A. Treating the Complex Patient

Athansio Koukopoulos, M.D.
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B. Establishing a Specialty Clinic for Children and Adolescents

David Axelson, M.D.
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Amy Schlonski, M.S.W.
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Susan Wassick, R.N.
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C. Clinical Epidemiology and Treatment Access

Valentim Gentil, M.D.
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Giovanni de Girolamo, M.D.
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D. Caring for Pregnant and Postpartum Women with Bipolar Disorder

Adele Viguera, M.D.
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Abstract:  Course and Treatment of Bipolar Illness During Pregnancy and the Postpartum Period
While the postpartum period has typically been considered a period of risk for relapse of bipolar disorder, systematic data regarding the course of bipolar disorder during pregnancy are essentially unknown. The management of bipolar women who plan to conceive or are pregnant poses significant challenges for clinicians that care for these patients. Recent data suggest that pregnancy is not protective and the risk for relapse after lithium discontinuation is similar in pregnant and nonpregnant women with 50 percent relapsing within 6 months. This presentation reviews the major clinical dilemmas in managing pregnant bipolar patients as well as recent data on the course of bipolar disorder during pregnancy and the postpartum period. Treatment guidelines for the management of bipolar illness during pregnancy and the postpartum period will also be presented.

Selected References:
1. Leibenluft E., Women with Bipolar Illness: Clinical and Research Issues. Am J Psychiatry, 1996; 153:163-73.
2. Viguera AC, Nonacs R, Cohen Ls, et al. Risks of Discontinuing Lithium Maintenance in Pregnant Women with Bipolar Disorder (Abstract). Proc Am Psychiatr Assoc Ann Meeting, Toronto: May 1998.
3. Nonacs R, Viguera AC, Cohen LS. Postpartum Course of Bipolar Illness (Abstract). Prod Am Psychiatr Assoc Ann Meeting, Toronto: May 1998.
4. Altshuler LL, Cohen LS, Szuba MP, et al. Pharmacologic Management of Psychiatric Illness in Pregnancy: Dilemmas and Guidelines. Am J Psychiatry, 1996; 153:592-606.
5. Cohen LS, Friedman JM, Jefferson JW, et al. A re-evaluation of risk of in utero exposure to lithium. JAMA, 1994; 271:146-50.
6. Viguera AC, Nonacs, r, Cohen LS, et al. Risk of discontinuing lithium maintenance in pregnant and nonpregnant women with bipolar disorders. AJP, submitted for publication.

E. How Does Lithium Compare to Other Treatments in the Management of Bipolar Disorder?

Frederick K. Goodwin, M.D.
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F. Legal and Ethical Issues in the Assessment and Treatment of Bipolar Disorder Patients