title: [Therapeutic strategies in refractory bipolar disorder].
abstract: Lithium is still regarded as the first choice substance in the prophylactic treatment of bipolar disorder. However, approximately one third of patients with a "classic" course of bipolar affective disorder do not adequately respond to lithium prophylaxis. The introduction of carbamazepine and valproic acid allowed a more differential syndrome- and course-orientated approach to the prophylactic treatment of bipolar disorder for the first time. However, about 10 to 20 percent of patients still remain refractory to standard regimes. Therefore, criteria for resistance to prophylactic treatment have to be further established. It has been suggested that at least two adequate trials of more than 12 months duration with sufficient drug blood levels have to be performed before refractoriness should be assumed. A severe subtype of affective disorder with poor response to lithium and other treatment approaches is a rapid cycling course which is characterised by at least four affective episodes per year. Here we present an overview of the currently available alternatives for prophylactic treatment, i.e. anticonvulsants, combination treatment, adjunctive thyroxine, calcium channel blockers, and more experimental approaches for treating refractory bipolar disorder patients. Suggestions for optimizing the prophylactic treatment of bipolar disorder are summarized in an algorithm.
authors.affiliation: Psychiatrische Klinik und Poliklinik, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Bauer
authors.forename: A
authors.initials: A
authors.lastname: Ströhle
mesh_terms: D000465:Algorithms; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D010349:Patient Compliance; D012008:Recurrence; D012307:Risk Factors; D013963:Thyroid Hormones / Q000627:therapeutic use
chemical_list: D014151:Anti-Anxiety Agents; D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002121:Calcium Channel Blockers; D018020:Lithium Compounds; D013963:Thyroid Hormones; D001569:Benzodiazepines
vernacular_title: Behandlungsstrategien bei prophylaxeresistenten bipolaren Störungen.