Defining and Improving Response to Treatment in Patients With Bipolar Disorder

Functional outcomes are more meaningful measures of response to treatment for bipolar disorderthan are scores on various psychiatric rating scales (all of which have limitations) used to gauge improvementin symptoms. With the former approach, patients are considered to be in remission if theyachieve normal or near-normal levels of functioning in occupational, family, and social settings. Sleeppatterns are reliable indicators of whether a patient with bipolar disorder is likely to relapse or sustainremission in the near term. Regularly scheduled nightly sleep periods may help prevent rapid cyclingin patients with mania, while perturbations in circadian rhythms may be early markers of impendingrelapse. Medications used to attain response and/or remission in maintenance therapy include lithiumand valproate. The choice of mood stabilizer depends on the patient’s symptoms, prior response to amood stabilizer, and tolerance of the drug. For patients requiring additional therapy, combination regimenswith mood stabilizers and atypical antipsychotics appear effective. Psychoeducation for patientsand families and interpersonal psychotherapy also can help prolong remission.