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Bipolar affective disorders: the specific features of the course and maintenance pharmacotherapy

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The paper reviews the literature on bipolar affective disorder (BAD). It considers the diagnosis, course, and treatment of BAD with emphasis on maintenance pharmacotherapy to prevent disease recurrence and to improve quality of life in patients. Major drug classes both used to prevent recurrent BAD and promising agents whose effect on the course of affective diseases is being just tested are viewed.

About the Authors

Nina Arkadyevna Tyuvina

Department of Psychiatry and Narcology

V N Smirnova

Department of Psychiatry and Narcology


1. <div><p>Angst J., Marneros A. Bipolarity from ancient to modern times: conception, birth and rebirth. J Affec Dis 2001;67:3—19.</p><p>Блейлер Е. Руководство по психиатрии. М.: Издательство независимой психиатрической ассоциации, 1993;542 с.</p><p>Akiskal H.S., Maser J.D., Zeller P. et al. Switching from ФunipolarХ to bipolar II: an 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry 1995;52:114-23.</p><p>Judd L.L., Akiskal H.S., Schlettler P.J. et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261—9.</p><p>Judd L.L., Akiskal H.S., Schlettler P.J. et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530.</p><p>Angst J. The emerging epidemiology of hypo-mania and bipolar II disorder. J Affect Dis 1998;50(2—3):143—51.</p><p>Мосолов С.Н. Биполярное аффективное расстройство: диагностика и терапия. М.: МЕДпресс-информ, 2008;384 с.</p><p>Akiskal H. S. Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. J Affect Dis 2001;62:17-31.</p><p>Akiskal, H.S., Downs, J., Jordan, P. et al. Affective disorders in the referred children and younger siblings of manic-depressives: mode of onset and prospective course. Arch Gen Psychiatry 1985;42:996-1003.</p><p>Akiskal H.S., Khani M.K., Scott-Strauss A. Cyclothymic temperamental disorders. Psychiatr Clin North Am 1979;2:527-54.</p><p>Дмитреева Т.Б., Краснов В.Н., Незнанов Н.Г. и др. Психиатрия: национальное руководство. М.: ГЭОТАР-Медиа, 2009;509-10.</p><p>Levitt A.J., Joffe R.T., Ennis J. et al. The prevalence of cyclothymia in borderline personality disorder. J Clin Psychiatry 1990;51:335-9.</p><p>Gershon F.S., Hamovit J., Guroff J.J. et al. A family study of schizoaffective, bipolar I bipolar II, unipolar, and n ormcontrol probands. Arch Gen Psychiatry 1982;39:1157-67.</p><p>Richards R., Kinney D.K., Lunde I. et al. Creativity in manic-depressives, cyclothymes, their normal relatives and control subjects. J Abnorm Psychol 1988;97:281-8.</p><p>Akiskal H.S. The Prevalent Clinical Spectrum of Bipolar Disorders: Beyond DSM-IV. J Clin Psychopharmacol 1996;16(Suppl. 11)2:4S-14S.</p><p>Akiskal H.S., Mallya G. Criteria for the 3sof® bipolar spectrum: treatment implications. Psychopharmacol Bull 1987;23(1):68—73.</p><p>Akiskal H.S., Pinto O. The evolving bipolar spectrum: prototypes I, II, III and IV. Psychiatr Clin North Am 1999;22:517-34.</p><p>Akiskal H.S., Akiskal K.K., Lancrenon S., Hantouche E.Validating the soft bipolar spectrum in the French National EPIDEP Study: the prominence of BP-II 1/2. J Affect Dis 2006;96(3):207—13.</p><p>Joyce P.R., Luty S.E., McKenzie J.M. et al. Bipolar II disorder: Personality and outcome in two clinical samples. Austral New Zealand J Psychiatry 2004;38:433-8.</p><p>Birmaher B., Axelson D., Goldstein B. et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: The Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiatry 2009;166:795-804.</p><p>Birmaher B., Axelson D., Strober M. et al. Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006;63:175-83.