New strategies in the treatment of bipolar disorder.

About 20-30 years ago the central pillar of psychiatry was schizophrenia. Today ́s interest has turned to a new paradigm bipolar disorder. Knowledge, skills and experiences in treatment of bipolar affective disorder are being enriched with new insights concerning molecular basis of disorder and psychosocial factors importance in its genesis and development, fostering presonalized psyhopharmacotherapeutic and psychotherapeutic treatment approach (Goodwin & Geddes 2007). Increased interest in bipolar disorder has resulted in recognizing the broader group of disorders which have in common periodical affective variability. The lifetime prevalence of type I and type II bipolar disorder is to 2.1% (Dilsaver 2011). In addition to type I and type II bipolar affective disorder and cyclothymia, which together make up 3-4% of today ́s general population, this group increasingly encompasses the socalled softer end of the bipolar spectrum. Together, mentioned disorders affect an impressive 5-8% of general population and represent the greatest diagnostic and therapeutic challenge for contemporary psychiatry. The type I and II of bipolar disorder and cyclothymia is not difficult to diagnose, but the bipolarity must be suspected in every early onset unipolar depression, frequent episodes of illness and in positive family history for bipolar and other comorbid disorders. These disorders are: alcoholism and other substance abuse disorders, uncontrollable episodes of rage and violence, suicide attempts and achievements, postpartum depression and psychotic depression. Mentioned states are often resistant to conventional antidepressant therapy or could even worsen and then require special therapeutic approach (Lieber). Recognizing the bipolar affective disorder as heterogenic in its phenomenology, ethiopathogenesis and comorbidity, the significantly increased early diagnostic and has set the path towards new therapeutic strategies. These new strategies in treatment of bipolar affective disorder have been based on its heterogeneity and knowledge on how significant role in occurrence also have negative life events, stressors which through biological connections potentiate immune reactions with inflammatory and metabolic changes causing excitotoxicity in central nervous system. So today, in addition to conventional mood stabilizers, antidepressants and antipsychotics in therapy of bipolar affective disorder are increasingly being introduced adjuvant agents: glutamate transport inhibitors, proinflammatory cytokines inhibitors, cyclooxygenase 2 inhibitors, regulators of metabolism and antioxidants (Ghaemi 2000, McInture & Cha 2011). The new strategies in the treatment of bipolar disorder are still being focused on treatment of acute phases (depressive, manic, mixed) and the prevention of new episodes, but emphasizing comparative treatment of cognitive deficits, persistent residual symptoms, comorbid conditions and suicide prevention common in this disorder (Müller-Oerlinghausen et al. 2002). Novel strategies have spurred re-examination of ongoing smoldering dilemma to follow treatment algorithms or to defer to, for clinician, more challenging personalized approach with greater diagnostic and therapeutic performance along with better suicide prevention and treatment of residual symptoms (Alda et al. 2009).