Bipolar disorder is a type of mood disorder that has both manic or hypomanic episodes and depressive episodes. According to its clinical manifestations, it is mainly divided into the following categories: bipolar I type, bipolar II type, cyclothymic mood disorder and mixed episodes. The etiology and pathogenesis of bipolar disorder are still unclear, and may be related to the combined effects of genetic factors, biological factors and psychosocial factors. The diagnosis and treatment of bipolar disorder at home and abroad are now not satisfactory, and the recognition rate and treatment rate of bipolar disorder are low. According to statistics from Europe and the United States, 69% of patients with bipolar disorder have been misdiagnosed as monophasic depression, anxiety disorders, schizophrenia, personality disorders and substance dependence. The direct consequence of misdiagnosis is that it leads to inappropriate treatment, causing the condition to change phases, shortening the cycle, aggravating the symptoms, worsening the condition, and in serious cases, the risk of suicide. Therefore, clinicians should fully understand the patient's medical history and family history, and revise the diagnosis in a timely manner according to the changes in the patient's symptoms, in order to improve the recognition rate of bipolar disorder and the rate of correct treatment.
2. New perspectives in the study of bipolar disorder
There are some new perspectives and understandings in the study of bipolar disorder, which can help clinicians understand bipolar disorder more objectively and correctly.
2.1 The prevalence of bipolar disorder was previously reported to be relatively low in China. The new view is that the prevalence of bipolar disorder is relatively high, ranging from 1.3% to 2.6%, with the prevalence of type II being 5-7 times higher than that of type I. The latest reports show that bipolar disorder is associated with a number of other disorders. The latest report shows that the ratio of bipolar disorder to monophasic disorder is 1:1.
2.2 Depressive episodes in bipolar disorder have not been emphasized in the past, but in fact, bipolar depression is the main manifestation of bipolar disorder, and bipolar depression accounts for 49.3% of depressive episodes, with type I accounting for a smaller proportion (3.9%) and type H accounting for the vast majority (45.4%). If bipolar depression is not treated properly, it can easily turn into a rapid cycle or result in suicide. It is difficult to make a diagnosis of bipolar depression at an early stage for the following reasons: (1) For mild mania or hypomania, patients often do not think it is an abnormal state, and more than half of the patients complain of depressive episodes as their first emotional experience. (2) Clinically atypical depressive symptoms, such as increased appetite, excessive sleep, marked fatigue, and psychomotor retardation, are more common in bipolar depression, and these are often overlooked. (3) In bipolar II or cyclothymic disorder, mania is relatively brief and mild, and patients often have difficulty recalling it or do not consider it abnormal. The new view is that the manic period in the diagnostic criteria should be shortened, such as shortening the original 1 week to l to 2 days.
2.3 The concept of bipolar spectrum disorder expands the original concept of bipolar disorder. Monophasic and biphasic are artificial diagnostic classifications, in fact, monophasic and biphasic are not diametrically separated, and there is a continuous spectrum from weak to strong between the two, and this continuous spectrum is called bipolar spectrum disorder, which includes: if there is a depressive episode with a family history of bipolar disorder, or an emotionally exuberant personality prior to the disease, or antidepressant-induced mania, or cyclothymic dysphoric disorder, or mildly manic or hypomanic episodes, all of which are classified in the bipolar spectrum disorder, and the treatment can be treated as bipolar disorder.
2.4 There is also a new understanding of mixed episodes of bipolar disorder. Among the mixed episodes, typical mixed episodes are not rare, accounting for only one-tenth of the mixed episodes, and the mixed episodes that are more common in clinical practice are depressive mixed episodes, which are characterized by symptoms similar to those of hypomania on the basis of depression.
3. Application of antipsychotics in bipolar disorder
Some antipsychotics have antimanic and antidepressant mood-stabilizing effects, and in the acute phase of manic episodes in bipolar disorder, combined with mood-stabilizing agents, they can control the symptoms more quickly. First-generation antipsychotic drugs, such as chlorpromazine and haloperidol, lack direct effect on affective symptoms due to their single mechanism of action, which mainly acts on D2 receptors, and have prominent adverse drug reactions, mainly extrapyramidal reactions, which are prone to malignant syndromes, epileptic-like seizures, and cognitive impairment. In addition, traditional antipsychotics bring many negative effects on the disease itself, such as the tendency to induce depression, or accelerated cyclic frequency. The combination of traditional antipsychotics with mood stabilizers also increases the toxicity of the former to the nervous system. Therefore, the first generation of antipsychotics in combination with mood stabilizers, although the efficacy is certain, but the negative effects are obvious, and the limitations are great.
