文档介绍：Update
Psychopharmacologic Treatment Strategies for Depression,
Bipolar Disorder, and Schizophrenia
Ira D. Glick, MD; Trisha Suppes, MD, PhD; Charles DeBattista, MD; Rona J. Hu, MD; and Stephen Marder, MD
Patients with serious psychiatric disorders are frequently treated size adherence, 2) treatment choice should be empirical, 3) com-
by primary care physicians, who may have difficulty keeping up binations of medications may be helpful, 4) bination of
with recent advances in psychiatry. This paper presents an up- psychosocial and pharmacologic treatments may be more useful
dated synopsis for three major psychiatric illnesses: major depres- than either alone, and 5) the family or “significant others” as well
sion, bipolar disorder, and schizophrenia. Current definitions, up- as a anization need to be involved. Some of the new
dated diagnostic criteria, short- and long-term treatment strategies directions in clinical research to refine these strategies and meet
with algorithms, and special challenges for the clinician are dis- these challenges are also described.
cussed for each of these illnesses. On the basis of each illness’s
distinct characteristics, five treatment principles are emphasized: Ann Intern Med. 2001;134:47-60.
1) Treatment strategies should be long-term and should empha- For author affiliations and current addresses, see end of text.
atients with major psychiatric illnesses are often in textbooks and consensus guidelines (4–6). For each
Ptreated first, and sometimes exclusively, by family condition, preferred medications (Table 2) and algo-
physicians and internists. Because the diagnosis and rithms (Figures 1 to 5) reflect general principles of drug
treatment of these disorders have changed profoundly in management.
two decades, it may be difficult for specialists outside of
psychiatry to keep informed (1–3). This, in turn, could
lead to underdiagnosis and undertreatment. We there-
DEPRESSION
fore provide an updated synopsis for