Postaveni neuroleptik v lecbe bipolarni poruchy

Before the era of atypical neuroleptics there was a relatively clear consensus how to use neuroleptics in the treatment of bipolar disorder (BD): they were considered one of the main choices in the treatment of the manic phase, while in depression they were recommended only of psychotic depth. The authors submit a review of investigations of typical neuroleptics in BD and suggest possible advantages of the use of atypical neuroleptics in this indication. They submit also a review of investigations of atypical neuroleptics in BD. So far in the treatment of BD clozapine, risperidone and olanzapine were used. Clozapine was sporadically used in the treatment of BD since the mid-seventies with a considerable increase of its use from the end of the eighties. It proved useful in the treatment of manic and depressive phases, whereby a considerable part of the treated patients was pharmacoresistent. The effectiveness of clozapine in mania seems to be greater than in depression. There were also publications on the effectiveness of clozapine in the treatment of rapid cycling and as a thymostabilizing agent. Risperidone has been tested in BD since 1992. It has a good antidepressive effect. Some authors described after monotherapy with risperidone deterioration of the manic syndrome, while in combination with a thymostabilizing agent the antimanic effect of risperidone was evaluated as convincing. In olazapine initial favourable experience with the treatment of BD is available, in manic as well as in depressive symptoms.