</p><p>Reeger E.J., Krabbendam L., De Graaf R. et al. A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychol Med 2006;36:619-27.</p><p>Краснов В.Н. Расстройства аффективного спектра. М.: Практическая медицина, 2011;432 с.</p><p>Cassano G.B., Akiskal H.S., Savino M. et al. Proposed subtypes of bipolar II and related disorders with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. J Affect Dis 1992;26:127-40.</p><p>Alloy B.L., Urosяevic S., Abramson L.Y. et al. Progression along the Bipolar Spectrum: A Longitudinal Study of Predictors of Conversion from Bipolar Spectrum Conditions to Bipolar I and II Disorders. J Abnorm Psychol 2012;121(1):16—27.</p><p>Angst J., Gamma A., Benazzi F. et al. Diagnostic issues in bipolar disirder. Eur Neuropsychopharm 2003;13:S43-S50.</p><p>Judd L.L., Akiskal H.S. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Dis 2003;73:123-31.</p><p>Акжигитов Р.Г., Яковлев А.Ю. К вопросу о диагностике расстройств биполярного спектра. Обозр психиатр и мед психол 2011;1:41-5.</p><p>Joffe R.T., MacQueen G.M., Marriott M. et al. A prospective, longitudinal study of percentage of time spent ill in patients with bipolar 1 or bipolar 2 disorders. Bipolar Dis 2004;6:62-6.</p><p>Marneros A., Akiskal H.S. The Overlap of Affective and Schizophrenic Spectra. Cambridge: Cambridge University Press, 2007;299 p.</p><p>Vieta E., Colom F. Psychoeducation Manual for Bipolar Disorder. Cambridge: Cambridge University Press, 2006;225 p.</p><p>Kessler R.C., Crum R.M., Warner L.A. et al. Lifetime cooccurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54(4):313—21.</p><p>Frye M.A., Altshuler L.L., McElroy S.L. et al. Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Am J Psychiatry 2003;160(5):883—9.</p><p>Kilbourne A.M., Cornelius J.R., Han X. et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Dis 2004;6:368-73.</p><p>Merikangas K.R., Akiskal H.S., Angst J. et al. Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2007;64:543-52.</p><p>Swann A.C., Dougherty D.M., Pazzaglia P. et al. Impulsivity: A Link between bipolar disorder and substance abuse. Bipolar Dis 2004;6:204-12.</p><p>Kilbourne A.M., Brar J.S., Drayer R.A. et al. Cardiovascular disease and metabolic risk factors in male patients with schizophrenia, schizoaffective disorder, and bipolar disorder. Psychosomatics 2007;48:412-7.</p><p>Frank E., Kupfer D.J., Thase M.E. et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005;62(9):996—1004.</p><p>Akiskal H.S., Tohen M. Bipolar Psychopharmacotherapy: Caring for the Patient. New York: John Wiley &amp; Sons, 2006;399 p.</p><p>Merikangas K.R., Jin R., He J.P. et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011;68:241-51.</p><p>Perlis R.H., Miyahara S., Marangell L.B. et al. STEP-BD Investigators. Long-term implications of early onset in bipolar disorder: data from the first 1,000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2004;55(9):875—81.</p><p>Giller B., Tillman R., Bolhofner K. et al. Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome. Arch Gen Psychiatry 2008;65(10):1125—33.</p><p>Goldstein T.R., Birmaher B., Axelson D. et al. History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk. Bipolar Dis 2005;7(6):525—35.</p><p>Kutcher S., Robertson H.A., Bird D. Premorbid functioning in adolescent onset bipolar I disorder: a preliminary report from an ongoing study. J Affect Dis 1998;51(2):137—44.</p><p>Leibenluft E. Pediatric bipolar disorder comes of age. Arch Gen Psychiatry 2008;65(10):1122—4.</p><p>Schenkel L.S., West A.E., Harral E.M. et al. Parent-child interactions in pediatric bipolar disorder. J Clin Psychol 2008;64(4):422-37.</p><p>Kemp D.E., Muzina D.J., McIntyre R.S. et al. Bipolar depression: treal-based insights to guide patient care. Dial clin neurosci 2008;10(2):181—92.