Medication treatment of bipolar disorder in developmentally disabled children and adolescents.

The authors conducted a literature search using major databases covering the period from 1950 to June 2007 on the somatic treatment of bipolar disorder (BD) in normally developing and developmentally disabled youth. BD is an under-recognized condition in patients with developmental disabilities (DD) that further impairs the functioning of patients who already suffer from severe disability. However, while core symptoms of developmental disability cannot be cured, symptoms of BD in this population do respond to appropriate treatments. Moreover, successful treatment of bipolar spectrum disorder may improve social reciprocity or even cognitive functioning in certain patients. Diagnosis and treatment of BD present specific challenges as manifestation of symptoms may differ from people with normal cognitive functioning as may tolerability and side effect profile of conventional treatments. Systematic review and analysis of the literature allow tentative guidelines for treating BD in this vulnerable population. Clinical trials are clearly needed to further accumulate data for evidence-based treatment.

Depression and demoralization among Russian-Jewish immigrants in primary care.

The purpose of this study was to examine the levels and nature of psychological distress and depression among Russian-Jewish émigrés in primary care. Fifty-seven consecutive patients at the primary care clinic were assessed with the Hamilton Depression Scale (Ham-D). The subjects completed self-rating scales, including the Beck Depression Inventory (BDI), Life Orientation Test, Beck Hopelessness Scale, Attributional Style Questionnaire, and Snaith-Hamilton Pleasure Scale. Data on demographics and physical complaints were collected and analyzed. Of the patients studied, 82.5% experienced psychological distress (BDI > or = 10), and 43.9% had clinically significant depressive symptoms (Ham-D > or = 17). BDI and Ham-D scores were significantly correlated with the number of psychosomatic complaints, hopelessness, lack of optimism, anhedonia, and dysfunctional attributional style. The distressed, but not depressed, patients had preservation of hedonic capacity. The authors found a high rate of depression based upon Ham-D scores among the Russian-Jewish émigrés in primary care. The authors suggest that this high rate is attributable to a culturally specific tendency to express distress in somatic terms. The nature of distress was phenomenologically similar to demoralization.