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16 - The use of atypical antipsychotic agents in the treatment of diagnostic subgroups of bipolar disorder: mixed and pure states, psychotic and non-psychotic

Published online by Cambridge University Press:  10 August 2009

By
Robert W. Baker ,
Leslie M. Schuh  and
Mauricio Mauricio Tohen
Edited by
Andreas Marneros  and
Frederick Goodwin
Robert W. Baker
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, USA
Leslie M. Schuh
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, USA
Mauricio Mauricio Tohen
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, and Harvard Medical School, Belmont, MA, USA
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
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Summary

Introduction

There are many challenges in treating bipolar disorder, including confronting marked variability in symptoms between patients, as well as highly differing symptomatic presentations within an individual patient's course of illness. Diversity of presentation and course is potentially quite important to prognosis and treatment selection, though the relevance has not been consistently well defined in empirical research. This chapter reviews controlled findings regarding the impact of variant bipolar presentations to predicting treatment response with atypical antipsychotic agents.

Classic bipolar I disorder consists of euthymic periods punctuated by episodes of mania or major depression. Interindividual variability is manifest in differing severity, length, and frequency of manic and depressive episodes and the degree of symptom relief occurring between acute episodes. There are, of course, many variations on the classic pattern, such as the concurrent dysphoric and manic symptoms of mixed states, subsyndromal presentations, or the markedly frequent episodes of rapid cycling. Bipolar disorder is also commonly complicated by psychiatric comorbidity, such as psychosis, as well as substance abuse or physical disorders. Not surprisingly, patients with bipolar disorder have increased mortality from suicide, accidents, substance-abuse-related causes, and various medical diseases (Baldessarini, 2002).

Variant presentations may be more difficult to treat than classic bipolar depression or mania. First, these presentations often broaden the range of target symptoms requiring treatment, including, for example, psychotic symptoms or the pivotal need to slow cycling in rapid cyclers. Such variant presentations may help to explain the polypharmacy that is typical of bipolar disorder treatment.

Keywords

acute maniaantipsychotic agentsaripiprazolebipolar disordernon-psychotic patientsolanzapineclozapinelithiumquetiapinerisperidone
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 353 - 368
Publisher: Cambridge University Press
Print publication year: 2005

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