Currently, lithium, valproate, carbamazepine, chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole are indicated for the treatment of acute mania in the majority of European countries and North America, with some minor variations from country to country, and lithium, valproate, lamotrigine, olanzapine, aripiprazole, and quetiapine are indicated for maintenance treatment, Inhibitors,research,lifescience,medical again depending on the country. However, the gap between evidence base and clinical practice is still huge, and the majority of patients have to be treated with combinations of several drugs and psychosocial interventions Inhibitors,research,lifescience,medical in order to achieve

a. reasonable outcome from the clinical as well as functional point, of view. This may be particularly true for patients with rapid-cycling bipolar disorder, who may need complex combinations of therapies and sometimes physical treatments such as electroconvulsive therapy to achieve clinical stability. For these patients, as well as for those with

mixed states, for those with enduring subsyndromal symptoms, and ultimately Inhibitors,research,lifescience,medical for the majority of people with bipolar disorder, more efficacious, tolerable treatments are badly needed.
Bipolar affective disorder, type I (BP-I) is a severe mental illness marked by periodic extremes of mood state (manias), as well as (in most cases) episodes of depression and (in many cases) psychosis. The consequences of BP-I are severe, and involve both direct, and indirect, issues. Rates of suicide in BP-I patients are high,1,2 and =BP-I subjects also suffer from poorer quality of life and lower productivity than unaffected individuals.3 Inhibitors,research,lifescience,medical Annual public health costs Inhibitors,research,lifescience,medical (combined direct, and indirect) of BP have been estimated to be between 24 billion and 45 billion dollars.4,5 BP-I occurs in all populations that have been studied, with lifetime prevalence rates worldwide

of the order of one per every 100 individuals.6 Segregation analyses, also adoption studies, and twin studies have consistently shown that, regardless of the population studied, genetic factors play an important role in determining one’s risk of developing BP-I.7-9 Since little is known about the actual etiology of BP, it would be a major contribution to our understanding of the pathophysiology of BP if the genes responsible for the neurobiologie changes which underlie this disorder could be identified. The difficulty in finding genetic loci that, are involved in BP most likely derives from the complex nature of the illness. When multiple transmission models for BP-I (the most, severe form of BP) have been tested, Caspase inhibitor oligogenic epistatic models arc found to be the best fit, rather than models which purport one major locus.