engleski

New strategies in the treatment of bipolar disorder

The recognition of bipolar affective disorder as heterogenic in its phenommenology, ethiopathogenesis and comorbidity significantly contributed to early diagnostic of this disorder and opened a pathway towards novel therapeutic approaches. The authors have searched latest literature regarding new treatment approaches for bipolar affective disorder and found that they still appreciate the knowledge on disorder genetic and clinical heterogeneity and insights about importance of psychosocial factors in its formation and development. New strategies, although constantly focused on acute phase treatment (depressive, manic, mixed) and prevention of relapses, have become more attentive towards treatment of cognitive deficits, persistent residual symptoms, comorbid conditions and suicide prevention. Treatment of this disorder had been based on following current medical expertise algorithms, however, widespread disorder heterogeneity and broaden therapeutic goals have not been sufficiently recognized in these guidelines even more accentuating advantages of personalized approach. This approach does not exclude the guideline recommendations, but extends to a "softer" part of the bipolar spectrum and new therapeutic targets (neurocognitive deficits, residual symptoms, suicidality). This new strategies are still relying on pharmacotherapy as crucial for treatment of bipolar affective disorder but are also integrating psychoeducation, psychotherapy and lifestyle changes. There are three main aspects of novel pharmacotherapeutic approach: 1. individualy and pharmacogeneticaly customized treatment with approved agents ; 2. considering new treatment modalities ( protein kinase C inhibitors, glycogenic synthase kinase inhibitors, glutamate neurotransmission inhibitors) and 3. improving outcomes targeting so far neglected pathology of bipolar affective disorder such as neurocognitive deficits, residual symptoms and high mortality. Today´s guidelines recommend earliest possible prevention, right after onset of first manic episode, but type II disorder prevention is dependant on frequency of depressive and hypomanic episodes. The commonly used psychotherapeutic techniques are: social rhythm maintenance therapy, interpersonal therapy, cognitive-behavioral therapy and family oriented therapy. Psychoeducation and psychotherapeutic treatment helps patients burdened with bipolar affective disorder and their families in coping with this chronic disease, prevention of new episodes and treatment adherence which enables better pharmacotherapeutic efficacy and stabile state sustension.

bipolar affective disorder; new treatment

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