Page 21 - e-book CPG - Bipolar Disorder

CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)

 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
(CGI-BP) scores
(CGI-BP) scores
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
 olanzapine was more effective than asenapine as an adjunct to valproate in reducing
(CGI-BP) scores
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
 lithium was more
 lithium was more effective than aripiprazole in reducing manic symptoms based on
(CGI-BP) scores effective than aripiprazole in reducing manic symptoms based on
Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar Disorder
 lithium was more effective than aripiprazole in reducing manic symptoms based on
(CGI-BP) scores
Manic State Rating Scale (MSRS)
Manic State Rating Scale (MSRS)
(CGI-BP) scores effective than aripiprazole in reducing manic symptoms based on
 lithium was more
 lithium was more effective than
Manic State Rating Scale (MSRS) aripiprazole in reducing manic symptoms based on
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
Manic State Rating Scale (MSRS)
 lithium was more effective than aripiprazole in reducing manic symptoms based on
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
Manic State Rating Scale (MSRS)
cholesterol compared with asenapine
cholesterol compared with asenapine
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
Manic State Rating Scale (MSRS)
cholesterol compared with asenapine
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
cholesterol compared with asenapine
 olanzapine was associated with increased waist circumference, waist-hip ratio and total
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
cholesterol compared with asenapine
were seen in lithium
were seen in lithium
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
cholesterol compared with asenapine
were seen in lithium
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
The risk of bias was reported to be high in most primary papers.
The risk of bias was reported to be high in most primary papers.
were seen in lithium
 reported AEs in aripiprazole were akathisia, mild stiffness and sedation whilst tremors
The risk of bias was reported to be high in most primary papers.
were seen in lithium

The risk of bias was reported to be high in most primary papers.
were seen in lithium
The risk of bias was reported to be high in most primary papers.

In another systematic review on adults with bipolar mania, lithium was found to be: 30, level I
Another systematic review on adults with bipolar mania, lithium was found to be:
30, level I

The risk of bias was reported to be high in most primary papers.
Another systematic review on adults with bipolar mania, lithium was found to be:

30, level I
 more effective than placebo in response, remission and improvement of YMRS scores
 more effective than placebo in response, remission and improvement of YMRS scores
30, level I
Another systematic review on adults with bipolar mania, lithium was found to be:

 more effective than placebo in response, remission and improvement of YMRS scores

30, level I
Another systematic review on adults with bipolar mania, lithium was found to be: olanzapine,
 more effective when used as a combination with either risperidone,
 more effective when used as a combination with either risperidone, olanzapine,
 more effective than placebo in response, remission and improvement of YMRS scores
30, level I

 more effective when used as a combination with either risperidone,
Another systematic review on adults with bipolar mania, lithium was found to be: olanzapine,
 more effective than placebo in response, remission and improvement of YMRS scores
quetiapine, asenapine or carbamazepine compared with lithium monotherapy
quetiapine, asenapine and carbamazepine compared with lithium monotherapy
 more effective when used as a combination with either risperidone, olanzapine,
 more effective than placebo in response, remission and improvement of YMRS scores
quetiapine, asenapine and carbamazepine compared with lithium monotherapy
 equally effective to valproate, carbamazepine and quetiapine risperidone, olanzapine,
 more effective when used as a combination with either
 equally effective to valproate, carbamazepine and quetiapine
quetiapine, asenapine and carbamazepine compared with lithium monotherapy
 more effective when used as a combination with either risperidone, olanzapine,
 equally effective to valproate, carbamazepine and quetiapine
quetiapine, asenapine and carbamazepine compared with lithium monotherapy
There was no mention of quality assessment done on the primary papers.
There was no mention of quality assessment done on the primary papers.
 equally effective to valproate, carbamazepine and quetiapine
quetiapine, asenapine and carbamazepine compared with lithium monotherapy
There was no mention of quality assessment done on the primary papers.
 equally effective to valproate, carbamazepine and quetiapine

There was no mention of quality assessment done on the primary papers.
 equally effective to valproate, carbamazepine and quetiapine
There was no mention of quality assessment done on the primary papers.
A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that:
A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that: 31,
31,

There was no mention of quality assessment done on the primary papers.
A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that:
31,

level I
level I
31,
A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that:

level I
A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that:
 brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo
level I  brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo

A systematic review on the effectiveness and safety of brexpiprazole in BD I revealed that: 31,
31,
 brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo
level I
 akathisia was the only AE with an incidence of 5% being reported
level I  akathisia was the only AE with an incidence of �5% being reported
 brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo
 akathisia was the only AE with an incidence of �5% being reported
 brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo
 akathisia was the only AE with an incidence of �5% being reported
 brexpiprazole showed no difference in YMRS scores at 21 days compared with placebo

 akathisia was the only AE with an incidence of �5% being reported either valproate or
An open-label RCT comparing the combinations of lithium with either valproate or
An open-label RCT comparing the combinations of lithium with

 akathisia was the only AE with an incidence of �5% being reported 32, level Ivalproate or
carbamazepine in young adults (18 - 35 years old) with BD I showed that: 32, level
carbamazepine in young adults (18 - 35 years old) with BD I showed that:
An open-label RCT comparing the combinations of lithium with either I
32, level I valproate or
An open-label RCT comparing the combinations of lithium with either

