Evidence-based strategies for achieving treatment goals in bipolar disorder: A review and synthesis of contemporary treatment guidelines

Abstract

The fundamental goals of treatment in bipolar disorder are full remission of acute mood episodes and prevention of future episodes. Contemporary treatment guidelines recommend a number of intermediate goals to facilitate remission and maintenance of bipolar disorder. These goals vary somewhat between guidelines, and the rationale behind them and strategies for achieving them often receive little discussion. We therefore reviewed published guidelines to derive a core set of treatment goals in bipolar disorder. During acute episodes, these goals include rapidly assuring safety for patients and those around them, and limiting the length and consequences of illness. Goals are more varied during maintenance phase treatment, and in addition to preventing recurrence include targeting residual symptoms, ensuring medication adherence, identifying and planning for sentinel symptoms, reducing risk of harm, minimizing possible precipitants of relapse, and maximizing psychosocial functioning. We review the rationale for selecting each of these, and suggest strategies for achieving them.