Guidelines out on psychiatric disorders

Psychiatrists have developed new clinical guidelines for treating bipolar disorder and schizophrenia.

The guidelines, published as a supplement to the November issue of the Journal of Clinical Psychiatry, are based on surveys of approximately 150 psychiatric research specialists.

Faculty members from Duke University, Columbia University and Cornell University directed the project. Abbott Laboratories and Janssen Pharmaceutica funded the project through unrestricted educational grants.

Bipolar disorder

The bipolar disorder guidelines named divalproex sodium, marketed as Depakote by Abbott Laboratories, and lithium as the first-line treatment for manic episodes. Divalproex sodium is rated the best tolerated treatment for preventing future episodes.

The guidelines also stated that combinations of carbamazepine, divalproex sodium and lithium should be used for treatment-resistant manic episodes. If these treatments fail, electroconvulsive therapy or Sandoz's antipsychotic medication Clozaril (clozapine) should be considered.

Researchers also said it is crucial for clinicians to educate patients and families about the medical nature of bipolar disorder and the need for taking medication. Clinicians should help patients and families develop coping strategies for stresses that may bring on episodes of mania and depression.

Schizophrenia

The schizophrenia guidelines named both Janssen's antipsychotic Risperdal (risperidone), and traditional antipsychotics such as haloperidol as first-line treatments for an initial episode of schizophrenia and for relapses.

The guidelines said clinicians should consider risperidone for any patient who has failed to respond to traditional antipsychotic medication.

As with bipolar disorder, it is crucial for clinicians to educate patients about the need for taking medication. Patients who have problems remaining on medications may benefit from outreach efforts with assigned caseworkers. PR