Pharmacological therapy for bipolar disorder

Scientists pay great attention to the phenomenology of bipolar disorder. This is due to significant difficulties in the diagnosis of this disease, namely , late detection and misdiagnosis, as well as the fact that the pharmacogenic factor influences its course.         

Mortality rates in patients receiving and not receiving pharmacotherapy indicate the effect of a pharmacogenic factor on the course and prognosis of bipolar disorder. In patients receiving pharmacotherapy, mortality rates are lower than in patients who are not receiving treatment. At the same time, in the process of pharmacotherapy, mortality from suicides is reduced by more than 4 times.             

In different periods of the disease, it can be seen that only complex pharmacotherapy with a careful choice of therapeutic tactics at different stages of the disease helps to stabilize the condition and maintain the social adaptation of patients.    

At the present time it does not exist “ideal” drug, which is provided to all the clinical effects of antidepressant for the treatment of the depressive phase, antimanic in the treatment of mania, an antipsychotic for the treatment of affective-delusional states and prophylactic to prevent recurrence.      

In bipolar disorder, the primary drugs are normotimics, which must be prescribed in the early stages, followed by continuous use throughout life. In this group include lithium carbonate, sodium valproate, and carbamazepine and lamotrigine.      

The success of preventive therapy will determine the high efficiency of treatment of bipolar disorder and can significantly reduce the social maladjustment of patients, which is associated with the development of exacerbations.  

The use of tricyclic antidepressants and antipsychotic drugs for the relief of affective and psychotic symptoms is inevitable during an exacerbation of bipolar disorder. They influence the course of the disease in their own way .       

With the use of antidepressants for the relief of bipolar depression, the risk of inversion of affect increases – the development of a hapomanic (manic) state. 

Timely diagnosis of mixed and manic-delusional states is of great importance for the choice of therapeutic tactics, as well as the prognosis of the course of the disease . Often, such conditions, together with manias, which have psychotic signs are mistakenly defined as psychomotor agitation in schizophrenia. This misdiagnosis leads to the prescription of powerful antipsychotics. Patients with bipolar disorder are more sensitive to the development of side effects when using antipsychotics. The cause of disability is often chronic extrapyramidal symptoms caused by prolonged use of antipsychotics.      

The search for a drug that would provide all of the therapeutic effects in bipolar disorder is continually ongoing . New drugs, including atypical antipsychotics , require special attention .  

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