Fri July 25/2008
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Bipolar Disorder TreatmentBefore reading on, we would recommend to first learn about bipolar disorder and its symptoms. The following page discusses on the treatments for bipolar disorder. Medication Treatment for Bipolar DisorderThe treatment of mania and hypomania has two phases: an acute phase, in which the acute syndrome is quelled and social and occupational impairment is improved; and a maintenance phase, in which medications are administered long term to prevent the recurrences of the condition. Mood StabilizersLithiumIn the 1940s Australian psychiatrist John Cade discovered the tranquilizing properties of lithium. Since that time lithium has been the primary treatment for acute and prophylactic treatment of mania. In comparative studies with antipsychotic agents, it yields better overall improvement in most aspects of manic symptomatology, including psychomotor activity, grandiosity, manic thought disorder, insomnia, and irritability, according to Post in 2000. The type of patient most likely to respond to lithium carbonate is someone with a classic presentation and euphoric mania (rather than dysphoric mania) and a pattern of mania followed by a depression and then a well interval. The number of patients with this “classic” presentation is relatively small, hence lithium’s status as the “gold standard” treatment is under threat. Valproic AcidStudies by Bowden and colleagues in 1994 demonstrated that anticonvulsant medications such as valproic acid are efficacious in acute and maintenance treatment of bipolar disorder. This is possibly due to the effects on temporal lobe kindling and also its effects in acting on so-called inhibitory neurotransmitter systems that reduce neural activity. This research indicates that valproic acid seems to be the treatment of choice for dysphoric mania or mixed states as well as those patients with rapid-cycling types of bipolar disorder. Valproic acid also has the potential benefit of rapid oral loading in acute mania, which is usually well tolerated and associated with a rapid onset of response, according to Post in 2000. CarbamazepineCarbamazepine appears to have similar benefits as valproic acid, as described by Denikoff and colleagues in 1997; however, its side effect profile and potential for drug interactions tend to lessen its use. Lamotrigine Lamotrigine is a newly approved anticonvulsant
for add-on therapy that has antidepressant
and possibly mood-stabilizing properties, according to
Calabrese and colleagues in 1999. Its place in the management
of bipolar disorder is still being investigated;
however, a significant risk of severe rash may limit its GabapentinGabapentin is a newly approved anticonvulsant for adjunctive therapy that may also have some mood-stabilizing effects in bipolar patients. The drug appears to have positive effects on sleep and anxiety. TopiramateTopiramate is a recently approved add-on agent for treatment of refractory epilepsy. Preliminary experience suggests that it may have mood-stabilizing properties in rapid-cycling patients, with better antimanic than antidepressant effects, according to Post in 2000. AntiPsychotic AgentsThe use of major tranquilizers has historically been confined to the acute treatment of mania, particularly if there are psychotic features present. In recent years, a new class of major tranquilizers that lack the troublesome side effects of older antipsychotic agents has helped to improve the acute management of mania. These agents include risperidone and olanzapine (both serotonin-dopamine antagonists), which are frequently coadministered with mood stabilizers to control acute mania. In some cases, these agents need to be used for maintenance treatment as well. Psychological Management for Bipolar Disorder TreatmentPsychosocial factors may contribute 25 to 30% to the outcome variance of bipolar disorder and despite optimal pharmacotherapy, up to 50% of sufferers may encounter further episodes, according to Joyce in 1992. It is important to note, however, that all of the studies of psychological interventions in the treatment of bipolar disorder have been used during the recovery phase of treatment, and have been used only to prevent relapse—there is no evidence that any psychological intervention is of benefit in the acute treatment of mania. Family TherapiesSeveral studies support the efficacy of brief family-focused interventions in both inpatient and outpatient settings, with an emphasis on education, problem solving, and reduction of ambient stress within the family, as discussed by Miklowitz and colleagues in 1996. Group PsychotherapiesSeveral studies suggest the benefits of group therapies, although no actual controlled studies exist. There is limited evidence of benefits in the areas of compliance with medication, problem solving, and interpersonal functioning, according to Scott in 1995. Cognitive Behavior TherapyCognitive behavior therapy for bipolar disorder has focused on improving compliance and in recognition of early symptoms of relapse. The results of some trials suggest that this reduces relapse rates, and there are some observations of improvement in social functioning and employment stability. |
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