</p><p>Нуллер Ю.Л., Михаленко И.Н. Аффективные психозы. Л.: Медицина, 1988; 264 с.</p><p>Arnold L.M. Gender differences in bipolar disorder. Psychiatr. Clin N Am 2003; 26(3):595—620.</p><p>Kawa I., Carter J.D., Joyce P.R. et al. Gender differences in bipolar disorder: age at onset, course, comorbidity, and symptom presentation. Bipolar Dis 2005;7(2):119—25.</p><p>Nivoli A.M., Pacchiarotti I., Rosa A.R. et al. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J Affect Dis 2011;133(3):443-9.</p><p>Romans S.E., McPherson H.M. The social networks of bipolar affective disorder patients. J Affect Dis 1992;25(4):221—8.</p><p>Miguel L., Roncero C., Lepez-Ortiz C., Casas M. Epidemiological and diagnostic axis I gender differences in dual diagnosis patients. Adicciones 2011;23(2):165—72.</p><p>Тювина Н.А. Психические нарушения у женщин в период климактерия. М.: Крон-пресс, 1996;237 с.</p><p>Payne J.L., Roy P.S., Murphy-Eberenz K. et al. Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Dis 2007;99:221-9.</p><p>Sharma V., Burt V.K., Ritchie H.L. Bipolar II postpartum depression: detection, diagnosis and treatment. Am J Psychiatr 2009;166(11):1217—21.</p><p>Marangell L.B. Current issues: women and bipolar disorder. Dialog Clin Neurosci 2008;10(2):229-38.</p><p>Grunze H. The clinical side of bipolar disorders. Pharmacopsychiatry 2011;44(Suppl 1):S43-S48.</p><p>Sajatovic M., Valenstein M., Blow F.C. et al. Treatment adherence with antipsychotic medications in bipolar disorder. Bipolar Dis 2006;8:231-2.</p><p>Keck P.E., McElroy S.L., Strakowski S.M. et al. Compliance with maintenance treatment in bipolar disorder. Psychopharmacol Bull 1997;33:87-91.</p><p>Baldessarini R., Henk H., Sklar A. et al. Psychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence. Psychiatr Serv 2008;59:1175-83.</p><p>Yathem L., Kennedy S.H., OXDonovan C. et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Dis 2009;11:225-55.</p><p>Goodwin G.M. Evidence-based guidelines for treating bipolar disorder: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003;17:149-73.</p><p>Yacobi S., Ornoy A. Is Lithiuma Real Teratogen?What CanWeConclude from the ProspectiveVersus Retrospective Studies? A Review. Isr J Psychiatry Relat Sci 2008;45(2):95—106.</p><p>Tondo L., Baldessarini R.J., Floris G. Long term clinical effectiveness of lithium maintenance treatment in type I and II bipolar disorders. Br J Psychiatry 2001;178(Suppl 41):181—90.</p><p>Peselow E.D., Dunner D.L., Fieve R.R., Lautin A. Lithium prophylaxis of depression in unipolar, bipolar II, and cyclothymic patients. Am J Psychiatry 1982;139:747-52.</p><p>Baldessarini R.J., Tondo L. Does lithium treatment still work? Evidence of stable responses over three decades. Arch Gen Psychiatry 2000;57:187-90.</p><p>Gelenberg A.J., Kane J.M., Keller M.B. et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med 1989;321(22):1489—93.</p><p>Birch N.J., Grof P., Hullin R.P. et al. Lithium prophylaxis: Proposed guidelines for good clinical practice. Lithium 1993;4:225-30.</p><p>Akiskal H.S. Affective disorders. In: Merck Manual of Diagnosisand Therapy. R. Berkow (ed.). 14th ed. Rathaway, NJ., Merck, Sharp and Dohme Research Laboratories 1999;1525—44.</p><p>Macritchie K.A., Geddes J.R., Scott J. et al. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2001;(3):CD003196.</p><p>Redden L., Pritchett Y., Robieson W. et al. Suicidality and divalproex sodium: analysis of controlled studies in multiple indications. Ann Gen Psychiatry 2011;10(1):1.</p><p>Hammer B.A., Brady K.T.Valproate treatment of alcohol withdrawal and mania. Am J Psychiatry 1996;153(9):1232.</p><p>De Vane C.L. Pharmacokinetics, drug interactions, and tolerability of valproate. Psychopharmacol Bull 2003;37 (Suppl 2):25—42.