BackgroundLithium carbonate and valproate semisodium (divalproex) are both recommended as monotherapy for prevention of relapse in bipolar disorder, but are not individually fully effective in many patients. If combination therapy with both agents is superior to monotherapy, many relapses and consequent disability could be avoided.
Methods330 patients with bipolar disorder, type 1 from 41 sites in UK, France, USA and Italy were randomly allocated to open-label lithium carbonate (plasma level 0.4 -1.0 mmol/l, n=110) monotherapy or valproate semisodium (750 to1250mg, n=110) monotherapy or both agents in combination (n=110), after an active run-in of 4-8 weeks on the combination. Participants were followed for up to 24 months. The primary outcome was the initiation of new treatment for an emergent mood episode which was compared between groups by Cox regression. BALANCE was registered with
Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.
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