Bipolar Psychopharmacotherapy: Caring for the Patient
http://www.100md.com
《新英格兰医药杂志》
Akiskal and Tohen's Bipolar Psychopharmacotherapy aims to provide an up-to-date and comprehensive review of the principal treatments for bipolar affective disorder. Also known as manic depression, bipolar affective disorder has been ranked by the World Health Organization as the eighth greatest cause of global illness in industrialized nations. The disorder often appears early in life (the median age at onset is 19 years), and although useful therapies have been available for decades, rates of recurrence are high. The disease is chronic and associated with extremely high levels of disability and morbidity, as well as increased risks of death from suicide and cardiovascular disease. The two main forms of bipolar affective disorder (type I and type II, defined according to whether the "up" episodes are manic or hypomanic) affect about 4% of the population of industrialized countries. Moreover, even though the concept of a spectrum of bipolar disorders is still somewhat controversial, up to 50% of persons with so-called unipolar depression have symptoms suggestive of bipolarity. Given the ubiquity of depression and the potential that antidepressants have to worsen unrecognized bipolar disorder, a book that provides authoritative reviews of recent advances in the treatment of bipolar disorder should be of interest to all health care professionals.
Bipolar Psychopharmacotherapy largely succeeds in providing such an update. The book's 19 chapters are written by leading experts, many of whom have conducted some of the most important research on the topic of their chapter. The book opens with an excellent chapter by one of the book's editors, Akiskal. It provides an overview of the disorder and a crystal-clear exposition of the concept of the bipolar spectrum. The next seven chapters cover specific pharmacotherapies — lithium, valproate, lamotrigine, carbamazepine, and olanzapine are discussed in individual chapters, while risperidone and haloperidol are grouped together, as are the remaining atypical antipsychotic medications. The next 11 chapters cover a range of special topics, including the use of complex multidrug regimens and the treatment of bipolar disorder in children, women, and the elderly. The general coverage of this disorder is solidly within the biomedical model, but there is also useful material on education, focused forms of psychotherapy, suicide prevention, and the role of the therapeutic milieu or treatment setting.
There is some unevenness in tone and expository style, and the book lacks a central unifying voice, especially in weighing the merits of various treatments (e.g., lithium vs. valproate or atypical antipsychotic agents vs. the older neuroleptic agents). The organization of the book is a little odd; the thought-provoking chapter by Koukopoulos on the primacy of mania and the chapter on the principles of care of bipolar disorder by Akiskal and Akiskal should have preceded the chapters on specific interventions.
Several notable omissions constitute the book's greatest shortcoming. Most obvious is that despite the clinical significance of bipolar depression, the editors did not set aside an entire chapter for discussion of antidepressants. The book could have included chapters on the use of nonpharmacologic "somatic" interventions (i.e., phototherapeutic and chronotherapeutic manipulations, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and vagus-nerve stimulation), as well as a chapter on self-help methods and the role of peer support, written from the point of view of the patient (or consumer). A chapter collating and critiquing the myriad practice guidelines, placed near the end of the book, would also have been worthwhile. Another problem is the book's cost: at $90, this book may well be beyond the budgets of students and trainees.
These criticisms aside, readers will not be able to find a more comprehensive and up-to-date review of the main therapeutic approaches to bipolar affective disorder, and for this reason, this book is recommended for psychiatrists and other interested health care practitioners.
Michael E. Thase, M.D.
University of Pittsburgh
Pittsburgh, PA 15213
thaseme@upmc.edu(Edited by Hagop S. Akiska)
Bipolar Psychopharmacotherapy largely succeeds in providing such an update. The book's 19 chapters are written by leading experts, many of whom have conducted some of the most important research on the topic of their chapter. The book opens with an excellent chapter by one of the book's editors, Akiskal. It provides an overview of the disorder and a crystal-clear exposition of the concept of the bipolar spectrum. The next seven chapters cover specific pharmacotherapies — lithium, valproate, lamotrigine, carbamazepine, and olanzapine are discussed in individual chapters, while risperidone and haloperidol are grouped together, as are the remaining atypical antipsychotic medications. The next 11 chapters cover a range of special topics, including the use of complex multidrug regimens and the treatment of bipolar disorder in children, women, and the elderly. The general coverage of this disorder is solidly within the biomedical model, but there is also useful material on education, focused forms of psychotherapy, suicide prevention, and the role of the therapeutic milieu or treatment setting.
There is some unevenness in tone and expository style, and the book lacks a central unifying voice, especially in weighing the merits of various treatments (e.g., lithium vs. valproate or atypical antipsychotic agents vs. the older neuroleptic agents). The organization of the book is a little odd; the thought-provoking chapter by Koukopoulos on the primacy of mania and the chapter on the principles of care of bipolar disorder by Akiskal and Akiskal should have preceded the chapters on specific interventions.
Several notable omissions constitute the book's greatest shortcoming. Most obvious is that despite the clinical significance of bipolar depression, the editors did not set aside an entire chapter for discussion of antidepressants. The book could have included chapters on the use of nonpharmacologic "somatic" interventions (i.e., phototherapeutic and chronotherapeutic manipulations, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and vagus-nerve stimulation), as well as a chapter on self-help methods and the role of peer support, written from the point of view of the patient (or consumer). A chapter collating and critiquing the myriad practice guidelines, placed near the end of the book, would also have been worthwhile. Another problem is the book's cost: at $90, this book may well be beyond the budgets of students and trainees.
These criticisms aside, readers will not be able to find a more comprehensive and up-to-date review of the main therapeutic approaches to bipolar affective disorder, and for this reason, this book is recommended for psychiatrists and other interested health care practitioners.
Michael E. Thase, M.D.
University of Pittsburgh
Pittsburgh, PA 15213
thaseme@upmc.edu(Edited by Hagop S. Akiska)