[Management of bipolar disorders]

Management of the bipolar disorders is well codified and rests on the prescription of mood stabilisers and psychotherapeutic measures. Mood stabilisers have considerably improved the prognosis of bipolar disorder, in limiting the number of recurrences. Lithium is still the leader of mood stabilisers. It has a preventative and curative action that has effect on the two poles of the illness. Carbamazepine, valpromide and its derivatives, and olanzapine are indicated in the case of resistance or contra-indication to lithium therapy and are more easily handled in the curative treatment of the manic state. Other therapeutic measures have been proposed in order to optimise the medical treatment and to act in anticipation of the precipitating elements. Psycho educational measures, the roles of which have been undervalued for a long time, are today the best-evaluated psychological treatments. An elevated level of proof exists for these treatments. Their value is stressed in most of the reference texts. The benefits of this complementary approach exists on different levels: early recognition of symptoms that announce a recurrence, improvement in compliance, acceptance of the illness, better management of the social life, both professional and emotional, control of precipitating factors... Recently published studies report a reduction in the number of recurrences and relapses, a reduction in the duration of hospitalisation, a better balance in the family life and an improvement in compliance.