As is so often the case in psychopharmacology, backward engineering of the mechanism of action has been used to try to understand both the drugs’ efficacies and any underlying dysfunction. In such a scenario, our current pharmacological reality, it is perhaps understandable that our initial attempts to treat bipolar depression were based on unipolar models and that the current Inhibitors,research,lifescience,medical therapeutic arsenal is often inadequate. Nevertheless, the pharmacological reverse engineering of existing medications and molecular biology are opening up better understanding of intracellular secondary messenger systems

and putative dysfunctional enzymatic components, such as inositol monophosphatase (IMPase) and glycogen synthase kinase 3 (GSK-3),

that might prove more efficacious future targets for treatment [O'Brien and Klein, 2009]. The time and cost of the development of such agents will be enormous, but until this happens there is no reason why clinical practice should not follow the best current evidence. Although there is some Inhibitors,research,lifescience,medical conflict in the literature about appropriate pharmacological treatment and a lack of clear Inhibitors,research,lifescience,medical and consistent guidelines, several clear themes emerge. Although antidepressants are by far the most commonly prescribed drug class for such patients, there is no good evidence for their use in monotherapy and very little to support their use to augment other treatments beyond the olanzapine–fluoxetine combination. In both acute and longer-term work, there is growing evidence for both mood stabilizers and Inhibitors,research,lifescience,medical antipsychotics, and within these PFT�� classes lamotrigine and quetiapine respectively are showing statistically superior efficacy. Further work is needed: Inhibitors,research,lifescience,medical better clinical guidance and psychoeducation of both patients and clinicians of this serious but treatable condition are required. Furthermore, there is a need for more

RCTs in this area, particularly covering the areas of bipolar II disorder and longer-term treatment, which have to date received less attention. Finally, whilst most trials have compared an active drug with placebo, direct comparative trials between postulated treatments are needed. Footnotes This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. old The author declares no conflict of interest in preparing this article.
Objective: Medication errors are a common cause of avoidable morbidity, and transfer between clinical settings is a known risk factor for such errors. Medicines reconciliation means there is no unintended discrepancy between the medication prescribed for a patient prior to admission and on admission. Our aim was to improve the quality of practice supporting medicines reconciliation at the point of admission to a psychiatric ward.