[Guideline on bipolar disorders and the importance of trialogue: chances and risks]. / Leitlinie Bipolare Störungen und die Bedeutung des Trialogs : Chancen und Risiken.

The term trialogue means the best possible equally contributing cooperation between affected patients and therapists as well as the self-evident inclusion of relatives. This is true for therapy, antistigma efforts by the planning of care, in associations such as the German Society for Bipolar Disorders and by assimilation of guidelines. Trialogue has a history and in its current version many levels and a hopeful vision of characteristics of understanding and treatment. This idea is presented here and relationships with characteristics of understanding and therapy of bipolar disorders will be made. Finally the recommendations of guidelines on trialogue will be presented and essential headings will be discussed under the aspect of trialogue: where and how are basic ideas and core demands of associations of affected persons and relatives considered? How is the process of trialogue to be assessed for the assimilation of guidelines? What are the chances and risks for the implementation? How can trialogue support the implementation?

[S3 guidelines on diagnostics and therapy of bipolar disorders: development process and essential recommendations]. / S3-Leitlinie zur Diagnostik und Therapie bipolarer Störungen: Entwicklungsprozess und wesentliche Empfehlungen.

Bipolar disorders are severe psychiatric disorders with extensive individual and health economic consequences. Starting in 2007 the first German evidence and consensus based guideline for diagnostics and treatment of bipolar disorders was developed which holds the potential of increasing confidence of therapists, patients and relatives in the decision-making process and improving healthcare service experiences of patients and relatives. Apart from recommendations for diagnostics and treatment the guidelines provide those for trialogue action, knowledge transfer and self-help and for strategies for healthcare provision of this complex disorder. In the present article the methodology and essential recommendations are outlined and complemented in specific topics by corresponding articles in this special issue. Due to restrictions of the length of this presentation there is the need to refer to the comprehensive version of the guidelines at several points also regarding a detailed discussion of the limitations.

Absolute bioavailability of pirenzepine in intensive care patients.

The absolute bioavailability (f) of pirenzepine was determined in 27 intensive care patients receiving the drug for prophylaxis and therapy of upper gastrointestinal tract bleeding. A multiple oral and intravenous dosage regimen and the times of blood sampling were adapted to individual conditions and treatment. Mean f in the patients was 0.28, which was significantly higher than in 12 normal subjects (0.14). It showed no dependence on age (range 20-82 y), nor on the risk factors cardiac insufficiency, renal and hepatic dysfunction, gastrectomy (Billroth II) and bleeding gastrointestinal ulcers, nor on concomitant administration of metoclopramide or antacids. Due to the wide therapeutic index of pirenzepine, it is concluded that individualization of therapy is not necessary for patients in intensive care.