Patient: Description of condition (time of onset, main symptoms, hospital visited, etc.): Male, 38 years old 1. Diagnosed with bipolar disorder in ’96. 2.From 1996 to now, there have been 5 episodes: 96, 97, 06, 09, 2011. The symptoms of each episode were similar, manic first, then depressive. The manic symptoms were more prominent, thinking that they were remarkable, easily provoked, and accompanied by exaggerated delusions and belligerent delusions. The latter 3 episodes of depression are not obvious. 3. In the interictal period, completely normal. 1, 96, 97 years in the local hospital medical treatment, mania when taking lithium carbonate and chlorpromazine; depression, taking lithium carbonate and amitriptyline, etc. 06, 09 years taking lithium carbonate and Seroquel, due to Seroquel on his side effects, this time recently taking lithium carbonate, carbamazepine and aripiprazole. At present, the symptoms are completely controlled, only the thinking is slower, the work efficiency is low, and the voice pronunciation is difficult. 2. After recovering from the onset of the disease in ’97, he was maintained with only 500 mg of lithium carbonate daily for more than 8 years without relapse. 3.After recovering from the onset of the disease in 2006, he was maintained with only 750 mg of lithium carbonate with a blood lithium concentration of 0.5. In 2009, he had another attack with no obvious cause. 4, 06 and 2011 relapses have obvious triggers: 06 years because no recurrence, they are careless, coupled with busy work, continuous night driving; 2011 because of some kidney indicators are not normal, with uremia, the doctor completely stopped lithium carbonate, only eat 250 mg daily Sericom, resulting in 2 months after the relapse. I would like to ask the experts: 1. Will bipolar disorder (bipolar disorder) turn into schizoaffective disorder after many episodes? The reason for this confusion is: After recovering from the onset of the disease in 1997, I only used 500 mg of lithium carbonate daily to maintain the disease for more than 8 years without relapse, which means that the diagnosis of bipolar disorder is correct, but after recovering from the onset of the disease in 2006, I used 750 mg of lithium carbonate to maintain the disease with a blood lithium concentration of 0.5, and then I had another attack in 2009 without any obvious cause. 2. Can antipsychotics (e.g., aripiprazole) be gradually reduced or discontinued during maintenance treatment, and only emotional stabilizers be used? This confusion is related to the first question, and I understand that if it is turning into schizoaffective disorder, the antipsychotics cannot be stopped. He had an onset in early February 2011 this time and his delusional symptoms disappeared completely in early March, after which he had mild depression but did not dare to take antidepressants and is now in a more normal mood. Lithium carbonate is 1050 mg per day since March, carbamazepine has been reduced from 600 mg to 400 mg per day, and aripiprazole has been gradually reduced from 30 mg to 5 mg in February, which is my biggest concern. 3. Can lithium carbonate and carbamazepine be used together for long-term maintenance treatment? I read from the manual that lithium carbonate may cause uremia (he did have uremia in 2009), and carbamazepine can treat uremia (after this relapse, the combination of lithium carbonate and carbamazepine has not resulted in excessive drinking and urination so far), but the manual also says that the combination of the two may produce neurotoxicity, so I wonder if lithium carbonate and carbamazepine can be combined for long-term maintenance treatment? Thank you! Li Da, Department of Psychological Counseling, Wuxi Mental Health Center
Li Da of Wuxi Mental Health Center: 1. Regarding “Will bipolar disorder (bipolar disorder) turn into schizoaffective disorder after many episodes?” This is a rather complicated issue, and most of the current psychiatric diagnoses can only be diagnosed in terms of symptomatology rather than etiology. At different times the doctor may observe only a certain time period of presentation and may get a different diagnosis. The goal of the physician is to reduce symptoms as much as possible and to facilitate the recovery of the patient’s social functioning.2 Theoretically, “antipsychotics (e.g., aripiprazole) can be gradually reduced or discontinued during maintenance treatment, and only emotional stabilizers can be used.” However, the decision depends on the specific patient. A good doctor should know in detail the patient’s previous treatment to constantly adjust the treatment plan, and if it has been effective, do not change the treatment plan as much as possible.3. Regarding the question “Can lithium carbonate and carbamazepine be combined for long-term maintenance treatment?” I prefer not to combine the two mood stabilizers as much as possible. My medication principle is that patients should take fewer times, types and doses of medication, and the medication should be “good”. The above answer is for reference only and depends on the patient’s condition. Li Da, Department of Psychiatric Rehabilitation, Wuxi Mental Health Center, Jiangsu, China
Patient: Thank you very much for your reply!