A review of bipolar disorder among adults

Objective: This paper reviews the epidemiology, etiology, assessment, and m anagement of bipolar disorder. Special attention is paid to factors that co mplicate treatment, including noncompliance, comorbid disorders, mixed mani a, and rapid cycling. Advances in biopsychosocial treatments are briefly re viewed, including new health service models for providing care. Methods: A MEDLINE search was done for the period from January 1988 through October 19 97 using the key terms of bipolar disorder, diagnosis, and treatment. Payer s selected for further review included those published in English in peer-r eviewed journals. Preference was given to articles reporting randomized, co ntrolled trials. Results: Bipolar disorder is a major public health problem . The etiology of the disorder appears multifactorial. Diagnosis often occu rs years after onset of the disorder. Comorbid conditions are common. manag ement includes a lifetime course of medication and attention to psychosocia l issues for patients and their families. Standardized treatment guidelines for the management of acute mania have been developed. New potential treat ments are being investigated, Conclusions: Assessment of bipolar disorder m ust include careful attention to comorbid disorders and predictors of compl iance. Randomized trials are needed to further evaluate the efficacy of med ication, pyschosocial interventions, and other health sen ice interventions , particularly as they relate to the management of acute bipolar depression , bipolar disorder co-accurring with other disorders, and maintenance proph ylactic treatment.