Page 26 - e-book CPG - Bipolar Disorder (full 92 pg) (1)
P. 26
CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
o better improvement in Positive and Negative Syndrome Scale (PANSS) (MD= -16.67,
o better improvement in Positive and Negative Syndrome Scale (PANSS) (MD= -16.67,
95% CI -22.98 to -10.36) and Brief Psychotic Rating Scale (BPRS) scores (MD=
95% CI -22.98 to -10.36) and Brief Psychotic Rating Scale (BPRS) scores (MD=
o better improvement in Positive and Negative Syndrome Scale (PANSS) (MD= -16.67,
-3.07, 95% CI -5.02 to -1.12)
o better improvement in Positive and Negative Syndrome Scale (PANSS) (MD= -16.67,
95% CI -22.98 to -10.36) and Brief Psychotic Rating Scale (BPRS) scores (MD=
-3.07, 95% CI -5.02 to -1.12)
95% CI -22.98 to -10.36) and Brief Psychotic Rating Scale (BPRS) scores (MD=
o better response rate (OR=4.26, 95% CI 1.65 to 10.99)
-3.07, 95% CI -5.02 to -1.12)
o better response rate (OR=4.26, 95% CI 1.65 to 10.99)
-3.07, 95% CI -5.02 to -1.12)
lithium monotherapy had NS difference in remission rate compared with any of the three
o better response rate (OR=4.26, 95% CI 1.65 to 10.99)
lithium monotherapy had NS difference in remission rate compared with any of the three
combination therapies (lamotrigine, lithium and valproate)
o better response rate (OR=4.26, 95% CI 1.65 to 10.99)
combination therapies (lamotrigine, lithium and valproate)
lithium monotherapy had NS difference in remission rate compared with any of the three
lithium monotherapy had NS difference in remission rate compared with any of the three
There was no mention of AEs. The quality of primary papers was high based on the Agency
combination therapies (lamotrigine, lithium and valproate)
There was no mention of AEs. The quality of primary papers was high based on the Agency
combination therapies (lamotrigine, lithium and valproate)
for Healthcare Research and Quality (AHRQ) assessment.
There was no mention of AEs. The quality of primary papers was high based on the Agency
for Healthcare Research and Quality (AHRQ) assessment.
There was no mention of AEs. The quality of primary papers was high based on the Agency
for Healthcare Research and Quality (AHRQ) assessment.
for Healthcare Research and Quality (AHRQ) assessment.
In another systematic review of RCTs and meta-analysis on adults with rapid cycling BD, it
In another systematic review of RCTs and meta-analysis on adults with rapid cycling BD, it
30, level I
was shown that:
In another systematic review of RCTs and meta-analysis on adults with rapid cycling BD, it
was shown that:30, level I
In another systematic review of RCTs and meta-analysis on adults with rapid cycling BD, it
both lithium and short-term venlafaxine monotherapy had equal effectiveness in acute
30, level I
was shown that:
both lithium and short-term venlafaxine monotherapy had equal effectiveness in acute
was shown that: 30, level I depression
episodes of BD-II
both lithium and short-term venlafaxine monotherapy had equal effectiveness in acute
episodes of BD-II depression
both lithium and short-term venlafaxine monotherapy had equal effectiveness in acute
combination of lithium and carbamazepine was more effective in preventing relapse
episodes of BD-II depression carbamazepine was more effective in preventing relapse
combination of lithium and
episodes of BD-II depression rapy
compared with either monothe
combination of lithium and carbamazepine was more effective in preventing relapse
compared with either monotherapy
quetiapine as an adjunct to lithium or valproate was effective and safe in the prevention
combination of lithium and carbamazepine was more effective in preventing relapse
compared with either monotherapy
quetiapine as an adjunct to lithium or valproate was effective and safe in the prevention
of mood episodes in BD-I
compared with either monotherapy
quetiapine as an adjunct to lithium or valproate was effective and safe in the prevention
of mood episodes in BD-I
quetiapine as an adjunct to lithium or valproate was effective and safe in the prevention
There was no mention of quality assessment on the primary papers.
of mood episodes in BD-I
There was no mention of quality assessment on the primary papers.
