yeeyan组：如何治疗双相情感障碍？及Ps
Ps：NIMH的小册子bipolar disorder 梅子翻完了，大家快挑刺，做PDF，做宣传手册，做网页，做flash，做视频，随你们了。。。刺挑完后，急切要求快速转帖^-^!我很虚荣滴！！！如何治疗双相情感障碍？
大多数患者——甚至是那些有重度症状的人群——能够得到恰当的治疗并拥有心境波动的基本稳定。由于双相情感障碍是一种反复发作的疾病，所以需要强调长期预防性的治疗。首选的双相长期管理策略是药物与心理治疗结合。
在大部分案例中，如果治疗是持续而不是间断的，那么双相情感障碍会控制得更好。但是尽管药物在治疗中没有间断，心境改变也会发生，这需要立刻的告知你的主治医师。医师会调整治疗计划以防止整个病程的到来。与医师紧密协作并多多交流治疗的观点及注意事项会取得更好的治疗效果。
另外，制作记录每日情绪状况，治疗，睡眠模式和生活事件的表格可以帮助患者及其家庭更好得理解这种疾病。这张表格也可以更有效地帮助医生追踪及治疗疾病。
药物
精神病医师（在诊断和治疗精神障碍方面有经验的医学博士）有资格开出双相情感障碍的医学处方。不以精神病学为专业的初级保健科医生（家庭医生——译者注）也可以开出这些药物，但我们推荐双相患者寻求精神科医师的治疗。
“心境稳定剂”类药物常常被开出以帮助治疗双相情感障碍。有几种不同类型的心境稳定剂可用。通常，双相患者需要持续服用心境稳定剂数年。其他药物在需要时，也会添加进来，主要是为了缩短病程，治疗稳定剂作用下的躁期或郁期的爆发。
锂盐，美国食品和药品管理局（FDA）批准的第一种治疗躁狂的心境稳定剂。它在控制躁狂和预防躁期和郁期复发方面有奇效。
抗癫痫药物，像丙戌酸钠（德巴金）或卡马西平（痛惊宁）也能有稳定心境的效果并且可能特别对难治性的双相周期有效。1995年，丙戌酸钠被FDA核准用于治疗躁狂。
新型抗癫痫药物包括拉莫三嗪（拉莫三嗪），加巴喷丁（镇顽癫）和托吡酯（妥泰）正在研究中，以确定在稳定心境过程中它们起到多大的作用。
为了取得最大的效果，抗癫痫药物会与锂盐共同使用，或与其他抗癫痫药物混用。
儿童和青少年患者常使用锂盐治疗，但也使用丙戌酸钠和卡马西平。研究者正评估这些及其他精神类药物在儿童和青少年中使用的安全性与有效性的问题。有证据表明卡马西平可能导致少女有害的荷尔蒙变化并且在20岁以前服用卡马西平的女性可能会得多囊性卵巢综合征。因此，女性病患在服用卡马西平时，医师应该严密监控。
想要怀孕或怀孕的女性患者需要应对特殊的挑战——使用心境稳定剂产生可能对发育中的胎儿和看护中婴儿有害的副作用。因此，患者应该与此领域的专家讨论所有可用治疗方案选择的风险和利益。新的怀孕和哺乳期过程中低风险的治疗方案正在研究中。
双相情感障碍的治疗
研究显示双相患者有转变为躁狂、轻躁或发展为快速循环的可能。因此，通常需要“心境稳定”药物或者合用抗抑郁药物来保证患者免于这种转换。锂盐和丙戌酸钠是心境稳定的常用药。当然，研究将继续评估新型药物潜在的稳定心境的效果。
非典型的抗精神类药物，包括氯氮平（氯氮平），奥氮平（再普乐），利培酮（维思通），喹硫平（思瑞康）和齐拉西酮（齐拉西酮）。它们被认为是有效治疗双相情感障碍的方法。有证据显示氯氮平作为心境稳定剂对那些不适合锂盐和抗癫痫药物的人群有帮助。其他研究也显示了奥氮平对急性躁狂的效果，它已被ＦＤＡ批准使用。阿立哌唑（阿立哌唑）是另一种非典型的抗精神类药物，它用于治疗精神分裂症状以及躁狂或双相Ｉ型的混合期。阿立哌唑有片剂和口腔崩解片两种。注射剂用于精神分裂以及躁狂或双相Ｉ型混合期有兴奋症状的患者。奥氮平也有助于解除精神病性的抑郁。
如果患者失眠，高效的苯二氮卓类药物，像氯硝西泮（氯硝西泮）或者劳拉西泮（安神镇静剂）能帮助提高睡眠。但是，因为这些药物会成瘾，它们最好开处短期药方。其他类型的镇静剂，像唑吡坦（使蒂诺斯）有时也替代使用。
患者需要在双相情感障碍的病程中不断调整治疗计划已达到更好管理疾病的效果。精神科医师应该指导患者所有药物剂量和类型的改变。
患者需确保已告知你的精神科医师所有其他处方药，非处方药或是其他你在吃的营养保健品，这很重要，因为有些药物和其他物质混用会引起不良反应。
减少复发机会或形成新周期的重点在于严格执行治疗计划。要是你有任何对药物的担忧，请与你的主治医师谈谈。
甲状腺功能
双相患者常有异常的甲状腺功能。因为太多或太少的甲状腺激素能导致情绪和精力的变化，所以医生要严密监控病人的甲状腺激素水平，这点很重要。
快速循环的患者往往有共病的甲状腺问题，因而除了双相药物外，还需要服用治疗甲状腺的药物。同样，锂盐治疗在一些患者中会导致甲状腺水平过低，通常需要服用甲状腺补充剂。
药物副作用
在双相情感障碍药物治疗开始前，你常需要和你的精神病医师和／或药剂师谈论副作用的问题。应对于不同的药物，副作用可能包括体重增加，恶心，颤抖，性欲衰退，能力下降，焦虑，脱发，运动障碍或口干。确保告知你的主治医生所有你在治疗过程中注意到的药物副作用。他或她可能会改变剂量或提供另一种药物以减轻症状。你不应该在没有精神科医师允许的情况下擅自停药或换药。
社会心理治疗
作为药物的辅助，社会心理治疗——包括一定形式的心理治疗（或“谈话”疗法）对支持，教育和指导双相患者和家人是有帮助的。研究表明心理治疗干预能够增加心境稳定，减少住院次数并且提高患者各方面的功能。执业心理学家、社工或是咨询师都能提供这些治疗，而且往往会和精神科医师共同协作监控患者的状况。会谈的次数，频率和方式应该根据每个人的治疗需要决定。
用于双相患者的社会心理干预通常是认知行为疗法，心理健康教育，家庭治疗以及一种更新的技术——人际与社会节律治疗。ＮＩＭＨ的研究者正在研究当加入双相情感障碍的药物治疗后，这些干预措施各自相比表现如何。
认知行为疗法帮助患者学会改变不恰当的或负面的思考方式以及那些与疾病有关的行为。
心理健康教育涉及到使患者领悟这项疾病的相关知识和它的治疗方法，以及如何识别复发症状，从而能够赶在疾病整个周期出现前尽早干预。心理健康教育也对家庭成员很有帮助。
家庭治疗使用一些方法减少家庭内部悲伤的程度——这些要么源于患者的症状，要么会导致患者的症状。
人际与社会节律治疗既帮助患者提高人际关系也帮助患者规划他们的日程安排。有规律的作息能保护帮助患者对抗躁狂期。
和药物治疗一样，最重要的是患者要依照有关的治疗计划达到最好的效果。
其他治疗
如果药物、社会心理治疗和联合干预措施都无效，或者因起效太慢而不能减轻像精神病或自杀倾向这样严重的症状，那么我们会考虑电休克治疗（ＥＴＣ）。考虑到身体条件（包括怀孕），如果用药过于危险，ＥＴＣ也会在治疗急性期中使用。ＥＣＴ对严重的抑郁，躁狂或／和混合期的治疗效果显著。长期记忆可能受损的问题虽然是过去的一个关注点，但如今ＥＣＴ技术已经显著克服了这个难点。可是，使用ＥＣＴ和其他可选干预手段潜在的利益与风险应该小心处理并向考虑接受的患者或在需要时向家属或其朋友澄清。
草药或天然补充剂，像圣约翰草（贯叶连翘）还未深入研究，我们对它们治疗双相的效果知之甚少。因为ＦＤＡ并未监控这些产品，这些补充剂各自品牌会含有不同的有效含量。在尝试草药或天然补充剂前，一定要与你的主治医生沟通。有证据显示圣约翰草能减少部分药物的疗效。另外，像处方类的抗抑郁药物一样，且特别在未服用心境稳定剂的情况下，圣约翰草可能在一些双相患者中导致躁狂。