</p><p>Horne R.L., Cunanan C. Safety and efficacy of switching psychiatric patients from a delayed-release to an extended-release formulation of divalproex sodium. J Clin Psychopharmacol 2003;23(2):176—81.</p><p>Keck P.E., Meinhold J.M., Prihoda T.J. et al. Relation of serum valproate and lithium concentrations to efficacy and tolerability in maintenance therapy for bipolar disorder. Accepted for publication by «Psychiatry in Clinical Practice», 2005.</p><p>Bowden C.L. Valproate. Bipolar Dis 2003;5:189—202.</p><p>Bauer J., Jarre A., Klingmueller D., Elger C.E. Polycystic ovary syndrome in patients with focal epilepsy: a study in 93 women. Epilepsy Res 2000; 41:163—7.</p><p>Duncan S. Polycystic ovarian syndrome in women wih epilepsy: A review. Eplepsia 2001;42(Suppl 3):60—5.</p><p>IsojKrvi J.I.T., Laatikainen T.J., Pakarinen A.J. et al. Polycystic ovaries and hyperandro-genism in women taking valproate for epilepsy. New Engl J Med 1993;329:1383-8.</p><p>OXDonovan C., Kusumakar V., Graves G.R., Bird D.C. Menstrual abnormalities and polycystic ovary syndrome in women taking valproate for bipolar mood disorder. J Clin Psychiatry 2002;63:322-30.</p><p>Aldemir E., Akdeniz F., Altay A.B. et al. Valproate-Associated Reproductive Hormone Abnormalities: Do Bipolar Men have the Same Risk as Epileptic Men? Turk Psikiyatri Derg 2012;23(4):223—8.</p><p>Jacobsen F.M. Low-dose valproate: A new treatment for cyclothymia, mild rapid cycling disorders, and premenstrual syndrome. J Clin Psychiatry 1993;54:229-34.</p><p>Fatemi S.H., Rapport D.J., Calabrese J.R., Thuras P. Lamotrigine in rapid-cycling bipolar disorder. J Clin Psychaitry 1997;58:522-7.</p><p>Calabrese J.R., Suppes T., Bowden C.L. et al. A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry 2000;61:841.</p><p>Dardennes R., Even C., Bange F., Heim A. Comparison of carbamazepine and lithium in the prophylaxis of bipolar disorders. A metaanalysis. Br J Psychiatry 1995;166:378-81.</p><p>Greil W., Kleindienst N., Erazo N., MЯller-Oerlinghausen B. Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. J Clin Psychopharmacol 1998;18:455—60.</p><p>Denicoff K.D., Smith-Jackson E.E., Disney E.R. et al. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry 1997;58:470—8.</p><p>Yerevanian B.I., Koek R.J., Mintz J. Lithium, anticonvulsants and suicidal behavior in bipolar disorder. J Affect Dis 2003;73, 223—8.</p><p>Emrich H.M., Dose M., von Zerssen D. In: H.M. Emrich, T. Okuma, A.A. Muller. Action of Sodium-Valproate and of Oxcarbazepine in Patients with Affective Disorders. Amsterdam: Excerpta Medica, 1984;45—55.</p><p>Grunze H., Walden J. Relevance of new and newly rediscovered anticonvulsants for atypical forms of bipolar disorder. J Affect Dis 2002;72(Suppl 1):15—21.</p><p>Hellewell J.S. Oxcarbazepine (Trileptal) in the treatment of bipolar disorders: A review of efficacy and tolerability. J Affect Dis 2002;72(Suppl 1):23—34.</p><p>Grunze H.C., Normann C., Langosch J. et al. Antimanic efficacy of topiramate in 11 patients in an open trial with an on-off-on design. J Clin Psychiatry 2001;62:464-8.</p><p>Kanba S., Yagi G., Kamijima K. et al. The first open study of zonisamide, a novel anticonvulsant, shows efficacy in mania. Prog Neuropsychopharmacol Biol Psychiatry 1994;18:707—15.</p><p>Vieta E., Sanchez-Moreno J. Acute and long-term treatment of mania. Dialog Clin Neurosci 2008;10(2):165—79.</p><p>Young A., McElroy S., Olausson B. et al. Quetiapine monotherapy up to 52 weeks in patients with bipolar depression: continuation phase data from EMBOLDEN I &amp; II. 21st ENCP Conference; Barcelona, Spain, 2008.