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Fortschr Neurol Psychiatr 2008; 76(5): 294-308
DOI: 10.1055/s-2008-1038151
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© Georg Thieme Verlag Stuttgart · New York

Bipolare affektive Störungen
Teil II: Genetik, Kognition und Therapie

Bipolar Affective Disorders
Part II: Genetics, Cognition and TherapyW.  E.  Severus1 , S.  Watzke2 , P.  Brieger3
  • 1Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München (Direktor: Prof. Dr. H.-J. Möller)
  • 2Universitätsklinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg (Direktor: Prof. Dr. Dr. h.c. Andreas Mameros)
  • 3Bezirkskrankenhaus Kempten (Direktor: Prof. Dr. Peter Brieger) und Medizinische Fakultät, Universität Ulm
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Publication History

Publication Date:
28 April 2008 (online)

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Lernziele

In unserem ersten Artikel zum Thema hatten wir Diagnostik, Epidemiologie und Verlauf bipolarer Erkrankungen dargestellt [1]. Der nachfolgende zweite Teil widmet sich Genetik, Kognition und Therapie. Ziel dieses Artikels ist es, neben neueren Erkenntnissen zur Neurobiologie differenzielle und evidenzbasierte Strategien der Therapie bipolar affektiver Störungen aufzuzeigen. Dabei wird neben der Psychopharmakotherapie auch der Aspekt der Psychotherapie und Psychoedukation sowie der gemeindepsychiatrischen Versorgung diskutiert.

