The recurrent and frequently chronic course of affective disorders requires careful delineation of the number, frequency, and pattern of prior and current episodes and their response to pharmacotherapies to help develop optimal assessment and treatment approaches for these Potentially lethal medical illnesses. To better track and monitor the longitudinal course of unipolar and bipolar illness and to promote more effective management, we developed the retrospective and prospective National Institute of Mental Health Life Chart Methodology (NIMH-LCM). The principles of retrospective and prospective life charting are the focus of this article. Following introductory background information on affective disorders, the influence of Kraepelin's work and his use of life charts are reviewed as the basis and framework for the NIMH-LCM. The use of life charting both retrospectively and prospectively is discussed, with examples of its utility and benefits.

Driving to the symposium, the vague anxiety and discomfort I had heen experiencing for the past few days finally culminated in the realization that 7 years ago that day, I awoke from my first night as an inpatient at a psychiatric unit.

Since then and because of that, I've learned a great deal about depressive and manic-depressive illness. I've learned about stigma and shame. I've learned about the devastation that the violence we benignly call “mood disorder” wreaks on families. I have been awed by the array of treatments we've found to ease the suffering, and humbled by the fact that we still have a long way to go. I have become painfully aware of how unenlightened the world still is about psychiatric illness, and saddened by the cruel irony that the only thing more stigmatizing than suffering from a psychiatric illness is seeking treatment for it.

The course of bipolar disorder is marked by relapses and remissions, even when patients are maintained on appropriate pharmacotherapy. This variability in illness course may occur in part because the disorder is affected by socioenvironmental stressors, particularly significant life events and high-conflict family relationships. Considering these factors, clinicians have focused more attention on psychosocial treatments as useful adjuncts to pharmacotherapy. In this article, a psychosocial treatment program known as family-focused psychoeducational treatment (FFT) is described. Delivered in combination with pharmacotherapy during the postepisode stabilization period, FFT begins with an assessment of the family or marital environment. Then, in three consecutive, modules, participants receive education about the nature, causes, and treatment of bipolar disorder, communication enhancement training, and problem-solving skills training. The overall goals of the program are to restore family equilibrium and improve the patient's clinical functioning after the acute-illness episode. A case study illustrating the approach is presented, and the future directions of FFT are reviewed.

Evidence continues to mount that anticonvulsants represent broad-spectrum central nervous system agents which are highly efficacious in the treatment of core psychiatric symptoms. The US Food and Drug Administration has extended the use of anticonvulsants beyond the treatment of epilepsy, to include wide-reaching neuropsychiatric illnesses such as mania, migraine, panic disorder, and trigeminal neurologia. From the perspective of psychiatric disorders, the most exciting development about these newer agents is the emergence of persuasive evidence that they are effective in treating mood disorders. Depakote and Tegretol have been joined by Neurontin and Lamictal as agents shown to be useful in the treatment of bipolar, and possibly unipolar, depression.

Recently, both clinical and research attention has focused specifically on the use of Neurontin and Lamictal as alternatives to standard, agents for the treatment of mood and anxiety disorders. Because many patients with bipolar disorder experience continued symptomology despite standard treatment, further study of these novel agents for the treatment of affective disorders is warranted.

In this article, we present rationales for using complex combination therapy in treatment-refractory bipolar patients and discuss the agents available for use in this therapeutic approach. We review a case example of successful remission that was achievable only with complex combination therapy, and examine its theoretical implications. Practical approaches to devising the optimal complex combination treatment for individual patients are explained, and we look to the development of new methodologies and a more systematic database for decision making in the future.