Evolving Role of Antipsychotic Therapy in the Management of Bipolar Disorder*

The lifetime prevalence of bipolar I disorder in the United States is reported to be between 1% and 1.6%; the prevalence of bipolar II disorder is estimated to be 0.5%. A more recent study, however, demonstrated an overall rate of 3.4%. Bipolar disorder is a lifelong debilitating and potentially fatal illness characterized by changes in mood, cognition, energy levels, behavior, and perception and is difficult to diagnose. The primary goal of treatment for bipolar disorder is to prevent subsequent episodes, thus limiting morbidity and mortality. Comprehensive nursing management includes more than just treating the acute phase of illness. Identifying effective maintenance therapies that are both efficacious and tolerable is a central challenge in the management of patients with bipolar disorder. The use of mood stabilizers and antipsychotic medications may provide more effective stabilization and help reduce the frequency and severity of episodes, therefore improving outcomes and quality of life in these patients. Advanced practice psychiatric nurses, clinically trained to provide care from a holistic approach, are in an optimal position to weigh the benefits and risks of antipsychotic therapy and individualize care to better meet patient needs and overall treatment goals. Atypical antipsychotic agents have been shown to be effective for acute manic episodes associated with bipolar disorder and some have been demonstrated to have mood-stabilizing properties. In this article, the data supporting the individual atypical agents used to treat this debilitating disorder are reviewed. (Adv Stud Nurs. 2004;2(1):24-32)