There was no mention of quality assessment on the primary papers.
of mood episodes in BD-I
There was no mention of quality assessment on the primary papers.
47, level I
In the third meta-analysis on adults with rapid cycling BD:
In the third meta-analysis on adults with rapid cycling BD:47, level I
In the third meta-analysis on adults with rapid cycling BD: 47, level I
AAPs and mood stabilisers were more effective than placebo in
AAPs and mood stabilisers were more effective than placebo in
In the third meta-analysis on adults with rapid cycling BD: g of 0.79 (95% CI 0.71 to 0.86) for
47, level I
o Clinical Global Impression (CGI) with Hedge’s
AAPs and mood stabilisers were more effective than placebo in
o Clinical Global Impression (CGI) with Hedge’s g of 0.79 (95% CI 0.71 to 0.86) for
AAPs and 0.67 (95% CI 0.40 to 0.95) for mood stabilisers
AAPs and mood stabilisers were more effective than placebo in
o Clinical Global Impression (CGI) with Hedge’s g of 0.79 (95% CI 0.71 to 0.86) for
AAPs and 0.67 (95% CI 0.40 to 0.95) for mood stabilisers
o Clinical Global Impression (CGI) with Hedge’s g of 0.79 (95% CI 0.71 to 0.86) for
o Montgomery-Asberg Depression Rating Scale (MADRS)/Hamilton Depression
AAPs and 0.67 (95% CI 0.40 to 0.95) for mood stabilisers
o Montgomery-Asberg Depression Rating Scale (MADRS)/Hamilton Depression
AAPs and 0.67 (95% CI 0.40 to 0.95) for mood stabilisers CI 0.56 to 0.93) for AAPs
Rating Scale (HAM-D) score with Hedge’s g of 0.75 (95%
o Montgomery-Asberg Depression Rating Scale (MADRS)/Hamilton Depression
Rating Scale (HAM-D) score with Hedge’s g of 0.75 (95% CI 0.56 to 0.93) for AAPs
and 0.83 (95% CI 0.57 to 1.08) for mood stabilisers
o Montgomery-Asberg Depression Rating Scale (MADRS)/Hamilton Depression
Rating Scale (HAM-D) score with Hedge’s g of 0.75 (95% CI 0.56 to 0.93) for AAPs
and 0.83 (95% CI 0.57 to 1.08) for mood stabilisers
Rating Scale (HAM-D) score with Hedge’s g of 0.75 (95% CI 0.56 to 0.93) for AAPs
AAPs were more effective than placebo in YMRS with Hedge’s g of 1.11 (95% CI 0.92
and 0.83 (95% CI 0.57 to 1.08) for mood stabilisers
AAPs were more effective than placebo in YMRS with Hedge’s g of 1.11 (95% CI 0.92
and 0.83 (95% CI 0.57 to 1.08) for mood stabilisers
to 1.30)
AAPs were more effective than placebo in YMRS with Hedge’s g of 1.11 (95% CI 0.92
to 1.30)
There was a mixture of quality on the primary papers based on risk of bias (RoB) assessment.
AAPs were more effective than placebo in YMRS with Hedge’s g of 1.11 (95% CI 0.92
There was a mixture of quality on the primary papers based on risk of bias (RoB) assessment.
to 1.30)
There was a mixture of quality on the primary papers based on risk of bias (RoB) assessment.
to 1.30)
Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines has no specific
There was a mixture of quality on the primary papers based on risk of bias (RoB) assessment.
Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines has no specific
40
recommendation on the use of antidepressants in BD with rapid cycling. The Royal
Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines has no specific
recommendation on the use of antidepressants in BD with rapid cycling. The Royal
40
Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines has no specific
Australian and New Zealand College of Psychiatrists (RANZCP) guidelines recommend
recommendation on the use of antidepressants in BD with rapid cycling. The Royal
40
Australian and New Zealand College of Psychiatrists (RANZCP) guidelines recommend
recommendation on the use of antidepressants in BD with rapid cycling. The Royal
antidepressant therapy should be used cautiously in the treatment of bipolar depression when
40
Australian and New Zealand College of Psychiatrists (RANZCP) guidelines recommend
antidepressant therapy should be used cautiously in the treatment of bipolar depression when
39
Australian and New Zealand College of Psychiatrists (RANZCP) guidelines recommend
antidepressant therapy should be used cautiously in the treatment of bipolar depression when
there is a history of rapid cycling.
there is a history of rapid cycling.39
antidepressant therapy should be used cautiously in the treatment of bipolar depression when
39
there is a history of rapid cycling.
there is a history of rapid cycling. 39
Recommendation 4
Recommendation 4
In bipolar disorder with specifiers:
Recommendation 4
In bipolar disorder with specifiers:
Recommendation 4 chotics (AAPs) or mood stabilisers may be used as monotherapy or
o atypical antipsy
In bipolar disorder with specifiers: or mood stabilisers may be used as monotherapy or
o atypical antipsychotics (AAPs)
combination therapy in mixed features
In bipolar disorder with specifiers:
combination therapy in mixed features
o atypical antipsychotics (AAPs) or mood stabilisers may be used as monotherapy or
o atypical antipsychotics (AAPs) or mood stabilisers may be used as monotherapy or
o AAPs may be used in anxious distress
combination therapy in mixed features
o AAPs may be used in anxious distress
combination therapy in mixed features
o combination of mood stabilisers with AAPs or another mood stabiliser is the preferred
o combination of mood stabilisers with AAPs or another mood stabiliser is the preferred
o AAPs may be used in anxious distress
o AAPs may be used in anxious distress
treatment of choice in rapid cycling
o combination of mood stabilisers with AAPs or another mood stabiliser is the preferred
treatment of choice in rapid cycling
o combination of mood stabilisers with AAPs or another mood stabiliser is the preferred
o antidepressants should be avoided in mixed features and used with caution in rapid
treatment of choice in rapid cycling
o antidepressants should be avoided in mixed features and used with caution in rapid
cycling
treatment of choice in rapid cycling
cycling
o antidepressants should be avoided in mixed features and used with caution in rapid
cycling
o antidepressants should be avoided in mixed features and used with caution in rapid
cycling
4.1.4. Maintenance phase
4.1.4. Maintenance phase
Maintenance phase focuses on prevention of recurrence after remission of acute mood
Maintenance phase focuses on prevention of recurrence after remission of acute mood
4.1.4. Maintenance phase
episodes.
4.1.4. Maintenance phase
Maintenance phase focuses on prevention of recurrence after remission of acute mood
episodes.
Maintenance phase focuses on prevention of recurrence after remission of acute mood
episodes.
The duration of maintenance phase in BD is debatable. In a meta-analysis on BD I, pooled
episodes.
The duration of maintenance phase in BD is debatable. In a meta-analysis on BD I, pooled
results of five RCTs showed that patients who were stable with combination therapy of mood
The duration of maintenance phase in BD is debatable. In a meta-analysis on BD I, pooled
results of five RCTs showed that patients who were stable with combination therapy of mood
The duration of maintenance phase in BD is debatable. In a meta-analysis on BD I, pooled
stabilisers and AAP had lower recurrence rate at 12 months compared with those on mood
results of five RCTs showed that patients who were stable with combination therapy of mood
stabilisers and AAP had lower recurrence rate at 12 months compared with those on mood
results of five RCTs showed that patients who were stable with combination therapy of mood
stabilisers and AAP had lower recurrence rate at 12 months compared with those on mood
stabilisers and AAP had lower recurrence rate at 12 months compared with those on mood
12
12
12
12
12
