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Feature Article

Bipolar disorder: focus on maintenance

Michael Berk, Lesley Berk, Melissa K Hasty, Rothanthi Daglas, Lisa P Henry, Philippe Conus

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Abstract

Bipolar disorder is a highly recurrent and potentially disabling disorder. Prevention of recurrence with maintenance therapy is a predominant focus of management. GPs are well placed to provide this long-term care.

Key Points

  • Despite bipolar disorder being a complex illness to manage, most individuals with the disorder derive substantial benefit from optimal management and have the potential to lead rich and fulfilling lives.
  • The highly recurrent nature of bipolar disorder means that prevention of recurrence with maintenance therapy is a predominant focus of management. Such therapy involves both polypharmacy and the combination of pharmacotherapy with psychological and lifestyle interventions.
  • The agents used in the acute treatment of bipolar disorder are likely to be continued as maintenance therapy.
  • Lithium is the benchmark in the maintenance therapy of bipolar disorder, and has an extensive evidence base. There is also evidence for the effectiveness in relapse prevention of sodium valproate, lamotrigine, carbamazepine, olanzapine and quetiapine.
  • It is important to address comorbidities such as medical factors, personality, smoking and substance use. Re-evaluation of the diagnosis may be necessary because comorbidities and psychosocial stressors can, with time, have a greater role than initially appreciated.

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