Bipolar disorders: new approaches to therapy

Expert Opinion on Pharmacotherapy
S Watson, A H Young

Abstract

This article reviews the evidence supporting different somatic treatment strategies in the acute and maintenance treatment phases of bipolar disorder. Bipolar affective disorder is a chronic disorder with a life time incidence of 0.3 - 1.5/100 [1]. Severe affective disorder is associated with a risk of completed suicide of 6 - 15% [2,3]. Traditionally, bipolar disorder has been considered as an episodic disorder with good inter-episode recovery [4]. This is being increasingly challenged with patients demonstrating social, marital, occupational and cognitive dysfunction, even when euthymic [5]. The management of bipolar disorder should be considered in the context of; the type of episode, this may be manic, depressed or mixed; the degree and rate of recovery; the cycling frequency and precipitant, if any, for recurrence and the onset and evolution of the underlying illness. On average, four episodes occur every 10 years. However 13 - 24% of patients develop rapid cycling disorder, in which four or more episodes occur within a year. Patients with bipolar disorder often have co-morbid anxiety and substance abuse. Moreover, axis I co-morbidity may be associated with an earlier age at onset and worsening course of bipolar illness. [...Continue Reading

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Jun 27, 2003·Journal of Clinical Psychopharmacology·Francois Curtin

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