Foreword

Summary

More than perhaps for virtually any other mental illness, there is a need for a comprehensive and integrated approach to the management of bipolar disorders. The limited view that treatment of bipolar disorders consists only of finding the “right” pharmacotherapy has largely been dispelled. The availability of an array of medications proven to be beneficial in research trials has not changed the course of bipolar disorders as we encounter them in contemporary practice. Evidence suggests that this efficacy–effectiveness gap is a product, on the one hand, of the difficulty in getting bipolar patients to adhere to their medication treatment as prescribed and, on the other, a consequence of the greater prevalence of adverse psychological and social factors influencing the course of bipolar disorder in the heterogeneous populations treated in non-research clinical settings.

There is an increasing acceptance of the importance of the stressvulnerability hypothesis as a model for understanding individual risk of relapse or poor prognosis in bipolar disorders. It is also accepted that patients’ attitudes and beliefs about their disorder and its treatment influence how or whether they adjust to their predicament, and that this adjustment or lack of it will ultimately affect their outcome. Furthermore, helping the individual to recognize and change potentially harmful behaviors (such as drug or alcohol use), or encouraging the adoption of more stable and regular patterns of social activity (which may in turn stabilize circadian rhythms) are hypothesized as additional ways of reducing the risk of relapse.