Altinbaş Kürşat
Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey.
Noro Psikiyatr Ars. 2021 Sep 20;58(Suppl 1):S41-S46. doi: 10.29399/npa.27615. eCollection 2021.
Life time psychiatric comorbidities of bipolar disorders are highly prevalent. Anxiety disorders, alcohol-substance use disorders, obsessive-compulsive disorder and attention deficit and hyperactivity disorder are the most common comorbid psychiatric conditions in bipolar disorders. Psychiatric comorbidity of bipolar disorders is strongly associated with poor treatment response, higher recurrence of mood episodes, suicide attempts, rapid-cycling, worse general functioning and quality of life. Therefore, considering the huge impact of comorbidity on the bipolar disorder illness course, treatment is usually challenging. The primary aim of the treatment in psychiatric comorbidity of bipolar disorder should be mood stabilization and prevention of mood episodes. Then, first line treatment options recommended for the specific psychiatric disorders might be preferred for the treatment of bipolar disorder comorbidity. With this rationale, quetiapine can be listed as a first line treatment for anxiety disorders comorbidity in bipolar disorders while serotonergic antidepressants and olanzapine are recommended as second line options. For the treatment of alcohol-substance use disorders comorbidity, first line mood stabilizers such as valproate and lithium and new generation antipsychotic quetiapine seem to be the leading options. Serotonergic antidepressants for obsessive-compulsive disorder and stimulants for the attention-deficit hyperactivity disorders are the key treatment choices. However, both treatment agents might cause to manic switch and mood destabilization. Thus, clinicians should be aware of these complications when prescribing in bipolar disorders comorbidity.
双相情感障碍的终生精神共病非常普遍。焦虑症、酒精-物质使用障碍、强迫症以及注意力缺陷多动障碍是双相情感障碍中最常见的共病精神疾病。双相情感障碍的精神共病与治疗反应不佳、情绪发作的更高复发率、自杀企图、快速循环、更差的总体功能和生活质量密切相关。因此,考虑到共病对双相情感障碍病程的巨大影响,治疗通常具有挑战性。双相情感障碍精神共病治疗的主要目标应该是情绪稳定和预防情绪发作。然后,针对特定精神疾病推荐的一线治疗选择可能更适合用于双相情感障碍共病的治疗。基于这一原理,喹硫平可列为双相情感障碍合并焦虑症的一线治疗药物,而血清素能抗抑郁药和奥氮平则被推荐为二线选择。对于双相情感障碍合并酒精-物质使用障碍的治疗,丙戊酸盐和锂等一线心境稳定剂以及新一代抗精神病药物喹硫平似乎是主要选择。用于治疗强迫症的血清素能抗抑郁药和用于治疗注意力缺陷多动障碍的兴奋剂是关键的治疗选择。然而,这两种治疗药物都可能导致躁狂发作和情绪不稳定。因此,临床医生在为双相情感障碍共病患者开处方时应意识到这些并发症。