Iloperidone for Bipolar Disorder

Most recent medication to be approved for bipolar disorder is an atypical anti-psychotic, Iloperidone. To be more specific, this drug was approved by the US Food and Drug Administration for treatment of manic or mixed episodes associated with bipolar I disorder in adults. This can be considered a significant development because new medications and treatments in the field of psychiatry are few.

Iloperidone is an atypical anti-psychotic, with a mixed D2/5HT2A antagonism as its mechanism of action. It was first approved for acute treatment of schizophrenia in adults. 

References:

•  Vanda Pharmaceuticals' Fanapt (iloperidone) receives US FDA approval for the acute treatment of bipolar I disorder. News release. Vanda Pharmaceuticals Inc. April 2, 2024. Accessed April 2, 2024. https://www.prnewswire.com/news-releases/vanda-pharmaceuticals-fanapt-iloperidone-receives-us-fda-approval-for-the-acute-treatment-of-bipolar-i-disorder-302106405.html
• Torres R, Czeisler EL, Chadwick SR, Stahl SM, Smieszek SP, Xiao C, Polymeropoulos CM, Birznieks G, Polymeropoulos MH. Efficacy and Safety of Iloperidone in Bipolar Mania: A Double-Blind, Placebo-Controlled Study. J Clin Psychiatry. 2024 Jan 15;85(1):23m14966. doi: 10.4088/JCP.23m14966. PMID: 38236020.

Neurological soft signs in bipolar disorder

Q: What are neurological soft signs (NSS)?
Ans. These include subtle deficits of motor coordination, sensory integration and sequencing of complex motor acts. 

Q. Why are these called "soft" signs?
Ans. These are termed soft signs because they cannot be localized to a particular area in the brain.

Q. Why are these being studied?
Ans. NSS are being studied in a variety of psychiatric illnesses because they might have a bearing on severity of symptoms and clinical outcome of psychiatric illnesses such as bipolar disorder

References

• Chrobak AA, Soltys Z, Dudek D, Siwek M. Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry. 2023 Mar 8;121:110673.
• Negash, A., Kebede, D., Alem, A., Melaku, Z., Deyessa, N., Shibire, T., Fekadu, A., Fekadu, D., Jacobsson, L. and Kullgren, G., 2004. Neurological soft signs in bipolar I disorder patients. Journal of affective disorders, 80(2-3), pp.221-230.

Bipolar Disorder - Differential Diagnoses

 Following organic and functional disorders might mimic symptoms of Bipolar Disorder

• Anxiety disorders (ex. generalized anxiety disorder, panic disorder etc.)
• Hyperthyroidism
• Cushing's disease/ syndrome
• Multiple sclerosis
• Post Traumatic Stress Disorder
• Schizo-affective disorder
• Schizophrenia
• Attention Deficit Hyperactivity Disorder

Ref: 

1. World Health Organization(WHO). (1993). The ICD-10 classification of mental and behavioural disorders. World Health Organization.
2. Price AL, Marzani-Nissen GR. Bipolar disorders: a review. Am Fam Physician. 2012 Mar 1. 85(5):483-93

Bipolar Disorder - Types (DSM-5)

 Bipolar Disorder, as per the Diagnostic and statistical manual of mental disorders (5th ed.), includes the following types

1. Bipolar 1 : this is diagnosed when symptoms of mania last 7 days or more. Also, can be diagnosed when an individual has severe mania which requires hospitalization. 
2. Bipolar 2 : diagnosed when an individual has symptoms of hypomania, preceded or followed by a major depressive episode
3. Cyclothymic disorder : Includes symptoms of hypomania and depression that last for 2 years or more in adults, not severe enough to warrant a diagnosis of the above 2 conditions. 

Ref:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596