Page 23 - e-book CPG - Bipolar Disorder
P. 23
CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
A few guidelines recommend that antidepressants may be used as short-term adjunctive
A few guidelines recommend that antidepressants may be used
6, 39, 40 as short-term adjunctive
treatment but not as monotherapy in acute bipolar depression.
6, 39, 40 as short-term adjunctive
treatment but not as monotherapy in acute bipolar depression.
A few guidelines recommend that antidepressants may be used 41,
A few guidelines recommend that antidepressants may be used as short-term adjunctive
6, 39, 40
treatment but not as monotherapy in acute bipolar depression.
A few guidelines recommend that antidepressants may be used as short-term adjunctive
In a Cochrane systematic review on glutamate receptor modulators in BD, the findings were:
6, 39, 40
treatment but not as monotherapy in acute bipolar depression.
In a Cochrane systematic review on glutamate receptor modulators in BD, the findings were:
level I
treat ment but not as monotherapy in acute bipolar depression. 6, 39, 40 41,
In a Cochrane systematic review on glutamate receptor modulators in BD, the findings were:
41,
level I
In a Cochrane systematic review on glutamate receptor modulators in BD, the findings were: 41,
IV ketamine was more effective in response than placebo at 24 hours only (OR=11.61,
level I
IV ketamine was more effective in response than placebo at 24 hours only (OR=11.61,
In a Cochrane systematic review on glutamate receptor modulators in BD, the findings were: 41,
95% CI 1.25 to 107.74) but showed no difference with midazolam; however, there was
level I
95% CI 1.25 to 107.74) but showed no difference with midazolam; however, there was
level I IV ketamine was more effective in response than placebo at 24 hours only (OR=11.61,
no difference in AEs between ketamine and placebo
IV ketamine was more effective in response than placebo at 24 hours only (OR=11.61,
95% CI 1.25 to 107.74) but showed no difference with midazolam; however, there was
no difference in AEs between ketamine and placebo
IV ketamine was more effective in response than placebo at 24 hours only (OR=11.61,
no difference in response between memantine and N-acetylcysteine compared with
95% CI 1.25 to 107.74) but showed no difference with midazolam; however, there was
no difference in AEs between ketamine and placebo
no difference in response between memantine and N-acetylcysteine compared with
95% CI 1.25 to 107.74) but showed no difference with midazolam; however, there was
placebo
no difference in AEs between ketamine and placebo
placebo
no difference in AEs between ketamine and placebo
no difference in response between memantine and N-acetylcysteine compared with
no difference in response between memantine and N-acetylcysteine compared with
placebo
Another systematic review of RCTs on adults with BD compared monotherapy or adjunctive
no difference in response between memantine and N-acetylcysteine compared with
placebo
Another systematic review of RCTs on adults with BD compared monotherapy or adjunctive
placebo
29, level I
AAPs vs placebo, the findings for acute depression were: 29, level I
Another systematic review of RCTs on adults with BD compared monotherapy or adjunctive
AAPs vs placebo, the findings for acute depression were: 29, level I
cariprazine showed significant improvement in depressive symptoms in two studies and
Another systematic review of RCTs on adults with BD compared monotherapy or adjunctive
AAPs vs placebo, the findings for acute depression were:
cariprazine showed significant improvement in depressive symptoms in two studies and
Another systematic review of RCTs on adults with BD compared monotherapy or adjunctive
NS changes in one study
AAPs vs placebo, the findings for acute depression were:
29, level I
cariprazine showed significant improvement in depressive symptoms in two studies and
NS changes in one study
AAPs vs placebo, the findings for acute depression were: 29, level I
quetiapine showed significant improvement in depressive symptoms, response rate and
cariprazine showed significant improvement in depressive symptoms in two studies and
NS changes in one study
quetiapine showed significant improvement in depressive symptoms, response rate and
cariprazine showed significant improvement in depressive symptoms in two studies and
remission rate
NS changes in one study
quetiapine showed significant improvement in depressive symptoms, response rate and
remission rate
NS changes in one study
The papers on cariprazine were of low risk while the ones on quetiapine had high risk of bias.
quetiapine showed significant improvement in depressive symptoms, response rate and
remission rate
The papers on cariprazine were of low risk while the ones on quetiapine had high risk of bias.
quetiapine showed significant improvement in depressive symptoms, response rate and
remission rate
The papers on cariprazine were of low risk while the ones on quetiapine had high risk of bias.
For the use of lithium, existing guidelines have recommended that it may be used in bipolar
remission rate
The papers on cariprazine were of low risk while the ones on quetiapine had high risk of bias.
For the use of li
39, 40 thium, existing guidelines have recommended that it may be used in bipolar
The papers on cariprazine were of low risk while the ones on quetiapine had high risk of bias.
depression.
