Bipolární porucha

SOUHRN

Bipolární poruchy jsou běžné, zneschopňující, recidivující psychické poruchy proměnlivé závažnosti. Často se začínají rozvíjet v pozdním dětství nebo v časném dospívání. Pacienti s bipolárními poruchami vykazují vyšší četnost dalších duševních poruch i somatických onemocnění. Včasným rozpoznáním a zahájením léčby bipolární poruchy lze zlepšit terapeutické výsledky. Terapie různých epizod poruch nálady závisí na fázi onemocnění – rozlišujeme mánii, hypománii, smíšený stav, depresi a období udržovací léčby. Psychoterapie a stabilizátory nálady, mezi něž patří lithium, antiepileptika a antipsychotika, jsou prostředky léčby první linie, v níž bychom měli s ohledem na riziko relapsu pokračovat celoživotně. Monoterapie antidepresivy je kontraindikována u smíšených stavů, u manických epizod a u bipolární poruchy I. Udržovací terapie zahrnuje screening zaměřený na sebevražedné myšlenky a na zneužívání návykových látek, hodnocení adherence k léčbě a diagnostiku metabolických komplikací farmakoterapie. Aktivní udržování tělesné hmotnosti zajistí pokles výskytu komplikací a vede ke zlepšení lipidogramu. Pacienti a členové systémů jejich podpory by měli být edukováni ohledně relapsů poruch nálady, sebevražedných myšlenek a účinnosti časné intervence s cílem snížit četnost komplikací.

SUMMARY

Bipolar disorders are common, disabling, recurrent mental health conditions of variable severity. Onset is often in late childhood or early adolescence. Patients with bipolar disorders have higher rates of other mental health disorders and general medical conditions. Early recognition and treatment of bipolar disorders improve outcomes. Treatment of mood episodes depends on the presenting phase of illness: mania, hypomania, mixed state, depression, or maintenance. Psychotherapy and mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, are first-line treatments that should be continued indefinitely because of the risk of relapse. Monotherapy with antidepressants is contraindicated in mixed states, manic episodes, and bipolar I disorder. Maintenance therapy for patients involves screening for suicidal ideation and substance abuse, evaluating adherence to treatment, and recognizing metabolic complications of pharmacotherapy. Active management of body weight reduces complications and improves lipid control. Patients and their support systems should be educated about mood relapse, suicidal ideation, and the effectiveness of early intervention to reduce complications.

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Zdroj: Medicína po promoci