania have waned and mood stabilizing agents can take effect. Sedation is a common effect, and clumsiness, lightheadedness, and slurred speech are other possible side effects of benzodiazepines.
·Neuroleptics such as chlorpromazine (Thorazine) and haloperidol (Haldol) also are used to control mania while a mood stabilizer such as lithium or valproate takes effect. Because neuroleptic side effects can be severe (difficulty in speaking or swallowing, paralysis of the eyes, loss of balance control, muscle spasms, severe restlessness, stiffness of arms and legs, tremors in fingers and hands, twisting movements of body, and weakness of arms and legs), benzodiazepines are generally preferred over neuroleptics.
·Psychotherapy and counseling. Because bipolar disorder is thought to be biological in nature, therapy is recommended as a companion to, but not a substitute for, pharmaceutical treatment of the disease. Psychotherapy, such as cognitive-behavioral therapy, can be a useful tool in helping patients and their families adjust to the disorder, in encouraging compliance to a medication regimen, and in reducing the risk of suicide. Also, educative counseling is recommended for the patient and family. In fact, a 2003 report revealed that people on medication for bipolar disorder had better results if they also participated in family-focused therapy.
Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood stabilizing agents. The drug has also been a useful prophylactic, or preventative treatment, in some bipolar patients. Common side effects of clozapine include tachycardia (rapid heart rate), hypotension, constipation, and weight gain. Agranulocytosis, a potentially serious but reversible condition in which the white blood cells that typically fight infection in the body are destroyed, is a possible side effect of clozapine. Patients treated with the drug should undergo weekly blood tests to monitor white blood cell counts.
Risperidone (Risperdal) is an atypical antipsychotic medication that has been successful in controlling mania when low doses were administered. In early 2004, the FDA approved its use for treating bipolar mania. The side effects of risperidone are mild compared to many other antipsychotics (constipation, coughing, diarrhea, dry mouth, headache, heartburn, increased length of sleep and dream activity, nausea, runny nose, sore throat, fatigue, and weight gain).
Olanzapine (Zyprexa) is another atypical antipsychotic approved in 2003 for use in combination with lithium or valproate for treatment of acute manic episodes associated with bipolar disorder. Side effects include hypotension (low blood pressure) associated with dizziness, rapid heartbeat, and syncope, or low blood pressure to the point of fainting.
Lamotrigine (Lamictal, or LTG), an anticonvulsant medication, was found to alleviate manic symptoms in a 1997 trial of 75 bipolar patients. The drug was used in conjunction with divalproex (divalproate) and/or lithium. Possible side effects of lamotrigine include skin rash, dizziness, drowsiness, headache, nausea, and vomiting.
Alternative treatment
General recommendations include maintaining a calm environment, avoiding overstimulation, getting plenty of rest, regular exercise, and proper diet. Chinese herbs may soften mood swings. Biofeedback is effective in helping some patients control symptoms such as irritability, poor self control, racing thoughts, and sleep problems. A diet low in vanadium (a mineral found in meats and other foods) and high in vitamin C may be helpful in reducing depression.
A surprising study in 2004 found that a rarely used combination of magnetic fields used in magnetic resonance imaging (MRI) scanning improved the moods of subjects with bipolar disorder. The discovery was made while scientists were using MRI to investigate effectiveness of certain medications. However, they found that a particular type of echo-planar magnetic field led to reports of mood improvement. Further studies may one day lead to a smaller, more convenient use of magnetic treatment.
Prognosis
While most patients will show some positive response to treatment, response varies widely, from full recovery to a complete lack of response to all drug and/or ECT therapy. Drug therapies frequently need adjustment to achieve the maximum benefit for the patient. Bipolar disorder is a chronic recurrent illness in over 90% of those afflicted, and one that requires lifelong observation and treatment after diagnosis. Patients with untreated or inadequately treated bipolar disorder have a suicide rate of 15-25% and a nine-year decrease in life expectancy. With proper treatment, the life expectancy of the bipolar patient will increase by nearly seven years and work productivity increases by ten years.
Prevention
The ongoing medical management of bipolar disorder is critical to preventing relapse, or recurrence, of manic episodes. Even in carefully controlled treatment programs, bipolar patients may experience recurring episodes of the disorder. Patient education in the form of psychotherapy or self-help groups is crucial for training bipolar patients to recognize signs of mania and depression and to take an active part in their treatment program.
Resources
Periodicals
"Family-focused Therapy May Reduce Relapse Rate." Health & Medicine Week (September 29, 2003): 70.
"FDA Approves Medication for Bipolar Depression." Drug Week (January 23, 2004): 320.
"Lithium and Risk of Suicide." The Lancet (September 20, 2003): 969.
Rossiter, Brian. "Bipolar Disorder." Med Ad News (March 2004): 82.
"Schizophrenia and Bipolar Disorder Could Have Similar Genetic Causes." Genomics & Genetics Weekly (September 26, 2003): 85.
Sherman, Carl. "Bipolar's Clinical, Financial Impact Widely Missed. (Prevalence May be Greater Than Expected)." Clinical Psychiatry News (August 2002): 6.
"Unique Type of MRI Scan Shows Promise in Treating Bipolar Disorder." AScribe Health News Service (January 1, 2004).
"Zyprexa." Formulary 9 (September 2003): 513.
Organizations
American Psychiatric Association. 1400 K Street NW, WashingtonDC20005. (888) 357-7924. http://www.psych.org.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA22201-3042. (800) 950-6264. http://www.nami.org.
National Depressive and Manic-Depressive Association (NDMDA). 730 N. Franklin St., Suite 501, Chicago, IL60610. (800) 826-3632. http://www.ndmda.org.
National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD20857. (888) 826-9438. http://www.nimh.nih.gov.
