课件：精神科双相情感障碍诊疗中应关注的几个问题.ppt

Following remission of an acute episode, patients may remain at particularly high risk of relapse for a period of up to 6 months. This period of treatment (sometimes referred to as continuation treatment) and the period thereafter can be considered to be part of the maintenance phase. As an example of current standards of care in maintenance treatment, the APA Guidelines recommend the following approaches with the highest level of certainty based on the available evidence (“substantial clinical confidence”). For maintenance treatment, monotherapy with lithium or divalproex is the first-line recommendation, but combination of these with lamotrigine or other agents is often needed. Medications used to achieve remission from the most recent episode should generally be continued in the maintenance phase, with dose adjustment. For patients treated with an antipsychotic during the preceding acute episode, the need for ongoing antipsychotic treatment should be reassessed when they enter maintenance treatment. Antipsychotics should be discontinued unless they are required for control of persistent psychosis. Support groups, education, and information about bipolar disorder and its treatment are useful for patients in the maintenance phase. Emerging EvidenceThere is emerging evidence that the efficacy of atypical antipsychotics in maintenance treatment is comparable to that of agents such as lithium or divalproex and these may be considered on the basis of individual circumstances. Moderate clinical confidence supports the addition of another maintenance medication, an atypical antipsychotic, or an antidepressant when patients continue to experience subthreshold symptoms or breakthrough mood episodes. LithiumEvidence from randomized controlled trials in maintenance therapy for bipolar disorder is limited. Lithium is the most established drug available for maintenance treatment in bipolar disorder. Multiple studies have demonstrated that patients treated with lithium