tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 6

Điều này phải được thực hiện một cách rất cởi mở và toàn diện, đầy đủ liên quan đến bệnh nhân và các cá nhân quan trọng khác, và nhấn mạnh một cuộc thảo luận kỹ lưỡng về cả các nguy cơ đã biết và các giới hạn của kiến thức của chúng tôi. | 126 handbook of psychiatric drugs of their need for specific agents and likelihood and speed of relapse off of medication. This must be done in a very open and comprehensive fashion fully involving the patient and other important individuals and emphasizing a thorough discussion of both the known risks and the limits of our knowledge. Ideally options for pharmacologic intervention if either elevation or depression intercedes should be thoroughly discussed in order to allow for the most efficient and informed intervention should one be needed. Another critical feature to consider is that the window of opportunity for medication discontinuation is very narrow with respect to the congenital abnormalities of concern with mood stabilizers. Cardiac development and neural tube closure occur relatively early in the first trimester. Therefore a patient presenting with one or two missed periods is likely already to be beyond the stage where medication discontinuation will be able to prevent increased risk. This argues for having a full discussion of risks with reproductive age women and a discussion about contraceptive methods being employed. Keep in mind as well that low potency oral contraceptives may be rendered ineffective by enzyme inducing medications such as carbamazepine. Evidence from retrospective studies suggests that there is no protective effect of pregnancy on mood stability. In the immediate post-partum period bipolar women are at markedly elevated risk of relapse. The most thorough study to date found a 90 relapse rate for unmedicated bipolar women in the first two months post-partum. Therefore regardless of the decisions made during pregnancy aggressive pharmacotherapy should be initiated in the immediate post-partum period. SUMMARY Recent years have seen a remarkable increase in our understanding of bipolar disorder and the range of pharmacologic agents with which it can be treated. Lithium and valproate remain the core treatment options for bipolar .