Bauer Michael, Andreassen Ole A, Geddes John R, Vedel Kessing Lars, Lewitzka Ute, Schulze Thomas G, Vieta Eduard
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany; European College of Neuropsychopharmcaology Bipolar Network, Utrecht, Netherlands.
The Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway; European College of Neuropsychopharmcaology Bipolar Network, Utrecht, Netherlands.
Lancet Psychiatry. 2018 Nov;5(11):930-939. doi: 10.1016/S2215-0366(18)30253-0. Epub 2018 Aug 23.
This Review discusses crucial areas related to the identification, clinical presentation, course, and therapeutic management of bipolar disorder, a major psychiatric illness. Bipolar disorder is often misdiagnosed, leading to inappropriate, inadequate, or delayed treatment. Even when bipolar disorder is successfully diagnosed, its clinical management presents several major challenges, including how best to optimise treatment for an individual patient, and how to balance the benefits and risks of polypharmacy. We discuss the major unmet needs in the diagnosis and management of bipolar disorder in this Review, including improvement of adequate recognition and intervention in at-risk and early-disease stages, identification of reliable warning signs and prevention of relapses in unstable and rapid cycling patients, treatment of refractory depression, and prevention of suicide. Taken together, there are several promising opportunities for improving treatment of bipolar disorder to deliver medical care that is more personalised.
本综述讨论了与双相情感障碍（一种主要的精神疾病）的识别、临床表现、病程及治疗管理相关的关键领域。双相情感障碍常被误诊，导致治疗不当、不足或延误。即使双相情感障碍被成功诊断，其临床管理仍面临若干重大挑战，包括如何为个体患者优化治疗，以及如何平衡联合用药的益处和风险。我们在本综述中讨论了双相情感障碍诊断和管理中尚未满足的主要需求，包括改善对高危和疾病早期阶段的充分识别和干预、识别可靠的警示信号以及预防不稳定和快速循环患者的复发、治疗难治性抑郁症以及预防自杀。总体而言，改善双相情感障碍的治疗以提供更个性化的医疗服务有几个很有前景的机会。