Literatur

  • 1 Brieger P. Bipolare affektive Störungen. Teil I: Diagnostik, Epidemiologie und Verlauf.  Fortschr Neurol Psychiatr. 2007;  75 673-684
    Google Scholar
  • 2 Craddock N, Forty L. Genetics of affective (mood) disorders.  Eur J Hum Genet. 2006;  14 660-668
    Google Scholar
  • 3 Kato T. Molecular genetics of bipolar disorder and depression.  Psychiatry and Clinical Neurosciences. 2007;  61 3-19
    Google Scholar
  • 4 Schulze T G, Hedeker D, Zandi P, Rietschel M, McMahon F J. What Is Familial About Familial Bipolar Disorder? Resemblance Among Relatives Across a Broad Spectrum of Phenotypic Characteristics.  Archives of General Psychiatry. 2006;  63 1368-1376
    Google Scholar
  • 5 Lerer B, Segman R H. Pharmacogenetics of antipsychotic therapy: pivotal research issues and the prospects for clinical implementation.  Dialogues Clin Neurosci. 2006;  8 85-94
    Google Scholar
  • 6 Alda M, Grof P, Rouleau G A, Turecki G, Young L T. Investigating responders to lithium prophylaxis as a strategy for mapping susceptibility genes for bipolar disorder.  Prog Neuropsychopharmacol Biol Psychiatry. 2005;  29 1038-1045
    Google Scholar
  • 7 Einat H, Yuan P, Szabo S T, Dogra S, Manji H K. Protein kinase C inhibition by tamoxifen antagonizes manic-like behavior in rats: implications for the development of novel therapeutics for bipolar disorder.  Neuropsychobiology. 2007;  55 123-131
    Google Scholar
  • 8 Zobel A, Maier W. Endophänotypen - ein neues Konzept zur biologischen Charakterisierung psychischer Störungen.  Der Nervenarzt. 2004;  75 205-214
    Google Scholar
  • 9 Akiskal H S, Brieger P, Mundt C, Angst J, Marneros A. Temperament und affektive Störungen. Die TEMPS-A-Skala als Konvergenz europäischer und US-amerikanischer Konzepte.  Nervenarzt. 2002;  73 262-271
    Google Scholar
  • 10 Chiaroni P, Hantouche E G, Gouvernet J, Azorin J M, Akiskal H S. The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies?.  J Affect Disord. 2005;  85 135-145
    Google Scholar
  • 11 Hallam K T, Olver J S, Chambers V. et al . The heritability of melatonin secretion and sensitivity to bright nocturnal light in twins.  Psychoneuroendocrinology. 2006;  31 867-875
    Google Scholar
  • 12 Hajek T, Carrey N, Alda M. Neuroanatomical abnormalities as risk factors for bipolar disorder.  Bipolar Disord. 2005;  7 393-403
    Google Scholar
  • 13 Drevets W C. Neuroimaging studies of mood disorders.  Biological Psychiatry. 2000;  48 813-829
    Google Scholar
  • 14 Scherk H, Reith W, Falkai P. Hirnstrukturelle Veränderungen bei bipolaren affektiven Störungen.  Nervenarzt. 2004;  75 861-872
    Google Scholar
  • 15 Savitz J, Solms M, Ramesar R. Neuropsychological dysfunction in bipolar affective disorder: a critical opinion.  Bipolar Disorders. 2005;  7 216-235
    Google Scholar
  • 16 Strakowski S M, Delbello M P, Adler C M. The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings.  Mol Psychiatry. 2005;  10 105-116
    Google Scholar
  • 17 Basso M R, Lowery N, Neel J, Purdie R, Bornstein R A. Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder.  Neuropsychology. 2002;  16 84-91
    Google Scholar
  • 18 Olley A, Malhi G S, Batchelor J. et al . Executive functioning and theory of mind in euthymic bipolar disorder.  Bipolar Disorders. 2005;  7 43-52
    Google Scholar
  • 19 Martinez-Aran A, Vieta E, Colom F. et al . Neuropsychological performance in depressed and euthymic bipolar patients.  Neuropsychobiology. 2002;  46 Suppl 1 16-21
    Google Scholar
  • 20 Clark L, Iversen S D, Goodwin G M. A neuropsychological investigation of prefrontal cortex involvement in acute mania.  American Journal of Psychiatry. 2001;  158 1605-1611
    Google Scholar
  • 21 Murphy F C, Rubinsztein J S, Michael A. et al . Decision-making cognition in mania and depression.  Psychol Med. 2001;  31 679-693
    Google Scholar
  • 22 Malhi G S, Ivanovski B, Hadzi-Pavlovic D. et al . Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia.  Bipolar Disord. 2007;  9 114-125
    Google Scholar
  • 23 Martinez-Aran A, Vieta E, Reinares M. et al . Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.  American Journal of Psychiatry. 2004;  161 262-270
    Google Scholar
  • 24 Nehra R, Chakrabarti S, Pradhan B K, Khehra N. Comparison of cognitive functions between first- and multi-episode bipolar affective disorders.  J Affect Disord. 2006;  93 185-192
    Google Scholar
  • 25 Robinson L J, Ferrier I N. Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence.  Bipolar Disord. 2006;  8 103-116
    Google Scholar
  • 26 Dittmann S, Seemuller F, Schwarz M J. et al . Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results.  Bipolar Disord. 2007;  9 63-70
    Google Scholar
  • 27 Altshuler L L, Ventura J, Gorp W van  G. et al . Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects.  Biological Psychiatry. 2004;  56 560-569
    Google Scholar
  • 28 Torrent C, Martinez-Aran A, Amann B. et al . Cognitive impairment in schizoaffective disorder: a comparison with non-psychotic bipolar and healthy subjects.  Acta Psychiatrica Scandinavica. 2007;  116 453-460
    Google Scholar
  • 29 Borkowska A, Rybakowski J K. Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar.  Bipolar Disorders. 2001;  3 88-94
    Google Scholar
