This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Bipolar disorder BD is considered one of the most disabling mental conditions, with high rates of morbidity, disability, and premature death from suicide. Although BD is often misdiagnosed as major depressive disorder, some attention has recently been drawn to the possibility that BD could be overdiagnosed in some settings.
Abstract We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine.
Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics.
Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs.
The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity.
Bipolar affective episodes were split up in three different groups according to its polarity and evaluated in terms of clinical and treatment characteristics (electrode placement, number of ECT sessions per course, length of hospitalization, number of readmissions, and time to readmission). Another step to treating cognitive impairment in bipolar disorder is to identify and treat subclinical symptoms and comorbidities, including substance use disorder, anxiety, attention deficit. Bipolar disorder is fraught with diagnostic difficulties. More than 1 in 3 times, patients with bipolar disorder leave the psychiatrist’s office with an incorrect diagnosis (1), and the resulting delay in proper treatment can sometimes lead to disastrous consequences, including a heightened risk of suicide.
We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients.
To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation. Treat ment of both phases of the illness can be complex, because the same treatments that alleviate depression can cause mania, hypomania, or rapid cycling defined as four or more episodes in 12 monthsand the treatments that reduce mania might cause rebound depressive episodes.
We focus on contemporary issues in the acute and maintenance treatment of bipolar disorder. Developments in diagnosis and neurobiology are beyond the scope of this review and are mentioned only when they have direct implications for management.
Despite a substantial expansion of research into bipolar disorder and potential treatments during the past 2 decades, true advances have been few. The development of effective treatments for bipolar disorder is hampered by our scarce knowledge of basic disease mechanisms and the consequent absence of validated pharmacological targets, and unconvincing animal or human experimental drug models table 1 provides a summary of putative treatment targets.
Most newly introduced treatments for bipolar disorder, whether pharmacological or psychological, have been based on an extension of use from another disorder—eg, antipsychotics in mania and antidepressants or cognitive-behavioural therapy for bipolar depression.
However, lithium remains unique because its main therapeutic use is in bipolar disorder, and investigation of its mechanism of action has, and remains, crucially important in the identification of future targets. Table 1 Validation evidence of putative treatment development targets in bipolar disorder Evidence of target validation.The characteristics and health needs of pregnant (inpatient or intensive home treatment) compared with women with affective disorders.
Both groups had high levels of domestic abuse in pregnancy (recorded in %), were from women with bipolar disorder or affective psychoses.
Oct 10, · Which patient characteristics predict the effectiveness and harms of pharmacologic and nonpharmacologic treatments for people with bipolar disorder, including disease-specific characteristics such as bipolar type, phase severity, pediatric onset, new onset, treatment resistant, types of depression, and other comorbidities .
Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.
been confined to unipolar affective disorders and have excluded bipolar dis orders. Investigations of bipolar disorders, on the other hand, have focused pre dominantly on psychobiological aspects of the illness and its pharmacological treatment.
As a result, the role of personality in bipolar disorder has been a rel atively neglected area of study. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
During the last few decades, there has been growing interest in identifying and treating cognitive impairment in bipolar disorder, especially as it .