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Fortschr Neurol Psychiatr 2013; 81(S 01): S35-S39
DOI: 10.1055/s-0033-1335275
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Herausforderungen der ambulanten Behandlung von Patienten mit bipolar-affektiven Störungen

The Challenge of Treating Bipolar Outpatients
F. Seemüller
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
M. Berger
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
R. Musil
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
E. Severus
2   Klinik für Psychiatrie und Psychotherapie, Carl-Gustav-Carus-Universitätsklinikum, Technische Universität Dresden
,
S. Dittmann
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
C. Born
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
A. Schaub
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
S. Dargel
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
H. Grunze
3   Academic Psychiatry, Institute of Neuroscience, Newcastle upon Tyne, UK
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2013 (online)

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Zusammenfassung

Der Verlauf bipolar-affektiver Erkrankungen umfasst ein weites Spektrum. Dieses kann von einer einzigen leichten Episode in fünf Jahren bis hin zu ausgeprägten Stimmungsschwankungen innerhalb eines Tages variieren. In der ambulanten Betreuung von Menschen mit bipolarer-affektiver Störung tauchen neben der Frage der medikamentösen Therapie verschiedene krankheitsspezifische Schwierigkeiten auf, die es zu berücksichtigen gilt. Klinisch im Vordergrund steht dabei häufig eine oftmals unzureichende funktionelle Genesung. Diese steht wiederum in engen Zusammenhang mit kognitiven Defiziten, Therapieabbrüchen sowie einer hohen Rückfallhäufigkeit.

Abstract

The course of bipolar illness comprises a wide range, which may vary between one single episode once every five years and a severe ultra rapid cycling course with mood changes within days. Even with optimal pharmacological treatment the functional outcome in bipolar patients is still poor. Underlying pathomechanisms are not fully understood yet. This article addresses three possible illness specific-aspects: cognitive defects, high relapse frequency and poor adherence. Causes as well as therapeutic interventions for these therapeutic pitfalls are summarised.

