- Bipolar disorder is a cyclic mental illness with recurrent mood episodes that occur over a person’s lifetime. The symptoms, course, severity, and response to treatment differ among individuals.
- Bipolar disorder is likely caused by genetic factors, environmental triggers, and the dysregulation of neurotransmitters, neurohormones, and second messenger systems in the brain.
- Clinicians should be sure to obtain a detailed history, including potential substance use and medical illness, to avoid a delay in the diagnosis and treatment of bipolar disorder.
- The goal of therapy for bipolar disorder should be to improve patient functioning by reducing mood episodes. This is accomplished by maximizing adherence to therapy and limiting adverse effects.
- Patients and family members should be educated about bipolar disorder and treatments. Long-term monitoring and adherence to treatment are major factors in obtaining stabilization of the disorder.
- Lithium and valproate are the mainstays of treatment for both acute mania and prophylaxis for recurrent manic and depressive episodes. Anticonvulsants (such as lamotrigine, carbamazepine, and oxcarbazepine) and second-generation antipsychotics (such as aripiprazole, olanzapine, risperidone, quetiapine, and ziprasidone) are alternative or adjunctive treatments for bipolar disorder. Anticonvulsants may be more effective than lithium in several mood subtypes (e.g., mixed states and rapid cycling). The use of lithium, valproate, or quetiapine for acute bipolar depression should be considered as a first-line treatment option.
- Baseline and followup laboratory tests are required for some medications to monitor for adverse effects.
- Some patients can be stabilized on one mood stabilizer, but others may require combination therapies or adjunctive agents during an acute mood episode. If possible, adjunctive agents should be tapered and discontinued when the acute mood episode remits and the patient is stabilized. Adjunctive agents may include benzodiazepines, additional mood stabilizers or antipsychotics, and/or antidepressants.
On completion of this chapter, the reader will be able to:
Define the incidence, etiology, and pathophysiology of bipolar disorder.
List the DSM-IV-TR criteria for diagnosing bipolar disorder.
Explain the various roles of antipsychotics in the treatment of bipolar disorder.
Describe how benzodiazepines can aid in the treatment of acute mania.
Summarize the literature supporting the use of antipsychotics as mood stabilizers.
Compare and contrast the antiepileptic medications used in the treatment of bipolar disorder.
List baseline and routine laboratory tests and monitoring when prescribing antipsychotics and mood stabilizers.
Describe how to appropriately select drug therapy for acute mania in a patient with bipolar disorder and how to monitor for response and adverse effects.
Describe how to appropriately select drug therapy for acute depression in a patient with bipolar disorder and how to monitor for response and adverse effects.
Given patient-specific information, formulate a general treatment plan for a patient with bipolar disorder in an acute manic or depressive episode.
Evaluate and discuss the appropriateness of using antidepressants in bipolar disorder.
Design a treatment plan for a patient with bipolar disorder whose illness is currently stable.
Formulate a treatment plan for a special population patient, that is, pregnancy.
List drug interactions associated with ...