An open-label RCT comparing the combinations of lithium with 32, level Iweeks, there
carbamazepine in young adults (18 - 35 years old) with BD I showed that: either valproate or
 although both groups had significant improvement in YMRS scores at eight
 although both groups had significant improvement in YMRS scores at eight weeks, there

carbamazepine in young adults (18 - 35 years old) with BD I showed that:
An open-label RCT comparing the combinations of lithium with either valproate or
 although both groups had significant improvement in YMRS scores at eight weeks, there

carbamazepine in young adults (18 - 35 years old) with BD I showed that:
32, level I
was NS difference between them
was NS difference between them
 although both groups had significant improvement in YMRS scores at eight
carbamazepine in young adults (18 - 35 years old) with BD I showed that: 32, level I weeks, there

was NS difference between them
 although both groups had significant improvement in YMRS scores at eight weeks, there
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
was NS difference between them
 although both groups had significant improvement in YMRS scores at eight weeks, there
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
was NS difference between them
sexual desire while the lithium plus carbamazepine group had significant increased rates
sexual desire while the lithium plus carbamazepine group had significant increased rates
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
was NS difference between them
sexual desire while the lithium plus carbamazepine group had significant increased rates
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
of diarrhoea
of diarrhoea
sexual desire while the lithium plus carbamazepine group had significant increased rates
of diarrhoea
sexual desire while the lithium plus carbamazepine group had significant increased rates
 AEs reported in lithium plus valproate group were fatigue, weight gain and decreased
of diarrhoea
sexual desire while the lithium plus carbamazepine group had significant increased rates

of diarrhoea
A post-hoc analysis of three RCTs on adults with bipolar mania comparing cariprazine vs
A post-hoc analysis of three RCTs on adults with bipolar mania comparing cariprazine vs

of diarrhoea
A post-hoc analysis of three RCTs
33, level I on adults with bipolar mania comparing cariprazine vs

placebo showed that the former:
33, level I
placebo showed that the former:
33, level I on adults with bipolar mania comparing cariprazine vs
A post-hoc analysis of three RCTs

placebo showed that the former: RCTs on adults with bipolar mania comparing cariprazine vs
A post-hoc analysis of three
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
placebo showed that the former:
A post-hoc analysis of three RCTs on adults with bipolar mania comparing cariprazine vs
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
placebo showed that the former:
33, level I
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
placebo showed that the former: 33, level I
33, level I
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
constipation and, changes in ALT and AST levels
constipation and, changes in ALT and AST levels
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 was more effective in reducing YMRS scores (SMD= -5.35, 95% Cl -6.69 to -4.01)
constipation and, changes in ALT and AST levels
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 had a low incidence of serious AEs with NS difference between groups
 had a low incidence of serious AEs with NS difference between groups
constipation and, changes in ALT and AST levels
 had a low incidence of serious AEs with NS difference between groups
constipation and, changes in ALT and AST levels
 appeared to have a dose-related response in terms of extra-pyramidal symptoms (EPS),
 had a low incidence of serious AEs with NS difference between groups
constipation and, changes in ALT and AST levels
 had a low incidence of serious AEs with NS difference between groups
Recommendation 2
Recommendation 2
 had a low incidence of serious AEs with NS difference between groups
Recommendation 2
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
Recommendation 2
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
Recommendation 2
used to treat acute mania in bipolar disorder.
used to treat acute mania in bipolar disorder.
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
Recommendation 2
used to treat acute mania in bipolar disorder.
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
used to treat acute mania in bipolar disorder.
 Antipsychotics or mood stabilisers, either as monotherapy* or combination**, should be
used to treat acute mania in bipolar disorder.
*Monotherapy APs:
*Monotherapy APs:
used to treat acute mania in bipolar disorder.
*Monotherapy APs:
 haloperidol, risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
 haloperidol, risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
*Monotherapy APs:
 haloperidol, risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
*Monotherapy APs:
ziprasidone or asenapine
ziprasidone or asenapine
 haloperidol, risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
*Monotherapy APs:
ziprasidone or asenapine paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
 haloperidol, risperidone,
Monotherapy mood stabilisers:
Monotherapy mood stabilisers:
ziprasidone or asenapine
 haloperidol, risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, cariprazine,
Monotherapy mood stabilisers:
ziprasidone or asenapine
 lithium, valproate or carbamazepine
 lithium, valproate or carbamazepine
Monotherapy mood stabilisers:
ziprasidone or asenapine
 lithium, valproate or carbamazepine
Monotherapy mood stabilisers:
**Combination therapies:
**Combination therapies:
 lithium, valproate or carbamazepine
Monotherapy mood stabilisers:
**Combination therapies:
 lithium, valproate or carbamazepine
 lithium with either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
 lithium with either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
**Combination therapies:
 lithium, valproate or carbamazepine
 lithium with either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
**Combination therapies:
asenapine
asenapine
 lithium with either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
**Combination therapies:
asenapine either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
 lithium with
 valproate with olanzapine
 valproate with olanzapine
asenapine
 lithium with either valproate, carbamazepine, risperidone, olanzapine, quetiapine or
 valproate with olanzapine
asenapine

 valproate with olanzapine
asenapine

 valproate with olanzapine

 valproate with olanzapine

7 7
7
7
7 7
7