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Clinical Crossroads |

A 25-Year-Old Woman With Bipolar Disorder

Gary S. Sachs, MD, Discussant
JAMA. 2001;285(4):454-462. doi:10.1001/jama.285.4.454.
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DR PARKER: Ms G is a 25-year-old woman who is slowly coming to terms with her diagnosis of bipolar disorder. She lives with her boyfriend and currently attends school. She experienced 2 manic episodes resulting in inpatient psychiatry hospitalizations. Ms G has lost her medical insurance, which is complicating her access to medical and psychiatric care.

In the summer of 1998, Ms G worked in a restaurant, and described the atmosphere as "very tense, pressured, nonsupportive, and demanding." Although she cannot recall all the details, her family brought her to a local emergency department for evaluation of her agitated mental state. She was transferred by ambulance to an inpatient psychiatry unit.

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Figure. Multiphase Treatment Strategy
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Effective acute phase treatment ameliorates symptoms of the depressive episode, but discontinuation prior to the natural end point (dashed line) is associated with high rates of relapse. Extending treatment beyond the point of initial remission (dark line) is associated with a low relapse rate. The period between initial remission and the estimated natural end point is designated "continuation phase."

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