Concepts in the treatment of bipolar disorder

Objective: Concepts in the treatment of bipolar disorder are discussed considering clinical practice. Method: Results of the Multicenter Study of Long-term Treatment of Affective and Schizoaffective Psychoses ( MAP) study, a controlled maintenance trial, are interpreted with respect to treatment concepts. Results: The spectrum of patients diagnosed as bipolar has become more heterogeneous. It now comprises subtypes requiring differentiated treatment. The MAP study confirms that prophylactic efficacy of lithium seems to be specific to classic manic-depressive illness, whereas carbamazepine might be more efficacious in non-classic bipolar patients. With respect to clinical practice, treatment evaluation should also consider antisuicidal effects, inter-episodic morbidity and compliance. In these respects, results are in favour of lithium. Furthermore, data indicate that adherence to lithium clearly depends on illness concepts. This encourages efforts to supplement pharmacotherapy by psychoeducation and psychotherapy. Conclusion: With the broadening of diagnostic criteria, the treatment of bipolar disorder has become more complex. Patients need an integrated approach, including differentiated mood-stabilizing pharmacotherapy and psychotherapeutic measures.