Bipolar Disorders
TREATMENT FOR BIPOLAR DISORDERS
That the BPDs are recurring and chronic illnesses, long - term management
is imperative, not only for specific episodes but also between
episodes where
sub - syndromal symptoms occur that impact upon socio - economic functioning.
Successful long - term management is achieved by constructing a
therapeutic alliance with emphasis on empathy and understanding.
PHARMACOTHERAPY
Pharmacotherapy for the BPDs seeks to minimise symptoms, prevent reoccurrence and optimise social and economic functioning. Today, pharmacotherapy in the treatment of BPDs is considered long - term. Moreover, non - compliance in the use of medications is a recognised difficulty; studies showing up to 50% will discontinue the use of medication. Factors influencing discontinuation include intolerability to side effects of medications, denial of the illness and the perception that they are cured during a symptom free period. When on medication, pharmacotherapy may include the use of one or a combination of medications. Changes in pharmacotherapy are common in BPDs due to the changes in symptoms that occur with this illness.
Types of mood stabilisers
The medications, known as the mood stabilisers are the most widely
prescribed drugs in the treatment of the BPDs and used in moderating
or preventing the occurrence of alternating moods. Mood stabilisers
commonly used in the BPDs are listed in Table 4. Lithium was the
first mood stabiliser and remains one of the more widely used. Recent
studies suggest that as one ages, the therapeutic value of Lithium
may diminish.
TABLE 4 Mood stabilisers used in treating BPDs
- Lithicarb – Lithium Carbonate
- Epilim – Sodium Valproate
- Neurontin – Gabapentin
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- Tegretol – Carbamazepine
- Topamax – Topiramate
- Lamictal – Lamotrigine
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Antidepressant medication
When the symptoms are mild following an episode of mania
or hypomania, sufferers often respond to mood stabilisers alone.
When the depression becomes
chronic and severe, the use of antidepressant medication
becomes necessary, despite a possible risk of inducing a
manic or hypomanic episode. This
risk is minimal when a mood stabiliser is simultaneously
used.
Antipsychotic medication
The atypical antipsychotic medications listed in Table 5
are now commonly used in BPDs to alleviate psychotic symptoms
or augment the effect of
traditional mood stabilisers. They can also be used alone
as a mood stabiliser or when other stabilisers are without
effect.
PSYCHOTHERAPY
Psycho - education of the patient and relatives is imperative
in the treatment of those with BPDs. It should emphasise the course,
nature and variability of the illness, the significance of being
compliant with medication and the importance of minimal stress.
TABLE 5 The atypical antipsychotics used for treatment of
BPDs
- Risperdal – Risperidone
- Seroquel – Quetiapine
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- Zyprexa – Olanzapine
- Clozaril – Clozapine
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