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Expanding the indications of second-generation antipsychotics: from schizophrenia to bipolar affective disorder

E.G. Kostyukova.
Moscow Research Institute of Psychiatry – a branch of the FSBI “National Medical Research Center for Psychiatry and Addiction named after V.P. Serbskij” Ministry of Health of Russian Federation, Moscow, Russia

Summary: Despite the availability of clinical guidelines and step-by-step treatment algorithms of bipolar disorder (BD) and schizophrenia, in practice, there are often difficulties choosing the right tactics of treatment due to problems of differential diagnosis of these diseases, especially when the structure of acute episodes of bipolar disorder present psychotic symptoms. Misdiagnosing and prescribing classic neuroleptics to patients with BD often leads to a worsening of the course of the disease and their social disadaptation. The article discusses the reasons for the existing diagnostic ambiguity and the possibility of overcoming the associated problems of therapy. In this diagnostic dilemma, therapeutic choices are simplified by the introduction of second-generation antipsychotics. Their proven effectiveness in various syndromic manifestations of bipolar disorder and schizophrenia, better tolerability in comparison with classical neuroleptics,  including a low risk of developing extrapyramidal syndrome, not only expand the possibilities of  bipolar disorder therapy, but also neutralize the harm resulting from mistaken  differential diagnosis of schizophrenia and BD. Based on the analysis of literature data, the article discusses the possibility of differentiated use of second-generation antipsychotics in BD, depending on the spectrum of their clinical activity and taking into account the features of somatotropic action.
Contact: ekostukova@gmail.com   
https://orcid.org/0000-0002-9830-1412

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