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Chapter 54. Treatment of Bipolar Disorder

Paul E. Keck, M.D.; Susan L. McElroy, M.D.
DOI: 10.1176/appi.books.9781585623860.443573

Sections

Excerpt

Bipolar disorder is a common, recurrent, often severe psychiatric illness that, without adequate treatment, is associated with high rates of morbidity and mortality (Goodwin and Jamison 2007). In the Global Burden of Disease survey, bipolar disorder was the sixth leading cause of disability worldwide in 1990 and, without improved access to treatment, was projected to remain so well into this century (Murray and Lopez 1996). Morbidity from bipolar disorder often extends well beyond manic, hypomanic, mixed, and depressive episodes. Full recovery of functioning can lag many months behind symptomatic improvement, and repeated episodes can lead to lasting functional impairment (Judd et al. 2005). Recent naturalistic outcome studies indicate that many patients with bipolar disorder spend protracted periods of time neither well nor syndromally ill but rather suffering from chronic subsyndromal, especially depressive, symptoms (Judd et al. 2002, 2003). Bipolar disorder is also among the most heritable of all medical illnesses (Goodwin and Jamison 2007).

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TABLE 54–1. Treatment principles for bipolar disorder
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TABLE 54–2. Clinical components of the management of bipolar disorder
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TABLE 54–3. Characteristics to evaluate in an assessment of suicide risk in patients with bipolar disorder
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TABLE 54–4. Evidence-based treatment of acute mania
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TABLE 54–5. Criteria for minimum adequate trials of antimanic agents
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TABLE 54–6. Evidence-based treatment of acute bipolar I depression
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TABLE 54–7. Evidence-based maintenance treatment of bipolar disorder
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TABLE 54–8. Common psychological issues associated with bipolar disorder

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A number of new atypical antipsychotic medications and antiepileptic agents are being studied as potential antimanic agents. Thus far, however, the only randomized, controlled clinical trial to demonstrate efficacy was for
2.
A 62-year-old woman is referred to you by a primary care colleague for evaluation of depression. After obtaining a detailed history, you make a diagnosis of bipolar II disorder with a current episode of depression. To avoid precipitating a switch from depression to mania, a prudent medication strategy for this patient would be to
3.
Which of the following mood stabilizers has demonstrated efficacy as monotherapy for acute bipolar depression?
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[Antimanic treatments in bipolar mixed states]. Encephale 2013;39 Suppl 3():S172-8.doi:10.1016/S0013-7006(13)70118-0.
[Treatment of depressive mixed states]. Encephale 2013;39 Suppl 3():S179-84.doi:10.1016/S0013-7006(13)70119-2.
 
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