Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control. Anxiety disorders occur more frequently as a comorbidity in mixed bipolar episodes than in non-mixed bipolar depression or mania. Substance (including alcohol) use also follows this trend, thereby appearing to depict bipolar symptoms as no more than a consequence of substance use. Comorbid conditions
People with bipolar disorder often have other co-existing psychiatric conditions such as anxiety (present in about 71% of people with bipolar disorder), substance abuse (56%), personality disorders (36%) and attention deficit hyperactivity disorder (10–20%) which can add to the burden of illness and worsen the prognosis. Certain medical conditions are also more common in people with bipolar disorder as compared to the general population. This includes increased rates of metabolic syndrome (present in 37% of people with bipolar disorder), migraine headaches (35%), obesity (21%) and type 2 diabetes (14%). This contributes to a risk of death that is two times higher in those with bipolar disorder as compared to the general population.Substance use disorder is a common comorbidity in bipolar disorder; the subject has been widely reviewed. Causes
The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear.
Meropenem/vaborbactam, sold under the brand name Vabomere among others, is a combination medication used to treat complicated urinary tract infections, complicated abdominal infections, and hospital-acquired pneumonia. It contains meropenem, a β-lactam antibiotic, and vaborbactam, a β-lactamase inhibitor. It is given by injection into a vein.Common side effects include headache, inflammation at the site of injection, nausea, diarrhea, liver inflammation, and low blood potassium. Severe side effects may include anaphylaxis, seizures, and Clostridium difficile-associated diarrhea. It is unclear if use during pregnancy is safe. Meropenem works by blocking the construction of the bacterial cell wall while vaborbactam blocks the breakdown of meropenem by some β-lactamases.The combination was approved for medical use in the United States in 2017 and Europe in 2018. It is on the World Health Organizations List of Essential Medicines. Medical uses
It is used to treat complicated urinary tract infections, complicated abdominal infections, and hospital-acquired pneumonia.In a study of 545 adults with complicated urinary tract infections, 98 percent of adults treated with Vabomere compared with about 94 percent of adults treated with piperacillin/tazobactam were cured defined as improvement in symptoms and a negative urine culture. About seven days after completing treatment, roughly 77 percent of adults treated with Vabomere compared with about 73 percent of those treated with piperacillin/tazobactam had resolved symptoms and a negative urine culture. Children
Successful bacteremia clearance in a child has been reported using a meropenem-vaborbactam dose of 40 mg/kg every 6 hours given over 3 hours.