The 1999 American Psychiatric Association Annual Meeting was held in Washington, DC from May 15-May 20, 1999. On the fourth day of the conference Fr. Frederick Goodwin, MD presented the paper "General Guidelines and Intricacies in the Treatment of Bipolar Disorder." My article will be a summation of this presentation, along with my own commentary regarding some of the points he makes. Read the full text of Dr. Goodwin's presentation at Medscape: http://www.medscape.com under the psychiatry/APA topic section.
Dr Goodwin is associated with the Center of Neuroscience, Behavior and Society at George Washington University in Washington, DC. In 1990 he co-authored the book Manic Depressive Illness with Kay Redfield Jamison. This book is a definitive guide to all aspects of Bipolar Disorder. Dr Goodwin writes also for the APA.
In his general guidelines Dr Goodwin stressed the importance of using a formal charting method to plot the course of the disorder in an individual patient, making readily available the onset and offset of episodes, and integrating that information with treatment courses and life events. To me this makes a lot of sense as often a pattern develops that is difficult to see if one has to go through past records individually. I also believe that each person being treated for bipolar illness should have and update a similar chart making him aware of his history and of the possibilities of recurrence, the events surrounding past episodes, and the treatment approaches that have been employed at various time. It is my belief that an informed patient is more likely to be aware and compliant to prescribed treatments.
Rather than dictating medications and dosages, Dr Goodwin advocates a partnership between clinician and patient. Many bipolars have enjoyed this sort of relationship with their physicians for years - far too many haven't. As bipolars we know the way we feel with medication, and we do deserve some control over our treatment.
Lithium, as well as the alternatives to it were discussed. Dr Goodwin points out that in studies over the past ten years it has been shown that lithium is not as effective now as it was reported to be in the '60s and '70s. He offers as possible explanations that lithium responsive patients are often treated in private practice, and never become a part of research studies, or that the substantial increase in substance abuse has been responsible for activating bipolar illness at an earlier age. It is these patients who often manifest a lithium resistant form of the disorder.
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