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New research is clarifying the link between brain glutamate levels and risk for psychosis in bipolar, as well as genes associated with the glutamate pathway that are overexpressed in bipolar.

Deficits in dopamine signaling are linked strongly to poor decision making in patients with bipolar. Is it time to stratify treatment based on this understanding?

Three studies investigate patterns of substance abuse among patients with bipolar disorder, and agents that may help.

Treating bipolar with lithium at its earliest onset increases the odds of success. However, vigilance for toxicities is in order, as two recent case studies demonstrate.

Bipolar patients with comorbid anxiety have worse outcomes, and adequate treatment for the anxiety is difficult. One recent study shows ziprasidone no better than placebo. A Canadian task force has offered guidelines.

Polypharmacy in the treatment of bipolar disorder is increasing in Asian countries, despite lack of evidence or support from guidelines. This echoes a broader trend for psychiatric conditions in North America.

Studies of dendritic spine density and of protein expression in the brain may indicate common origin for similar symptoms in schizophrenia and bipolar.

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