Concepts in the treatment of bipolar disorder

Summary In sum, options in the treatment of bipolardisorders have expanded greatly over recentyears. Bipolar disorder has become more hetero-geneous and there is increasing evidence thatdifferent subtypes of the disorder need differentpharmacotherapeutical approaches. Lithium effic-acy seems to be specific to classic bipolar illness.Other types of the bipolar spectrum that arediagnosed more frequently in recent years mightrespondbettertoanalternativemoodstabilizerortoacombinationtherapy(23,45).Efficacyofmedicationshould,however,bejustone aspect when selecting a treatment strategy.Recent results from the MAP study show thatvarious medications may differ substantiallyregarding further aspects of relevance, such asinter-episodic morbidity or unscheduled discon-tinuation of treatment. As the best medication isuselessifnottaken,theprescriptionofmedicationhas to be complemented by active measures tosupport compliance. This includes intensive psy-chiatric management, comprising co-operationwith patients’ relatives and elicitation of thepatient’sillnessconcepts,psychoeducationregard-ingillnessanditstreatmentand,ifpossible,specificpsychotherapy (46, 47). Only a comprehensivetreatment approach will have a beneficial effecton the long-term course of the illness and mighteven help bipolar patients to profit from thesurplus energy characteristic for bipolar patients(48).