</p><p>Suppes T., Vieta E., Liu S. et al. Maintenance treatment for patients with bipolar I disorder: results from a north american study of quetiapine in combination with lithium or divalproex (trial 127). Am J Psychiatry 2009;166:476-88.</p><p>Calabrese J.R., Keck P.E. Jr, Macfadden W. et al. A randomized, double-blind, placebocontrolled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 2005;162:1351-60.</p><p>Vieta E., Parramon G., Padrell E. et al. Quetiapine in the treatment of rapid cycling bipolar disorder. Bipolar Dis 2002;4(5):335—40.</p><p>American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision) Am J Psychiatry 2002;159(Suppl 4):1—50.</p><p>Pacchiarotti I., Manfredi G., Kotzalidis G.D. et al. Quetiapine-induced mania (letter). Aust NZ J Psychiatry 2003;37:626.</p><p>Narasimhan M., Bruce T.O., Masand P. Review of olanzapine in the management of bipolar disorders. Neuropsychiatr Dis Treat 2007;3(5):579—87.</p><p>Данилов Д.С. Применение клозапина при лечении шизофрении. М.; Новокузнецк: ОАО «Органика», 2010;48 с.</p><p>Сиволап Ю.П., Савченков В.А. Фармакотерапия острых состояний и неврологических нарушений в клинике алкоголизма (проблемы и ошибки). М.: Анахарсис, 2011;44 с.</p><p>Сиволап Ю.П. Психопатология опиоидной зависимости. Автореф. дисс.. докт. мед. наук. М., 2004;47 с.</p><p>Macfadden W., Alphs L., Haskins J.T. et al. A randomized, double-blind, placebo-controlled study of maintenance treatment with adjunctive risperidone long-acting therapy in patients with bipolar I disorder who relapse frequently. Bipolar Dis 2009;11:827-39.</p><p>Vieta E., Nieto E., Autet A. et al. A longterm prospective study on the outcome of bipolar patients treated with long-acting injectable risperidone. World J Biol Psychiatry 2008;9:219—24.</p><p>Vieta E., Nuamah I., Lim P. et al. A randomized, placebo- and active-controlled study of paliperidone extended release for the treatment of acute manic and mixed episodes of bipolar I disorder. Bipolar Dis 2010;12:230-43.</p><p>Hsieh C., Liou Y. Manic symptoms induced by paliperidone. J Clin Psychopharmacol 2010;30:202-4.</p><p>Goodwin G.M. Evidence-based guidelines for treating bipolar disorder: revised second edition-recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2009;23(4):346—88.</p><p>Malhi G.S., Adams D., Lampe L. et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatrica Scand 2009;119:27—46.</p><p>Fountoulakis K.N., Vieta E., Sanchez-Moreno J. et al. Treatment guidelines for bipolar disorder: A critical review. J Affect Dis 2005;86:1—10.</p><p>Wehr T.A., Sack D.A., Rosenthal N.E., Cowdry R.W. Rapid cycling affective disorder: сontributing factors and treatment responses in 51 patients. Am J Psychiatry 1988;145:179-84.</p><p>Parker G., Tully L., Olley A., Hadzi-Pavlovic D. SSRIs as mood stabilizers for bipolar II disorder? A proof of concept study. J Affect Dis 2006;92:205-14.</p><p>Aaronson S., Zuzarte E., Sklar J., Sklar M. Lamotrigine monotherapy with and without bupropion in the treatment of bipolar II depression [Abstract NR3-111]. New Research Abstracts, Annual Meeting of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association, 2008.</p><p>Amsterdam J.D., Shults J. Comparison of short-term venlafaxine versus lithium monotherapy for bipolar II major depressive episode: a randomized open-label study. J Clin Psychopharmacol 2008;28:171-81.</p><p>Altshuler L., Suppes T., Black D.O. et al. Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants. Am J Psychiatry 2006;163:313-5.</p></div><br />


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Tyuvina N.A., Smirnova V.N. Bipolar affective disorders: the specific features of the course and maintenance pharmacotherapy. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(1):87-95. (In Russ.)

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