专家正在研究确定鱼油中发现的Omega-3脂肪酸及其添加到通常药物后对双相情感障碍长期治疗的有效性。
长期的疾病是可以有效治疗的
尽管躁期和郁期本身必然来来去去不休止，但我们需要认清双相情感障碍是长期的疾病，目前无法治愈。在平稳期也坚持治疗能帮助你控制疾病从而减少复发和恶化的机会。
How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.
Medications
Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.
Medications known as “mood stabilizers” usually are prescribed to help control bipolar disorder.10Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
·Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
·Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
·Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
·Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
·Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13Therefore, young female patients taking valproate should be monitored carefully by a physician.
·Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.
Treatment of Bipolar Depression
Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.
·Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.1Aripiprazole (Abilify) is another atypical antipsychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder. Olanzapine may also help relieve psychotic depression.19
·If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
·Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
·Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
·To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.
Thyroid Function
People with bipolar disorder often have abnormal thyroid gland function.4Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.
People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.
Medication Side Effects
Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist’s guidance.
Psychosocial Treatments
As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or “talk” therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient’s progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.
·Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
·Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
·Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms.
·Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
·As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.
Other Treatments
·In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19
·Herbal or natural supplements, such as St. John’s wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John’s wort can reduce the effectiveness of certain medications.20In addition, like prescription antidepressants, St. John’s wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21
·Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22
A Long-Term Illness That Can Be Effectively Treated
Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.
译者注：译者不是专业人士，没有执业资格，故有关细节，并不十分明确，有曲解之处，请直接提出。同时，译者不对此译文造成的后果负责，患者请根据医嘱行事。
[ 本帖最后由 woodmqf 于 09-2-1 21:41 编辑 ] woodmqf
Thanks a lot. :handshake PDF版出炉了：
http://rapidshare.com/files/193289057/__21452___30456___24773___24863___38556___30861_bv12W.pdf.html 恭喜梅子！也谢谢你为病友做了这么多！
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