1. interview family members or other persons providing information
There are several reasons why we should try to ask wife, parents, child, “the other special people” or
friends of the patient. The patient cannot remember the symptoms of mania or hypomania or does not
wise to know the impact of symptoms on his activities. In other words, many patients evaluate that they
can control their activities in hypomania episodes and does not think they are disease. Many patients
may feel disgrace when having bipolar disorder. Therefore, interview several people close to the
patients may provide a history for an accurate diagnosis.
2.This treatment of patients with bipolar depression
Although the statement true bipolar depression often in the hands of the primary care physician,
referral or check psychiatrist should be considered a positive in the treatment of these patients.
Pharmaceutical therapy of bipolar disorder are more at risk than in major depression (unipolar). In
addition, multi‐therapeutic principle in many patients; only 20.6% of patients with bipolar disorder was
used as monotherapy.
Discuss chemotherapy of bipolar disorder outside the scope of this article, however, some keywords will
be talking about. Lithium is the standard drug treatment for bipolar disorder for decades. In recent
years, the presence of multiple antiepileptic drugs is characterized by mood stabilizers, among which
Coordinate Olanzapine ‐ Fluoxetine is approved recently treated depressive phase of
bipolar disorder; This combination effectively described in 8‐week study, randomized, controlled, double
blind bipolar depressed patients.
Carbamazepine and lamotrigine as well as increased awareness of using antipsychotics such as
olanzapine, an atypical, risperidone, quetiapine and ziprasidone were enhanced treatment of bipolar
Although no manic idiopathic factors in this study, the risk of developing mania associated with the use
of fluoxetine would need to be fully evaluated. Lithium, olanzapine and Lamotrigine is FDA approved for
the maintenance treatment; Lamotrigine is approved for use in the maintenance treatment of bipolar
The appearance of many new drug treatment of bipolar disorder is understood that the drug may
choose not only effective but also tolerance. Lithium has a number of side effects, low‐threshold
treatment and risk of fatal overdose; however it is the only drug reduced the risk of suicide in patients
with bipolar disorder. Divalproex used in manic episodes than in depressive episode; accompanied by
weight gain, tremor, hepatotoxicity and drug interactions; Carbamazepine though never FDA approved
treatment of bipolar disorder, has been studied and shown to be effective, but requires checking drug
concentration / serum and risk reduction Na + blood and confusion created blood. Lamotrigine is
described effective in bipolar depression and prevention of relapse of depression in patients with
bipolar disorder, to increase the dose slowly and carefully checked to avoid the possibility of erythema
but does not require blood count test and together with light weight, sexual side effects, drowsiness or
Olanzapine, Quetiapine, Risperidone and some other antipsychotics with moving disorders include
weight gain, increased risk of diabetes and increased triglycerides, sometimes accompanied by
inflammation of the pancreas. Therefore, screening of patients is required when these drugs are used
long term, according to the American Diabetes Association / American Psychiatric Association, the
Committee agreed on antipsychotic drugs and obesity.
Treatment of antidepressants in patients with bipolar disorder have its own difficulties. Although the
treatment of antidepressant monotherapy in user manuals are now treating bipolar disorder using
antidepressants necessary in some patients. Instructions American Psychiatric Association now
recommends using Bupropion and Paroxetine is an antidepressant top. However, this is only the
antidepressant was evaluated for the treatment of bipolar disorder in the randomized controlled
demonstrate that describes a relatively low risk of switching to mania; Therefore, the conclusion can not
be regarded as superior to the other antidepressants in the treatment of bipolar disorder. In general,
clinicians agree that antidepressants inhibit the reuptake of serotonin in SSRI sertraline as effective and
safe and monoamine oxidase inhibitors also relatively rarely switch to mania.
The other reason is taken to a mental examination of patients with bipolar disorder can cause various
diseases, with progression, clinical manifestations difficult to predict depressive feelings chart carefully
assess mental and often requires particularly apparent illness each patient and give the optimal
treatment. Games substance abuse power with high and difficult treatment and increased non‐
adherence to treatment and prognosis.
Finally, the influence of social psychology at the importance of bipolar disorder. The divorce rate higher
than 2‐3 times higher than the general population and the majority of people are experiencing
difficulties in occupational, social, and long to be part dinhkeo psychosocial intervention. All these issues
are resolved in a mental environment more suitable.