Schlüsselwörter

bipolar - funktionelle Genesung - ambulante Betreuung - therapeutische Allianz

Key words

bipolar - functional recovery - outpatient treatment - treatment alliance
 

  • Literatur

  • 1 Tohen M, Zarate CA Jr, Hennen J et al. The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry 2003; 160: 2099-2107
    CrossrefPubMedSearch in Google Scholar
  • 2 Sole B, Bonnin CM, Torrent C et al. Neurocognitive impairment and psychosocial functioning in bipolar II disorder. Acta Psychiatr Scand 2012; 125: 309-317
    CrossrefPubMedSearch in Google Scholar
  • 3 Rosa AR, Gonzalez-Ortega I, Gonzalez-Pinto A et al. One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatr Scand 2012; 125: 335-341
    CrossrefPubMedSearch in Google Scholar
  • 4 Zarate CA Jr, Tohen M, Land M et al. Functional impairment and cognition in bipolar disorder. Psychiatr Q 2000; 71: 309-329
    CrossrefPubMedSearch in Google Scholar
  • 5 Kupka RW, Luckenbaugh DA, Post RM et al. Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry 2005; 162: 1273-1280
    CrossrefPubMedSearch in Google Scholar
  • 6 Post RM, Denicoff KD, Leverich GS et al. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003; 64: 680-690
    CrossrefPubMedSearch in Google Scholar
  • 7 Teter CJ, Falone AE, Bakaian AM et al. Medication adherence and attitudes in patients with bipolar disorder and current versus past substance use disorder. Psychiatry Res 2011; 190: 253-258
    CrossrefPubMedSearch in Google Scholar
  • 8 Weiss RD. Adherence to pharmacotherapy in patients with alcohol and opioid dependence. Addiction 2004; 99: 1382-1392
    CrossrefPubMedSearch in Google Scholar
  • 9 Sajatovic M, Bauer MS, Kilbourne AM et al. Self-reported medication treatment adherence among veterans with bipolar disorder. Psychiatr Serv 2006; 57: 56-62
    CrossrefPubMedSearch in Google Scholar
  • 10 Levy B, Monzani BA, Stephansky MR et al. Neurocognitive impairment in patients with co-occurring bipolar disorder and alcohol dependence upon discharge from inpatient care. Psychiatry Res 2008; 161: 28-35
    CrossrefPubMedSearch in Google Scholar
  • 11 Leverich GS, Post RM. Life charting the course of bipolar disorder. Current review of Mood & Anxiety disorders 1996; 1: 48-61
    PubMedSearch in Google Scholar
  • 12 Denicoff KD, Leverich GS, Nolen WA et al. Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychol Med 2000; 30: 1391-1397
    CrossrefPubMedSearch in Google Scholar
  • 13 Mur M, Portella MJ, Martinez-Aran A et al. Long-term stability of cognitive impairment in bipolar disorder: a 2-year follow-up study of lithium-treated euthymic bipolar patients. J Clin Psychiatry 2008; 69: 712-719
    CrossrefPubMedSearch in Google Scholar
  • 14 Marangell LB, Dennehy EB, Miyahara S et al. The functional impact of subsyndromal depressive symptoms in bipolar disorder: data from STEP-BD. J Affect Disord 2009; 114: 58-67
    CrossrefPubMedSearch in Google Scholar
  • 15 Quraishi S, Frangou S. Neuropsychology of bipolar disorder: a review. J Affect Disord 2002; 72: 209-226
    CrossrefPubMedSearch in Google Scholar
  • 16 Mann-Wrobel MC, Carreno JT, Dickinson D. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord 2011; 13: 334-42
    CrossrefPubMedSearch in Google Scholar
  • 17 Depp CA, Mausbach BT, Harmell AL et al. Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012; 14: 217-226
    CrossrefPubMedSearch in Google Scholar
  • 18 Kessing LV, Andersen PK. Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?. J Neurol Neurosurg Psychiatry 2004; 75: 1662-1666
    CrossrefPubMedSearch in Google Scholar
  • 19 Schouws SN, Stek ML, Comijs HC et al. Risk factors for cognitive impairment in elderly bipolar patients. J Affect Disord 2010; 125: 330-335
    CrossrefPubMedSearch in Google Scholar
  • 20 Dittmann S, Seemuller F, Grunze HC et al. The impact of homocysteine levels on cognition in euthymic bipolar patients: a cross-sectional study. J Clin Psychiatry 2008; 69: 899-906
    CrossrefPubMedSearch in Google Scholar
  • 21 Dittmann S, Seemuller F, Schwarz MJ et al. Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results. Bipolar Disord 2007; 9: 63-70
    CrossrefPubMedSearch in Google Scholar
  • 22 Martinez-Aran A, Vieta E, Colom F et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004; 6: 224-232
    CrossrefPubMedSearch in Google Scholar
  • 23 Judd LL, Akiskal HS. Depressive episodes and symptoms dominate the longitudinal course of bipolar disorder. Curr Psychiatry Rep 2003; 5: 417-418
    CrossrefPubMedSearch in Google Scholar
  • 24 Pompili M, Serafini G, Del CasaleA et al. Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk. Expert Rev Neurother 2009; 9: 985-1004
    CrossrefPubMedSearch in Google Scholar
  • 25 Scott J, Pope M. Nonadherence with mood stabilizers: prevalence and predictors. J Clin Psychiatry 2002; 63: 384-390
    CrossrefPubMedSearch in Google Scholar
  • 26 Hong J, Reed C, Novick D et al. Clinical and economic consequences of medication non-adherence in the treatment of patients with a manic/mixed episode of bipolar disorder: results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. Psychiatry Res 2011; 190: 110-114
    CrossrefPubMedSearch in Google Scholar
  • 27 Martinez-Aran A, Scott J, Colom F et al. Treatment nonadherence and neurocognitive impairment in bipolar disorder. J Clin Psychiatry 2009; 70: 1017-1023
    CrossrefPubMedSearch in Google Scholar
  • 28 Baldessarini RJ, Perry R, Pike J. Factors associated with treatment nonadherence among US bipolar disorder patients. Hum Psychopharmacol 2008; 23: 95-105
    CrossrefPubMedSearch in Google Scholar
  • 29 Gonzalez-Pinto A, Mosquera F, Alonso M et al. Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord 2006; 8: 618-624
    CrossrefPubMedSearch in Google Scholar
  • 30 Moon E, Chang JS, Kim MY et al. Dropout rate and associated factors in patients with bipolar disorders. J Affect Disord 2012;
    PubMedSearch in Google Scholar
  • 31 Morselli PL, Elgie R, Cesana BM. GAMIAN-Europe/BEAM survey II: cross-national analysis of unemployment, family history, treatment satisfaction and impact of the bipolar disorder on life style. Bipolar Disord 2004; 6: 487-497
    CrossrefPubMedSearch in Google Scholar
  • 32 Berk M, Berk L. Mood stabilizers and treatment adherence in bipolar disorder: addressing adverse events. Ann Clin Psychiatry 2003; 15: 217-224
    CrossrefPubMedSearch in Google Scholar
  • 33 Seemuller F, Forsthoff A, Dittmann S et al. The safety and tolerability of atypical antipsychotics in bipolar disorder. Expert Opin Drug Saf 2005; 4: 849-868
    CrossrefPubMedSearch in Google Scholar
  • 34 Schaub A, Bernhard B, Gauck L. Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Ein Therapiemanual. Göttingen: Hogrefe; 2004
    Search in Google Scholar
  • 35 Colom F, Vieta E, Martinez-Aran A et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60: 402-407
    CrossrefPubMedSearch in Google Scholar
  • 36 Colom F, Vieta E, Sanchez-Moreno J et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009; 194: 260-265
    CrossrefPubMedSearch in Google Scholar
  • 37 Berk M, Berk L, Castle D. A collaborative approach to the treatment alliance in bipolar disorder. Bipolar Disord 2004; 6: 504-518
    CrossrefPubMedSearch in Google Scholar
  • 38 Quill TE, Brody H. Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 1996; 125: 763-769
    CrossrefPubMedSearch in Google Scholar
  • 39 DGBS e. V. und DGPPN e.V. S3-Leitlinie zur Diagnostik und Therapie Bipolarer Störungen. Langversion 1.0, Mai 2012
    PubMedSearch in Google Scholar
  • 40 Zeber JE, Copeland LA, Good CB et al. Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder. J Affect Disord 2008; 107: 53-62
    CrossrefPubMedSearch in Google Scholar