Newer antipsychotics, such as Visteon, are more effective and safer than traditional antipsychotics. New antipsychotic drugs in addition to the dopamine receptor has a blocking effect on the 5-HT receptor also has a blocking effect, which makes the drug itself has some of the properties of a mood stabilizer, in addition to rapid control of acute manic symptoms in the treatment, but also on the improvement of emotional symptoms, can improve cognitive function, unlike the traditional antipsychotic drugs as damage to cognitive function. In addition, newer antipsychotics have fewer adverse effects and are less likely to have extrapyramidal reactions, which can improve patient adherence to maintenance therapy. In the treatment of bipolar disorder, if long-term use of antipsychotics is required, it is appropriate to use new antipsychotics.
4. Domestic and international studies on the treatment of acute manic episodes in bipolar disorder with Visteon
At present, there are many domestic and international studies on the treatment of acute manic episodes in bipolar disorder with Visteon, and only a few of the major studies are introduced here.
A controlled study of the efficacy and safety of a mood stabilizer combined with either Visteon or haloperidol versus placebo in the treatment of acute manic episodes, published in the American Journal of Psychiatry in 2002, demonstrated that the combination of Visteon and a mood stabilizer was significantly more effective than the placebo group in the treatment of acute mania, and was comparable to the efficacy of haloperidol. In order to determine whether Visteon worked by directly treating mania or by treating psychotic symptoms, the study was conducted with and without psychotic symptoms. The results showed that Visteon was more effective than placebo in treating mania in both the group with and without psychotic symptoms, suggesting that Visteon has a direct antimanic effect. In terms of safety, for the severity of extrapyramidal symptoms caused, the Visteon group was similar to the placebo group, whereas the haloperidol group caused significantly higher severity than the placebo group, and in addition, the rate of anti-Parkinsonian medication used in the haloperidol group was twice as high as in the Visteon group.
The results of a 6-month open multicenter study of the safety and efficacy of Visteon in the treatment of bipolar and schizoaffective disorders, published in the Journal of Clinical Psychiatry in 2001, showed that in bipolar disorder, whether in the manic, depressive, or mixed phases of bipolar disorder or in schizoaffective disorder, scores of the 6-month combination of Visteon and a mood stabilizing agent were significantly lower and patients improved significantly from baseline values. Significant decreases were seen in patients, and Visteon was extremely well tolerated, with significant decreases in extrapyramidal scale scores and no cases of tardive dyskinesia (TD).
In 2004, the American Journal of Psychiatry reported a 3-week, multicenter, double-blind, placebo-controlled study of the rapid antimanic effect of Visteon monotherapy showed that Visteon, a mean of 4 mg / day monotherapy for the treatment of acute manic episodes, can significantly improve the symptoms of mania, and the onset of action is rapid, in the third day of treatment, YMRS scores that is, compared with the placebo group significantly lower, and can be significantly improved. GAS score during treatment does not aggravate depressive symptoms and is less likely to lead to depressive episodes.
Recently completed in the domestic Visteon and haloperidol treatment of bipolar I affective disorder acute manic episodes of efficacy and safety of non-inferiority clinical research shows that Visteon average 4.59 mg / d and haloperidol 5.48 mg / d treatment of acute mania efficacy is similar to that of the two groups, the two groups of total effective rate is not significantly different from that of haloperidol, compared with the Visteon is not easy to induce depression, and can be obviously Compared with haloperidol, Visteon is less likely to induce depression and can significantly reduce depressive symptoms. In terms of safety, Visteon is better tolerated, and the incidence of extrapyramidal reactions is significantly lower than that of haloperidol.
Numerous studies have confirmed the efficacy of Visteon in the treatment of acute manic episodes of bipolar disorder, either in combination with a mood stabilizer or as monotherapy, which has a direct antimanic effect, does not easily lead to depressive episodes, and is well tolerated.
The feeling you experience with Visteon is directly related to the diagnosis of your condition, the dosage of the medication, and the duration of the medication.