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the cause of bipolar symptoms. Therapy for bipolar disorder often includes individual, group, and familytherapy to help patients and their friends and family understand the triggers, early signs, and treatmentof this condition.HEALTH SYSTEMS EDITIONVol. 34 No. 11TEAR ALONG PERFORATIONPATIENT TEACHING AIDBipolarDisorderNOVEMBER 2009The Journal for Pharmacists’ EducationU.S. Pharmacist is a Peer-Reviewed JournalDramatic High andLow Mood SwingsBipolar disorder, sometimes ca led manic depression,is a mental i lne s that is described as a fluctuationin mood extremes. Patients with bipolar disorder mayexperience high (mania) and low (depression) moodswings that are dramatic, seriously a fecting their livesand the lives of those around them. The cla sic picture of bipolar disorder includes swings from high tolow moods and back again, with each swing lasting from weeks to months and often with periods ofnormal mood in between the extremes. During mania, patients are often agitated, speeding throughtheir days with increased activity, little sleep, erratic behavior, and problems concentrating or stayingfocused. During depression, feelings of exhaustion, hopelessness, and futility are common, sometimeswith suicidal thoughts.The cause of bipolar disorder is most likely an imbalance in brain chemicals that a fect mood. Thisimbalance may be hereditary, since there is an increased risk of bipolar disorder and schizophreniawithin families. Diagnosis depends on a thorough history of mood and behavior in the past. Althoughabout 1% of the population has been diagnosed with bipolar disorder, the actual number of people isprobably much higher due to misdiagnosis.Without treatment, bipolar disorder is a debilitating condition that wi l not improve on its own.The goal of treatment is to stabilize the patient’s mood to avoid drastic and damaging mood swings.There are a variety of medications that act to even out the imbalance of brain chemicals thought to beCopyright Jobson Medical Information LLC, 2009 continuedIllustration: © 2009 Teri J. McDermott, MA, CMICOVER IMAGE:TeriMcDermott.comAs part of the reward pathway in alcoholuse, endorphins are released. Naltrexoneblocks the binding of endorphins to opioidreceptors, preventing dopamine release.CE CREDITSEmergency Contraception:An Update of Clinical andRegulatory Changes. See page 70THIS MONTHEditorial Focus: PsychotropicsNEXT MONTHEditorial Focus:Gastroenterologic DiseasesEarn additional CE credits online. Visit:www.uspharmacist.comCE PROGRAMS ON THEU.S. PHARMACIST WEB SITENew:Emergency Contraception: An Updateof Clinical and Regulatory ChangesRecent:Ovarian Cancer: One of theCommon Gynecologic MalignanciesPerimenopause: Managementof Common Symptoms Duringthe Menopausal TransitionAn Update on the CurrentTreatment of HIVIf you have any questions about ourCE programs, call (800) 825-4696,fax (212) 219-7849, or e-mailcecustomerservice@jobson.com.FEATURESSenior CareProgressive Supranuclear Palsy ...20Difficulty looking up without extending theneck or trouble using the stairs may be an initialsymptom of this condition.Mary Ann E. Zagaria, PharmD, MS, CGPSo Many Options, So LittleDifference in Efficacy: What Is theAppropriate Antidepressant? ...... 26These agents are equal in effectiveness, but itis hard to predict which one will work best fora given patient.Marjorie Rochette DeLucia, PharmD, MS,and Michael J. Schuh, PharmD, MBAMedications Used in OpioidMaintenance Treatment ............ 40It is important to keep abreast of currenttherapeutic options as increasingly morepatients are treated for dependence.Christie Choo, PharmD, BCPSHEALTH SYSTEMS EDITIONPTA0911 Bipolar 10_14scbo.indd 1 10/15/09 12:24 PMPATIENT TEACHING AIDBipolar Disorder. See page 17Pharmacologic Managementof Alcohol Dependence ............. 60Several medications are available that may helppatients achieve abstinence and avoid relapse.Krina H. Patel, PharmDPharmacy LawCriminalization ofMedication Errors ............ 66A recent case equating a pharmacist’s mistakewith manslaughter raises the question of pharmacytechnician responsibility.Jesse C. Vivian, BS Pharm, JD●2 CE CreditsEmergency Contraception:An Update of Clinical andRegulatory Changes ................ 70Current information about levonorgestrel-basedemergency birth control and strategies for educatingconsumers are discussed.Kathleen H. Besinque, PharmD, MSEdSchizophrenia: A Review of Pharmacologic andNonpharmacologic Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HS-2Pharmacists should play an active role in the management of this complicated form of mental illness.Stacy Eon, PharmD, and Jennifer Durham, PharmDProphylactic Therapies in Traumatic Brain Injury Management . . . . . HS-10Clear guidelines for the proper administration of drugs used to treat this condition are lacking.Jennifer Confer, PharmD, and Jon Wietholter, PharmDNewly Approved mTOR Inhibitors for the Treatment ofMetastatic Renal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . HS-20Temsirolimus and everolimus are now indicated as therapy for this type of cancer.Diana Hey Cauley, PharmD, BCOPIn-Service PrimersNutrition and Clinical Depression . . . . . . . . . . . . . . . . . . . . . . . . . . HS-28Manouchehr Saljoughian, PharmD, PhDU.S. PHARMACIST ® (ISSN 01484818; USPS No. 333-490) is published monthly by Jobson Medical Information LLC, 100 Avenue of the Americas, New York, NY 10013-1678. Periodicals postagepaid at New York, and additional mailing offices. Postmaster: Send address changes to U.S. PHARMACIST, P.O. Box 2027, Skokie, IL 60076-7927. Canada Post: Publications Mail Agreement #40612608.Canada Returns to be sent to Bleuchip International, P.O. Box 25542, London, ON N6C 6B2. Subscriptions: One-year subscription rate: USA $58.00; Faculty and Students at U.S. Colleges of Pharmacy$39.00; Canada $81.00 (U.S.); and air mail to all other countries $157.00. Single copies are $6.00 each. All subscriptions payable in U.S. dollars. Payment must accompany order. Send checks andsubscription requests to U.S. PHARMACIST, P.O. Box 2027, Skokie, IL 60076-7927 or call Customer Service:1-877-529-1746 (U.S. only) or 1-847-763-9630. Copyright 2009 by Jobson MedicalInformation LLC, 100 Avenue of the Americas, New York, NY 10013-1678. Reproduction of articles without permission from the publisher is expressly prohibited. Acceptance of advertising by U.S.PHARMACIST does not constitute endorsement of the advertiser, its products or services. The opinions, statements and views expressed by contributors to U.S. PHARMACIST are the authors’ and donot necessarily reflect those of the publisher, editor-in-chief, editors, editorial board of advisors, or the staff of U.S. PHARMACIST.6U.S. Pharmacist • November 2009 • www.uspharmacist.com