  • 30 Martinez-Aran A, Vieta E, Torrent C. et al . Functional outcome in bipolar disorder: the role of clinical and cognitive factors.  Bipolar Disord. 2007;  9 103-113
    Google Scholar
  • 31 Dickerson F B, Boronow J J, Stallings C R. et al . Association between cognitive functioning and employment status of persons with bipolar disorder.  Psychiatr Serv. 2004;  55 54-58
    Google Scholar
  • 32 Laes J R, Sponheim S R. Does cognition predict community function only in schizophrenia?: A study of schizophrenia patients, bipolar affective disorder patients, and community control subjects.  Schizophr Res. 2006;  84 121-131
    Google Scholar
  • 33 Tohen M, Zarate Jr  C A, Hennen J. et al . The McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence.  Am J Psychiatry. 2003;  160 2099-2107
    Google Scholar
  • 34 Brieger P, Rottig S, Rottig D, Marneros A, Priebe S. Dimensions underlying outcome criteria in bipolar I disorder.  Journal of Affective Disorders. 2007;  99 1-7
    Google Scholar
  • 35 Tohen M, Bowden C L, Calabrese J R. et al . Influence of sub-syndromal symptoms after remission from manic or mixed episodes.  Br J Psychiatry. 2006;  189 515-519
    Google Scholar
  • 36 Fountoulakis K N, Vieta E, Sanchez-Moreno J. et al . Treatment guidelines for bipolar disorder: a critical review.  J Affect Disord. 2005;  86 1-10
    Google Scholar
  • 37 American Psychiatric Association . Practice guideline for the treatment of patients with bipolar disorder (revision).  American Journal of Psychiatry. 2002;  159 1-50
    Google Scholar
  • 38 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder . Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder.  Aust N Z J Psychiatry. 2004;  38 280-305
    Google Scholar
  • 39 Yatham L N, Kennedy S H, O'Donovan C. et al . Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007.  Bipolar Disord. 2006;  8 721-739
    Google Scholar
  • 40 National Institute for Health and Clinical Excellence .NICE clinical guideline 38: Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care. London: National Institute for Health and Clinical Excellence 2006
    Google Scholar
  • 41 Goodwin F K. The biology of recurrence: new directions for the pharmacologic bridge.  J Clin Psychiatry. 1989;  50 Suppl 40-44; discussion 45 - 47
    Google Scholar
  • 42 Findling R L, Frazier T W, Youngstrom E A. et al . Double-blind, placebo-controlled trial of divalproex monotherapy in the treatment of symptomatic youth at high risk for developing bipolar disorder.  J Clin Psychiatry. 2007;  68 781-788
    Google Scholar
  • 43 Judd L L, Akiskal H S, Schettler P J. et al . Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study.  Arch Gen Psychiatry. 2005;  62 1322-1330
    Google Scholar
  • 44 Gijsman H J, Geddes J R, Rendell J M, Nolen W A, Goodwin G M. Antidepressants for Bipolar Depression: A Systematic Review of Randomized, Controlled Trials.  Am J Psychiatry. 2004;  161 1537-1547
    Google Scholar
  • 45 Ketter T A, Calabrese J R. Stabilization of mood from below versus above baseline in bipolar disorder: a new nomenclature.  J Clin Psychiatry. 2002;  63 146-151
    Google Scholar
  • 46 Keck Jr P E, Calabrese J R, McQuade R D. et al . A randomized, double-blind, placebo-controlled 26-week trial of aripiprazole in recently manic patients with bipolar I disorder.  J Clin Psychiatry. 2006;  67 626-637
    Google Scholar
  • 47 Keck Jr P E, Calabrese J R, McIntyre R S. et al . Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: a 100-week, double-blind study versus placebo.  J Clin Psychiatry. 2007;  68 1480-1491
    Google Scholar
  • 48 Krüger S. Olanzapin in der Behandlung bipolarer affektiver Erkrankungen.  Psychiatr Prax. 2006;  33 Suppl 1 S18-26
    Google Scholar
  • 49 Geddes J R, Burgess S, Hawton K, Jamison K, Goodwin G M. Long-Term Lithium Therapy for Bipolar Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials.  Am J Psychiatry. 2004;  161 217-222
    Google Scholar
  • 50 Goodwin G M, Bowden C L, Calabrese J R. et al . A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder.  J Clin Psychiatry. 2004;  65 432-441
    Google Scholar
  • 51 Ghaemi S N, Gilmer W S, Goldberg J F. et al . Divalproex in the treatment of acute bipolar depression: a preliminary double-blind, randomized, placebo-controlled pilot study.  J Clin Psychiatry. 2007;  68 1840-1844
    Google Scholar
  • 52 Bowden C L, Calabrese J R, McElroy S L. et al . A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group.  Arch Gen Psychiatry. 2000;  57 481-489
    Google Scholar
  • 53 Gyulai L, Bowden C L, McElroy S L. et al . Maintenance efficacy of divalproex in the prevention of bipolar depression.  Neuropsychopharmacology. 2003;  28 1374-1382
    Google Scholar
  • 54 Dando T M, Keating G M. Quetiapine: a review of its use in acute mania and depression associated with bipolar disorder.  Drugs. 2005;  65 2533-2551
    Google Scholar
  • 55 Severus W E, Kleindienst N, Seemuller F. et al .What is the optimal serum lithium level in the long-term treatment of bipolar disorder? A review. Bipolar Disord im Druck
    Google Scholar
  • 56 Zarate Jr  C A, Tohen M. Double-blind comparison of the continued use of antipsychotic treatment versus its discontinuation in remitted manic patients.  Am J Psychiatry. 2004;  161 169-171
    Google Scholar
