RESUMO
The need for long-term management of bipolar disorder is evident. Bipolar patients spend more time depressed than manic; however, few agents used for maintenance therapy of bipolar disorder have demonstrated good efficacy in delaying relapse into depression. This article provides a comprehensive review of open-label and randomized, controlled studies examining prophylactic efficacy in bipolar disorder, especially bipolar depression. Lithium, considered the gold standard for bipolar disorder maintenance therapy may be more effective in delaying manic relapse than in delaying depressive relapse. Evidence for the efficacy of divalproex and carbamazepine in delaying depressive relapse is yet to be fully elucidated. Lamotrigine has demonstrated efficacy in delaying time to depressive relapse. Unpublished studies show olanzapine's efficacy in preventing manic recurrence, while its efficacy in preventing depressive recurrence is yet to be proven. As patients with bipolar disorder are prone to experiencing depressive episodes, more attention needs to be focused on preventing depressive relapse. To date, three agents--lithium, lamotrigine, and olanzapine--have been shown to have prophylactic benefits in treating this highly recurrent disorder.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Frutose/análogos & derivados , Aminas/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Carbamazepina/uso terapêutico , Doença Crônica , Ácidos Cicloexanocarboxílicos/uso terapêutico , Frutose/uso terapêutico , Gabapentina , Humanos , Lamotrigina , Carbonato de Lítio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo , Topiramato , Triazinas/uso terapêutico , Ácido Valproico/uso terapêutico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
The treatment of patients with unexplained medical symptoms is difficult because there is neither a clear etiology for the symptoms, nor a useful paradigm with which to understand and treat them. Patients with such symptoms are often referred to psychiatry with vague diagnoses of "somatization" or "hypochondriasis." Rather than considering somatoform diagnoses based on the number or diversity of physical symptoms, evolving research suggests an emphasis on the type of physical symptom as an indicator of Axis I pathology. This article links specific symptomatic complaints, such as chronic pain, chest pain, and dizziness, to the respective Axis I disorders associated with them, such as depression, panic disorder, and anxiety disorders.
Assuntos
Hipocondríase/diagnóstico , Hipocondríase/terapia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Idoso , Doença Crônica , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Dor/diagnóstico , Manejo da DorAssuntos
Antidepressivos de Segunda Geração/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Paroxetina/uso terapêutico , Efeito Placebo , Transtornos de Ansiedade/psicologia , Ensaios Clínicos como Assunto , Humanos , Placebos/uso terapêutico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicofarmacologia , Resultado do TratamentoRESUMO
Modafinil is a novel wake-promoting agent approved for the treatment of excessive sleepiness associated with narcolepsy that holds significant promise as an alternative treatment to traditional psychostimulants for excessive fatigue associated with medical and psychiatric disorders and as augmentation medication for treatment-resistant depression.