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Bipolar Disorder: A Clinician’s Guide to Treatment Management, Second Edition

Deepak Prabhakar, MD, MPH

Wayne State University, Detroit, MI, USA

Edited by Lakshmi N. Yatham and Vivek Kusumakar. New York, NY: Routledge; (Taylor & Francis Group); 2009; ISBN 978-0-415-96136-3; pp 628; $74.95 (Web price $67.46) (hardcover).

Bipolar disorder is one of the most researched topics in psychiatry. Any new text or innovative research finding on bipolar disorder invites inquisitiveness from clinicians, researchers, patients, and the general public. The second edition of Bipolar Disorder: A Clinician’s Guide to Treatment Management, edited by Dr. Yatham and the late Dr. Kusumakar, sets out with the objective “to provide an up-to-date synthesis of all new information in a manner that can be readily applied in clinical situations to manage patients with bipolar disorder” (p xi).

This book includes contributions from 38 authors from Australia, Europe, and North America. The main body consists of a Preface and 18 chapters. The book begins with a tribute to Dr. Kusumakar, who died in January 2009. It introduces the readers to many of his accomplishments and contributions to psychiatry. This leaves us wondering how much more Dr. Kusumakar could have contributed to advancement of psychiatry and alleviation of mental illness if his life had not been cut short by sudden death.

The first 5 chapters include “Diagnosis and treatment of hypomania and mania,” “Bipolar depression: Diagnosis and treatment,” “Diagnosis and treatment of rapid cycling bipolar disorder,” “Bipolar II disorder: Assessment and treatment,” and “Maintenance treatment in bipolar I disorder.” All 5 chapters are written to include comprehensive diagnostic and assessment strategies. Treatment strategies are discussed at length and recommendations based on up-to-date data are provided. The chapters on hypomania, mania, and rapid cycling include treatment algorithms, which readers will find valuable in practice. The discussion is informative, eg, the chapter on hypomania and mania states “the principles that guide the management of mania and hypomania include choosing a setting for treatment which will assure the safety of the patient and adherence with the treatment plan; prescribing medications which will rapidly reduce manic symptoms, protect against mania and depression during long-term treatment; and cause minimal side effects; and promoting a return to full psychosocial functioning” (p 5). The recommendations are specific, eg, in the chapter on bipolar depression the authors write that “the treatment of acute bipolar depression should initially be undertaken with one of the first-line, evidence-favored options: olanzapine-fluoxetine combination, quetiapine, lithium, or lamotrigine” (p 35). In the chapter on bipolar II disorder, the authors acknowledge the paucity of evidence, stating that “extrapolation from the evidence base for bipolar I disorder treatments may provide the best available, albeit suboptimal, guidance” (p 97) and state that “an open-minded and vigilant approach to clinical management of bipolar II disorder patients may be the most realistic option” (p 97).

The next 4 chapters “deal with the management of bipolar disorder in women at various stages of reproductive cycle, young people, the elderly, and those with psychiatric comorbidity” (p xi). In the chapter on bipolar disorder in women, the authors remind readers that “The treatment of bipolar disorder in women is complicated by a myriad of hormonal factors that are specific to this population, adding a degree of complexity to its biological management” (p 170). The chapter on bipolar disorder in children and adolescents points out that “psychiatric comorbidity seems to be a rule rather than an exception in bipolar disorder” (p 189) and recommend that “treatment for bipolar disorder should only be instituted after establishing the diagnosis by longitudinal observation” (p 190) and “when there is a question whether the young person has attention deficit hyperactivity disorder or bipolar disorder, it is more pragmatic to institute a trial of medications for ADHD” (p 190). The chapter on comorbidities presents an informative review of psychiatric and medical comorbidities. This chapter also discusses a set of clinically useful diagnostic assessment and treatment strategies for managing patients with bipolar disorder and comorbidities.

Chapters 10 through 14 review the efficacy of various psychotropic and somatic treatments commonly used for treatment of bipolar disorder. Chapter 15 focuses on psychotropic medication adverse effects, drug interactions, and their management. In the Preface, the editors point out that “the division of chapters necessitated some overlap in content between the chapters” (p xii). In this section the overlap is apparent, compared with the rest of the chapters. For example, evidence and recommendations on the use of medications are discussed in the earlier section on treatment of different phases and types of bipolar disorder and are repeated separately in this section with every class of medications. Inclusion of evidence dating back to the 1950s in the chapter on lithium and detailed discussion of most of the cited studies, although informative, might put a time strain on the target audience (clinicians). Nevertheless this segment provides readers with a comprehensive review of psychotropic and somatic treatment modalities for bipolar disorder.

The next 2 chapters focus on psychosocial treatment. The authors of the chapter “Practical issues in psychological approaches to individuals with bipolar disorders” set the tone for an interesting discussion on this important aspect by reaffirming that “it is impossible for clinicians not to be psychologically important to clients with bipolar” (p 551). This chapter uses reader-friendly boxes to discuss various salient patient management strategies, such as “developing a positive therapeutic alliance,” “questions to establish the client’s views of their problems,” “exploring coping strategies,” “exploring the benefits and barriers for adherence,” and “behavioral techniques for increasing medication adherence.” The chapter on psychosocial interventions reviews evidence of effectiveness of adjunctive psychotherapeutic modalities and concludes with supportive evidence for “group psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, and cognitive-behavioral therapy” (p 586).

The last chapter, “Novel treatments in bipolar disorder: Future directions,” discusses various therapeutic strategies such as “neurotrophic cascades,” “intracellular signaling cascades,” “neuropeptides, stress, and the HPA axis,” and “heavy metals.” The discussion is informative and emphasizes the need for relentless investigation of novel modalities that could mitigate suffering associated with bipolar disorder. The authors conclude by stating, “recurrent unipolar and bipolar mood disorders can be associated with a progressive and downhill course if not adequately treated with appropriate and timely interventions” (p 609).

The authors, for the most part, meet the editors’ goal of providing a comprehensive review of up-to-date information on bipolar disorder. The editors encourage clinicians to “mould their practice around the long-term symptomatic and functional needs of their patients with bipolar disorder” (p xii) and suggest that “optimal treatment of bipolar disorder includes a combination of psychoeducation, life style management, psychotherapy, and rehabilitative techniques with medications in the context of an empathic and longitudinal therapeutic relationship to improve symptoms, functioning and quality of life” (p xii). This book presents readers with the information necessary to provide comprehensive care to the patients suffering from bipolar disorder.

In summary, I found this book a clinically practical and useful text. Readers will find the treatment strategies and recommendations valuable and those interested in this field would be able to update their knowledge base and use this book as a reference text. Residents will find this book especially useful in updating their knowledge base in accordance with current evidence.