Treatment and Prognosis.pptx

8/17/2019 Treatment and Prognosis.pptx

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Treatment andPrognosis

Depressed Episode


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• In a patient with bipolar depression who is not currently betreated with a mood-stabilizing agent, antidepressants arefor short-term use, but it remains controversial as to whetbetter to administer them in combination with mood-stabiagents or as monotherapy.

• If the patient is already optimally treated with a mood-stabagent appropriate dose, good compliance! such as lithiumoption would be lamotrigine.

• "o evidence suggests additional bene#t from antidepressapatient is already being treated with a mood stabilizer, buoften tried in practice.

• the $%&DoD advised against the use of gabapentin and tricantidepressant agents T'%s! for monotherapy or augmenpatients with bipolar depression, e(cept in cases in which was * +! a previous good response during depression withswitch to mania or ! a history of treatment of refractory

depression.


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• iving mood stabilizer should starts in low doses depend severity of the symptoms. eevaluate patients every +- a minimum of 0 wee/s. %s noted earlier, the therapeutic lithium is a serum through concentration between 1.0-+.

for valproate, 51-+5 mcg&m34 and for carbamazepine, 6-mcg&m3.

• If the patient7s serum concentrations of their medication the therapeutic range, ad8ust the drug7s dose to the ma(irange. 9or medications without /nown therapeutic plasmconcentrations, increase the dose until symptomatic impr

patient intolerance, or the manufacturer7s ma(imum dosehave been reached.

• In patients with a partial treatment response no responsewee/s after initiation of an ade2uate medication dose!, coaugmenting the medication with additional agents orelectroconvulsive therapy E'T! if multiple trials of switch

medications&augmentation strategies have been unsucce


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• :ehavioral interventions e.g., cognitive behavior therapy, caregivepsychoeducation regarding the early warning signs of mood relapsconsidered #rst-line ad8uncts to pharmacotherapy to improve sociareduce the need for medications, number of hospitalizations, and r

• Three types of therapy are especially helpful in the treatment of bidisorder*

+. Cognitive-behavioral therapy * e(amine how your thoughts a;emotions. . Family-focused therapy : Educating family members about thehow to cope with its symptoms is a ma8or component of treatment. through problems in the home and improving communication is alsotreatment.


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Prognosis

9actors suggesting a worse prognosis include the fo• Poor 8ob history

• ?ubstance abuse

• Psychotic features

• Depressive features between periods of mania anddepression

• Evidence of depression

• @ale se(

• Pattern of depression-mania-euthymia


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9actors suggesting a better prognosis include thefollowing*

• 3ength of manic phases short duration!

• 3ate age of onset

• 9ew thoughts of suicide

• 9ew psychotic symptoms

• 9ew medical problems

Treatment and Prognosis.pptx

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