1. Principles of treatment
(1) Individualized treatment principle It is necessary to consider various factors such as patient's gender, age, main symptoms, somatic condition, whether to combine the use of medications, the first relapse or relapse, and previous treatment history, etc., to choose the appropriate medication, start from a lower dose, and titrate according to the patient's response. The treatment process requires close observation of the therapeutic response, adverse reactions, and possible drug interactions and other timely adjustments to improve patient tolerance and compliance.
(2) Principle of comprehensive treatment A combination of medication, physical therapy, psychotherapy, and crisis intervention should be adopted to improve the efficacy of treatment, compliance, prevention of relapse and suicide, and improvement of social function and quality of life.
(3) Principle of long-term treatment Since bipolar disorder tends to recur in a cyclical manner, and the frequency of its episodes is much higher than that of depressive disorders, the principle of long-term treatment should be adhered to. The purpose of acute treatment is to control the symptoms and shorten the duration of the disease; the purpose of consolidation treatment is to prevent the recurrence of symptoms and promote the recovery of social functioning; the purpose of maintenance treatment is to prevent relapse, maintain good social functioning and improve the quality of life.
2. Drug therapy
The most important therapeutic drugs are lithium carbonate, an antimanic drug, and antiepileptic drugs (valproate, carbamazepine, lamotrigine, etc.), which are also known as mood stabilizers. In patients with significant euphoric agitation, antipsychotic medications can be combined, including the classic antipsychotics haloperidol and chlorpromazine and the atypical antipsychotics olanzapine, quetiapine, risperidone, ziprasidone, and aripiprazole. Severe patients may be treated with a combination of modified electroconvulsive therapy. For refractory patients, clozapine combined with lithium carbonate treatment can be considered. Adverse drug reactions and interactions need to be noted in the treatment. For patients with bipolar depression, in principle, the use of antidepressants is not advocated, because it is easy to induce manic episodes, rapid cyclic episodes or lead to the chronicity of depressive symptoms, for the depression episodes are more serious and even accompanied by obvious negative behaviors, depression episodes in the whole course of the disease occupies the majority of the people, as well as accompanied by serious anxiety, obsessive-compulsive symptoms, we can consider in the mood stabilizers on the basis of adequate treatment, short-term combination of the application of Antidepressants should be reduced or discontinued as soon as possible once the above symptoms are relieved.
3. Physical therapy
Acute severe manic episodes, bipolar depressive episodes with severe negativity, or refractory bipolar disorder can be treated with modified electroconvulsive therapy (MECT), but the dose of the drug should be reduced appropriately. Repetitive transcranial magnetic stimulation (rTMS) can be considered for mild to moderate bipolar depressive episodes
Family considerations and their care
Respect, understanding, acceptance, caring, support, and help the patient;
Correctly recognize the disease, support the patient to be actively treated and treated as early as possible, and set up the concept of long-term treatment for those with recurrent episodes, and regular clinic review and communication with the doctor. Monitor the condition and drug side effects, maintain the stability of the condition and prevent relapse;
When the condition is unstable, pay attention to prevent self-injury and suicide, impulsive injuries, early consultation and treatment, and do a good job of psychological guidance. When depressed, let the patient see hope, feel concerned about the support, in a state of agitation and severe mania to avoid conflict, avoid provoking the patient;
Learn the knowledge of the disease and knowledge of the treatment, help the patient to observe the condition, timely response to changes in the condition, to take the correct coping strategy, to avoid harming themselves and others;
Pay attention to weekdays to help the patient to cultivate a good character, to correct the adverse
To help patients cultivate a good character, correct poor cognitive and behavioral patterns, and learn methods of psychological regulation;
Prompting patients to actively participate in social activities, with a view to reducing or preventing the occurrence of disability. In this process, we should give more encouragement and affirmation to the patients, and set practical goals together with them according to their abilities, without being too hasty.