One factor that negatively affects the prognosis of bipolar disorder is incomplete pharmacotherapy. At present, bipolar disorder is recognized as "disorder of relapsing mood episodes that proceeds to a chronic condition". Therefore, maintenance therapy is usually administered after acute treatment of mood episodes to prevent deterioration of the prognosis. However, in the field of psychiatric care in Japan, despite maintenance therapy, the prognosis of patients with bipolar disorder may become poor due to the insufficient usage of mood stabilizers or atypical antipsychotics. For example, regarding maintenance therapy with lithium, the lowest blood concentration of lithium that can prevent recurrence is 0.4 mEq/L. However, there are many patients whose blood concentration is maintained at less than 0.4 mEq/L in Japan, and periodic blood concentration measurement may not be performed. A similar situation is observed for other mood stabilizers and atypical antipsychotics. It is unclear whether 50 mg/day of lamotrigine or quetiapine can prevent mood episodes; however, such prescriptions are common in clinical practice. In addition, clinical guidelines recommend maintenance therapy for several years, although there is no consensus on the duration, but there are patients whose mood episodes have recurred after reducing or withdrawing their medication after less than a year. A similar trend is observed in the treatment of acute mood episodes. When the effects of lithium are insufficient in the acute phase of a manic episode, the dose should be increased to 1.0 mEq/L. A follow-up period of 8 weeks is needed after reaching a blood concentration greater than 0.8 mEq/L in the acute phase of a depressive episode. Atypical antipsychotics should also be used in a sufficient amount and for a sufficient period if their effects are not satisfactory.
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