再普乐治疗双相情感障碍.ppt

KeyPoint:Thisgraphicshowsanoverviewofthespectrumofhighandlowmoodstatesforapatientwithbipolardisorder.Beforeaccuratediagnosisismade,thereisoftenaperiodof“subsyndromal”highsandlowsbeforeacutemaniaormajordepressiveepisodesoccur.Thesehighsandlowsmaybeassociatedwithreducedoccupationalandsocialfunctioning,butmaynotbeaccuratelydiagnosed.Bipolardisorderposesauniquechallengeforclinicians,sincetheymustmanageboththemaniaandthedepression,andstrivetopreventrelapse.Duringthehighandlowepisodes,patientsseeadecreaseintheirabilitytoengageintherapy,work,andsocialinteractionwithfamilyandfriends.Betweenthesetwoextremes,patientstrytogetsomesemblanceofnormalcyintheirlife.Buteveninthesetimesofeuthymia,theylivewiththethreatofslippingbackintoanacutehighorlowthatisextremelydisruptivetotheirlife.Theclinicianplaysacriticalrolethroughoutthetreatmentprocessindevelopingatrustingrelationshipthatcanenhanceengagementintherapy,compliance,andbetteroutcomesforthepatient.Reference:1.ManningJS,AhmedS,McGuireHC,etal.MoodDisordersinFamilyPractice:BeyondUnipolaritytoBipolarity.ThePrimaryCareCompanionJClin Psychiatry2002;4(4):142-150.*KeyPoint:Itispossibletomeetcriteriaformixedmoodstates,whichwhenrigorouslydefined(criteriaformanicANDmajordepressedepisodesmustbemetconcurrently)maybepresentingsyndromesinupto30-40%ofbipolarIpatients.Evenmorecommonly,inthemajorityofpatientswithbipolardisorder,combinationsofmanic/hypomanicanddepressivesymptomsoccurconcurrently.Anothersyndrometobeawareofisrapidcycling.Thesepatientstendnottorespondwelltolithiumtreatment.Bothmixedandrapidcyclingaremorecommonlyfoundinwomen.References:1. EvansDL.BipolarDisorder:DiagnosticChallengesandTreatmentConsiderations.JClinPsychiat