A medication algorithm for treatment of bipolar rapid cycling

Over the last decade, our clinical research team has evolved effective methods for forming a strong treatment alliance with mood disorder patients. These methods, in turn, have been associated with very low rates of patient dropout ( 85%) over multiyear treatment trials. We have every reason to believe that our technique for alliance building would be equally effective in general clinical practice. The cornerstones of our methods are education of, information for, and active participatinn by the patient in the treatment process. We begin by educating the patient about high or her disorder and its treatment, giving patients as much information as their clinical condition will allow them to absorb. As patients begin to improve, we provide additional information. We continuously inform patients about what to expect in treatment and when, both with respect to amelioration of symptoms and with respect to the medication side effects they may experience. We present the treatment experience as an experiment in which clinician and patient are coinvestigators, each with his or her own expertise. The clinician is the expert on the disorder 'and its treatment in general; the patient is the expert on his or her own disorder and his or her own experience of the treatment. We try to keep the experiment interesting and, whenever possible, to inject some humor into it. We work to engage family members as adjunct members of the experimental team by educating them as well and keeping them informed throughout the treatment process. Informed family members rarely undercut the treatment process and will often be of considerable help in keeping the patient committed to treatment. Finally, whenever possible, we try to obtain objective measures of treatment adherence. In pharmacotherapy, these take the form of regular serum level measurements. In psychotherapy, they may take the form of a request for written «homework» between sessions or simply a review at the outset of each therapy session of the patient's accomplishments since the last visit