Bipolar Disorders and Their Clinical Management, Part II: Diagnosis, Differential Diagnosis, and Treatment

DeckerMed Medicine Pub Date : 2019-03-04 DOI:10.2310/im.13100

Bernadette DeMuri-Maletic, V. Maletić

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Abstract

Bipolar disorder is a biologically and phenotypically diverse disorder and its diagnosis and treatment provides a significant challenge to even the most seasoned clinician. We provide an update on the diagnosis and differential diagnosis of bipolar disorder, reflecting recent changes in DSM-5. Our review provides a succinct summary of the treatment literature, encompassing pharmacologic and psychosocial interventions for bipolar depression, mania/hypomania, mixed states, and prevention of disease recurrence. We provide a brief critical review of emerging treatment modalities, including those used in treatment resistance. Challenges involved in maintaining adherence are further discussed. Additionally, we review common treatment adverse effects and provide recommendations for proper side effect monitoring. There is evidence of significant functional impairment in patients with bipolar disorder and we conclude with a discussion of the impact of impairment on prognosis and quality of life. This review contains 4 figures, 8 tables, and 45 references. Key Words: bipolar disorders, differential diagnosis, maintenance pharmacotherapy, prognosis, psychosocial interventions, treatment, quality of life

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双相情感障碍及其临床管理，第二部分:诊断、鉴别诊断和治疗

双相情感障碍是一种生物学和表型多样的疾病，其诊断和治疗对即使是最有经验的临床医生也提出了重大挑战。我们提供了双相情感障碍的诊断和鉴别诊断的更新，反映了DSM-5最近的变化。我们的综述简要总结了治疗文献，包括双相抑郁、躁狂症/轻躁症、混合状态和疾病复发预防的药理学和社会心理干预。我们提供了一个简短的关键审查新兴的治疗方式，包括那些用于治疗耐药。进一步讨论了维持依从性所涉及的挑战。此外，我们回顾了常见的治疗不良反应，并提供了适当的副作用监测建议。有证据表明，双相情感障碍患者存在显著的功能障碍，我们最后讨论了功能障碍对预后和生活质量的影响。本综述包含4个图，8个表，45篇文献。关键词:双相情感障碍，鉴别诊断，维持药物治疗，预后，心理社会干预，治疗，生活质量

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