What is the role of electrophysiologic kindling and behavioral sensitization processes in the pathophysiology of bipolar affective disorder (manic-depressive illness)?

Updated: May 30, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Post et al had previously proposed a mechanism involving electrophysiologic kindling and behavioral sensitization processes, which resonates with the neuronal injury hypothesis. [24] They asserted that a person who is susceptible to bipolar disorder experiences an increasing number of minor neurologic insults—such as those induced by drugs of abuse, stress-related excessive glucocorticoid stimulation, oxidative or immune-mediated damage—that eventually resulting in mania that further compromises the injured neurons. [24] Sufficient brain damage might persist to cause mania to recur even with no or minor environmental or behavioral stressors.

Post et al’s formulation helps explain the effective role of anticonvulsant medications (eg, carbamazepine and valproate) in the prevention of the highs and lows of bipolar disorder. It also supports clinical observations that the more episodes a person experiences, the more he or she will have in the future, underscoring the need for long-term treatment.

For more information, see the Medscape Reference topic Genetics of Bipolar Disorder.

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