Therapy of bipolar disorders

Therapeutic goals in the individual phases

The treatment of bipolar disorders - depending on the phase of the illness in which the person affected is to be found – is based on different goals. The following three therapeutic phases can be distinguished:

  1. Acute therapy (approx. two to eight weeks),
  2. Maintenance therapy (approx. six to twelve months)
  3. Prophylaxis against relapses (over years).

The acute therapy includes a medicinal and psychotherapeutic treatment, and distinguishes between the acute bipolar mania and the acute bipolar depression. During an acute mania, a stress-free environment must be provided, as far as is possible, and the sleeping-waking rhythm must be re-established as rapidly as possible. In the manic, hypomanic or mixed episodes of the illness, a further goal is to restore the insight concerning the illness. It may often be necessary to take several medications. In part, this is necessary at the beginning of a phase if, for example, psychomotoric excitation, insomnia, suicidal tendencies, etc. stand in the foreground. Aside from the medicinal treatment, psychoeducational and other interventions (psychoeducation for relatives, family discussion therapy, etc.) should be employed. Other biological treatments (e.g. electrotherapeutic shocks or sleep deprivation therapy) can also be used in the event of an acute bipolar depression. The acute therapy is continued until the acute symptoms have been seen to have improved significantly.

The maintenance therapy which subsequently follows the acute therapy is carried out in order to stabilise the somewhat instable condition of the afflicted individual, so that a direct relapse does not occur. Its goal is to achieve this stable condition for at least six to twelve months. The measures thereby applied involve a coordinated combination of psychotherapeutic and medicinal treatments.

As a goal, the prophylaxis against relapses attempts to hinder a renewed development of a phase of the illness and to further stabilise the psychic state of the individual affected. It is initiated as soon as the emotional state of the afflicted individual has returned to normal and become stable. Dependent on the number of phases and the severity of the individual episodes, among other things, it is recommended that the prophylaxis against a relapse be continued over a period of from two to five years. Some persons affected must even take their medications for the rest of their lives. The possibly shocking recommendation of a long-term medicinal therapy should be discussed in detail. The prophylaxis against a relapse is a combined psychotherapeutic and medicinal treatment.

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