Need for Long term care management of bipolar disorder:
o Most bipolar disorders require long term course management for the effective treatment.
o Complete recovery of the individual Bipolar Disorder cannot be said to occur, if the initial symptoms subside for sometime under the effect of medication. There can be several episodes of relapse.
o In fact Bipolar disorder has one percent chance of lasting for a lifetime even after diagnosis and treatment.
o Bipolar disorder differs from one individual to another in its severity, frequency of cycles of mania and depression, and various psychotic states that can be debilitating.
o A single or few episodes of relapse can trigger further relapses.
o In many cases the patients stops having medication once the initial symptoms have subsided.
It is exceedingly vital that, a proper plan of action is formulated for long term course management, in order to make the treatment viable. Due to the progressive, chronic and episodic nature of the illness, long term treatment is essential for most bipolar disorder patients.
Long term course management for bipolar disorder requires careful consideration of various components like:
o Proper diagnosis and assessment of the degree, and type of the disorder.
o Course of the treatment and its goals.
o A plan to combine various therapeutic procedures along with medication.
o Continual management of the drugs course and possible alteration depending on individual need on a long term basis.
o Careful consideration of the psychosocial factors
The main goals of a long term or at times life long management or maintenance therapy are:
o Treatment of the attacks of depression and manic.
o Prevention of relapses.
o Limiting the side effects of the treatment.
o Enhancing the quality of life and functioning.
An optimum long-term treatment strategy and course manage is still unavailable. In this scenario there can be two distinct mode of action depending on the individual patients need, namely
- Mono-therapy
- Combined-therapy
Managing the long-term course for treatment of bipolar disorder
1. A proper diagnosis is the first step for long term course management of bipolar disorder. It requires thorough investigation about the degree of dysfunction in the work place, family and interpersonal relationship.
The family medical history and the risk that the individual patient poses for him/her self and others also need to be investigated. Further the presence or absence of psychosis, requirement for urgent medical help, the severity of the disorder, patient's medical history as well as history of substance abuse also needs to be investigated. All this go a long way in helping in setting up the treatment pattern.
2. The second step, in long term course management for treatment of bipolar disorder, is to set up a proper pharmacological treatment course based on the diagnosis. Certain drugs are more useful for, rapid cyclers, while others are more effective for manic or depressive attacks.
Certain patient can be resistant to some medicines, while others are incapable of tolerating the side effects. An expert can recommend a monotherapy or a combination treatment, according to the requirement of the bipolar patient. The treatment plan and course, for a patient with a mixed state is completely distinct from one with more pronounced manic or depressive attacks.
3. At the acute stage the main aim is to get the individual patient to respond to the treatment. Finding the right therapy and treatment course may take some time.
4. When the patient is on his/her way to recovery the frequency of therapy and treatment may reduce. At this point the patient can be educated by various psychotherapeutic techniques to identify the signs before a relapse and be warned of their dangers. The services of an expert psychotherapist as well as the support of the family should be pitched in.
5. There is also a need to build a strong and therapeutic relationship between the patient with bipolar disorder and the doctor.
There is a dearth of proper studies regarding a properly designed management therapy for long-term course maintenance of bipolar disorder. Due to this treatment can sometimes be inadequate and improper.
Medication for long-term treatment of bipolar disorder and its management
o It has been established by various controlled studies that, atypical antipsychotic like olanzapine, risperidone, and quetiapine, play a major role in the management of long term courses. These act as mood stabilizers and have greater tolerability profile in comparison to antipsychotic.
o At times mood stabilizers like Lithium, lamotrigine, carbamazepine and divalproex may be used. However many patients are unresponsive to such drugs, or incapable of tolerating their side effects.
o Although Lithium is the oldest and most commonly used drug for Bipolar disorder, it may pose various problems when used as long term drug. Certain individual may be resistant to lithium, while certain others find the side effects intolerable, some individuals may experience manic attacks when taken off Lithium abruptly.
Further lithium can cause nervousness, excessive sweating and hyperthyroidism. Certain recent studies however reveal that lithium as well as lamotigine has efficiency as a long term drug for bipolar disease. Further lithium is the only drug that is recommended by FDA for children with bipolar disorder.
o Lamotrigine has been found to be of high efficacy for long term course maintenance. This anticonvulsant can however cause skin rashes, and is not effective for acute mania patients.
o Studies have found that divalproex is also a viable option for long term course maintenance, and can help reduce the incidence of relapses. According to certain studies, Carbamazepine and valproate have fewer efficacies as drugs for long-term course.
Thus Bipolar disorder most generally may need life long or at least a long term treatment program. Managing a long term treatment course for bipolar disorder is a challenge. It requires proper diagnosis, a suitable mode of treatment for the acute and initial stages, subsequent maintenance therapy and treatment and psycho education or psychotherapeutic intervention, support of family, in addition to the pharmacological treatment.
Lastly each individual case is different and hence management of long term course for treatment of each bipolar patient will be distinct.
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