  • 57 Okuma T, Inanaga K, Otsuki S. et al . A preliminary double-blind study on the efficacy of carbamazepine in prophylaxis of manic-depressive illness.  Psychopharmacology (Berl). 1981;  73 95-96
    Google Scholar
  • 58 Greil W, Ludwig-Mayerhofer W, Erazo N. et al . Lithium versus carbamazepine in the maintenance treatment of bipolar disorders - a randomised study.  J Affect Disord. 1997;  43 151-161
    Google Scholar
  • 59 Calabrese J R, Keck Jr P E, Macfadden W. et al . A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression.  Am J Psychiatry. 2005;  162 1351-1360
    Google Scholar
  • 60 Tohen M, Vieta E, Calabrese J. et al . Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression.  Arch Gen Psychiatry. 2003;  60 1079-1088
    Google Scholar
  • 61 Sachs G S, Nierenberg A A, Calabrese J R. et al . Effectiveness of adjunctive antidepressant treatment for bipolar depression.  N Engl J Med. 2007;  356 1711-1722
    Google Scholar
  • 62 Calabrese J R, Bowden C L, Sachs G S. et al . A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group.  J Clin Psychiatry. 1999;  60 79-88
    Google Scholar
  • 63 Brown E B, McElroy S L, Keck Jr P E. et al . A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression.  J Clin Psychiatry. 2006;  67 1025-1033
    Google Scholar
  • 64 Vieta E, Calabrese J R, Goikolea J M, Raines S, Macfadden W. Quetiapine monotherapy in the treatment of patients with bipolar I or II depression and a rapid-cycling disease course: a randomized, double-blind, placebo-controlled study.  Bipolar Disord. 2007;  9 413-425
    Google Scholar
  • 65 Zarate Jr  C A, Payne J L, Singh J. et al . Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.  Biol Psychiatry. 2004;  56 54-60
    Google Scholar
  • 66 Goldberg J F, Burdick K E, Endick C J. Preliminary randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression.  Am J Psychiatry. 2004;  161 564-566
    Google Scholar
  • 67 Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study.  Br J Psychiatry. 2006;  188 46-50
    Google Scholar
  • 68 Frye M A, Grunze H, Suppes T. et al . A placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression.  Am J Psychiatry. 2007;  164 1242-1249
    Google Scholar
  • 69 Bschor T, Lewitzka U, Sasse J. et al . Lithium augmentation in treatment-resistant depression: clinical evidence, serotonergic and endocrine mechanisms.  Pharmacopsychiatry. 2003;  36 Suppl 3 S230-234
    Google Scholar
  • 70 Nolen W A, Kupka R W, Hellemann G. et al . Tranylcypromine vs. lamotrigine in the treatment of refractory bipolar depression: a failed but clinically useful study.  Acta Psychiatr Scand. 2007;  115 360-365
    Google Scholar
  • 71 Gajwani P, Kemp D E, Muzina D J. et al . Acute treatment of mania: an update on new medications.  Curr Psychiatry Rep. 2006;  8 504-509
    Google Scholar
  • 72 Scherk H, Pajonk F G, Leucht S. Second-generation antipsychotic agents in the treatment of acute mania: a systematic review and meta-analysis of randomized controlled trials.  Arch Gen Psychiatry. 2007;  64 442-455
    Google Scholar
  • 73 Licht R W. Limitations in randomised controlled trials evaluating drug effects in mania.  Eur Arch Psychiatry Clin Neurosci. 2001;  251 Suppl 2 II66-71
    Google Scholar
  • 74 Colom F, Vieta E, Tacchi M J, Sanchez-Moreno J, Scott J. Identifying and improving non-adherence in bipolar disorders.  Bipolar Disord. 2005;  7 Suppl 5 24-31
    Google Scholar
  • 75 Meyer T D, Hautzinger M. Psychoedukation und Psychotherapie. In: DGBS (ed). Weißbuch Bipolare Störungen in Deutschland Stand des Wissens - Defizite - Was ist zu tun? 2. überarbeitete Auflage ed. Hamburg: ConferencePoint Verlag 2006: 325-298
    Google Scholar
  • 76 Scott J, Colom F, Vieta E. A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders.  Int J Neuropsychopharmacol. 2007;  10 123-129
    Google Scholar
  • 77 Colom F, Vieta E, Martinez-Aran A. et al . A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.  Arch Gen Psychiatry. 2003;  60 402-407
    Google Scholar
  • 78 Meyer T, Hautzinger M. Manisch-depressive Störungen. Weinheim: Beltz PVU 2004
    Google Scholar
  • 79 Schaub A, Bernhard B, Gauck L. Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Ein Therapiemanual. Göttingen: Hogrefe 2004
    Google Scholar
  • 80 Wagner P, Bräunig P. Psychoedukation bei bipolaren Störungen. Ein Therapiemanual für Gruppen. Stuttgart: Schattauer 2006
    Google Scholar
  • 81 Scott J, Paykel E, Morriss R. et al . Cognitive-behavioural therapy for severe and recurrent bipolar disorders: Randomised controlled trial.  Br J Psychiatry. 2006;  188 313-320
    Google Scholar
  • 82 Miklowitz D J, Otto M W, Frank E. et al . Psychosocial Treatments for Bipolar Depression: A 1-Year Randomized Trial From the Systematic Treatment Enhancement Program.  Arch Gen Psychiatry. 2007;  64 419-426
    Google Scholar
  • 83 Brieger P, Becker T. Spezialisierung in der Gemeindepsychiatrie?.  Die Psychiatrie. 2007;  4 216-220
    Google Scholar
  • 84 Kunze H. Personenzentrierter Ansatz in der psychiatrischen Versorgung in Deutschland.  Psycho. 1999;  25 728-735
    Google Scholar

Prof. Dr. Peter Brieger

Bezirkskrankenhaus Kempten

Freudental 1

87435 Kempten

Email: peter.brieger@extern.uni-ulm.de

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