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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.

Best evidence shows that antidepressant monotherapy threatens emergent mania in bipolar I (but evidently not bipolar II). Concurrent mood stabilizers avert the problem.

People with bipolar show abnormal circadian cycles of temperature and melatonin. Treatments for sleep disorder may help treat the bipolar itself.

New neuroanatomical studies demonstrate abnormalities in brain circuitry and anatomical disconnects between regions of the brain that help to explain the aberrations of emotion and reward processing in bipolar disorder.

New brain biomarker studies hint at an intriguing pathological mechanism for bipolar disorder. This kind of research is just what is needed, judging from recent editorials on the question.

Diagnosis and treatment problems for bipolar patients extend well beyond mere mood symptoms. These studies examine who needs care most, who is least likely to get it, and one way to improve adherence to treatment.

A bipolar "cure" is unlikely, because most patients who discontinue medication relapse, and often fairly quickly. For pregnant women, this presents difficult questions.

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