Grunze H, Dittmann S
Psychiatrische Klinik, LMU München.
MMW Fortschr Med. 2003 May 26;145 Suppl 2:27-30.
The term bipolar disorder is no longer limited to the classical manic-depressive condition, but now subsumes a wide spectrum of illnesses. As a consequence of this expansion of the classification systems, the therapeutic utility of lithium and other mood stabilizing agents has to be defined anew. The majority treatment recommendations differentiate, symptom-related, between euphoric mania, mixed conditions, mania with psychotic symptoms and rapid cycling manic episodes. Current acute treatment includes, in addition to lithium, in particular carbamazepine and valproate, but also newer antiepileptic drugs such as lamotrigine or atypical neuroleptic agents such as olanzapine and risperidone. Due to the high suicidal risk, patients with bipolar depression often need to be given an antidepressant as well. It must, however, be remembered that in patients with rapid cycling, antidepressants may re-trigger mania.
双相情感障碍这一术语不再局限于经典的躁狂抑郁状态，而是涵盖了广泛的一系列疾病。由于分类系统的这种扩展，锂盐及其他心境稳定剂的治疗效用必须重新界定。多数治疗建议根据症状，将欣快性躁狂、混合状态、伴有精神病性症状的躁狂以及快速循环型躁狂发作区分开来。当前的急性治疗除锂盐外，尤其包括卡马西平和丙戊酸盐，还有新型抗癫痫药物如拉莫三嗪或非典型抗精神病药物如奥氮平和利培酮。由于自杀风险高，双相抑郁患者通常也需要给予抗抑郁药。然而，必须记住，在快速循环型患者中，抗抑郁药可能会再次引发躁狂。