39, 40 thium, existing guidelines have recommended that it may be used in bipolar
For the use of li
depression. 39, 40
For the use of lithium, existing guidelines have recommended that it may be used in bipolar
depression.
For the use of lithium, existing guidelines have recommended that it may be used in bipolar
depression.
Recommendation 3
39, 40
depression. 39, 40
Recommendation 3
Recommendation 3
Atypical antipsychotics* or mood stabilisers**, either as monotherapy or combination,
Atypical antipsychotics* or mood stabilisers**, either as monotherapy or combination,
should be used to treat depressive episodes in bipolar disorder.
Recommendation 3
Atypical antipsychotics* or mood stabilisers**, either as monotherapy or combination,
should be used to treat depressive episodes in bipolar disorder.
Recommendation 3
Antidepressants may be used as short-term adjunctive treatment but not as
Atypical antipsychotics* or mood stabilisers**, either as monotherapy or combination,
should be used to treat depressive episodes in bipolar disorder.
Antidepressants may be used as short-term adjunctive treatment but not as
Atypical antipsychotics* or mood stabilisers**, either as monotherapy or combination,
monotherapy in acute bipolar depression.
should be used to treat depressive episodes in bipolar disorder.
Antidepressants may be used as short-term adjunctive treatment but not as
monotherapy in acute bipolar depression.
should be used to treat depressive episodes in bipolar disorder.
Antidepressants may be used as short-term adjunctive treatment
o Occurrence of treatment-emergent manic switch should be monitored. but not as
monotherapy in acute bipolar depression.
Antidepressants may be used as short-term adjunctive treatment
o Occurrence of treatment-emergent manic switch should be monitored. but not as
monotherapy in acute bipolar depression.
o Occurrence of treatment-emergent manic switch should be monitored.
monotherapy in acute bipolar depression.
*AAPs: olanzapine, quetiapine, lurasidone, cariprazine, OFC, lumateperone
o Occurrence of treatment-emergent manic switch should be monitored.
*AAPs: olanzapine, quetiapine, lurasidone, cariprazine, OFC, lumateperone
o Occurrence of treatment-emergent manic
**mood stabilisers: lamotrigine, valproate, lithium switch should be monitored.
*AAPs: olanzapine, quetiapine, lurasidone, cariprazine, OFC, lumateperone
**mood stabilisers: lamotrigine, valproate, lithium
*AAPs: olanzapine, quetiapine, lurasidone, cariprazine, OFC, lumateperone
**mood stabilisers: lamotrigine, valproate, lithium
4.1.3. Bipolar disorder with specifiers
*AAPs: olanzapine, quetiapine, lurasidone, cariprazine, OFC, lumateperone
**mood stabilisers: lamotrigine, valproate, lithium
4.1.3. Bipolar disorder with specifiers
**mood stabilisers: lamotrigine, valproate, lithium
Specifiers in BD are descriptive terms on different features of the disorder. They are outlined
4.1.3. Bipolar disorder with specifiers
Specifiers in BD are descriptive terms on different features of the disorder. They are outlined
in the International Classification of Disease (ICD-11) and Diagnostic and Statistical Manual
4.1.3. Bipolar disorder with specifiers
Specifiers in BD are descriptive terms on different features of the disorder. They are outlined
in the International Classification of Disease (ICD-11) and Diagnostic and Statistical Manual
4.1.3. Bipolar disorder with specifiers
of Mental Health (DSM-5). Only the three most commonly studied specifiers will be addressed
Specifiers in BD are descriptive terms on different features of the disorder. They are outlined
in the International Classification of Disease (ICD-11) and Diagnostic and Statistical Manual
of Mental Health (DSM-5). Only the three most commonly studied specifiers will be addressed
Specifiers in BD are descriptive terms on different features of the disorder. They are outlined
in this CPG.
in the International Classification of Disease (ICD-11) and Diagnostic and Statistical Manual
of Mental Health (DSM-5). Only the three most commonly studied specifiers will be addressed
in this CPG.
in the International Classification of Diseases (ICD-11) and Diagnostic and Statistical Manual
of Mental Health (DSM-5). Only the three most commonly studied specifiers will be addressed
in this CPG.
of Mixed features
a. Mental Health (DSM-5). Only the three most commonly studied specifiers will be addressed
in this CPG.
Mixed features
a.
in this CPG.
Mixed features are present in one-third of BD patients as either mania or depression. The
Mixed features
a.
Mixed features are present in one-third of BD patients as either mania or depression. The
presence of mixed features is associated with poorer outcomes e.g. increased time in illness,
a.
Mixed features are
Mixed features present in one-third of BD patients as either mania or depression. The
presence of mixed features is associated with poorer outcomes e.g. increased time in illness,
a. Mixed features 42
poorer response to treatment and suicidality. Management of mixed features is challenging
42 patients as either mania or depression. The
Mixed features are present in one-third of BD
presence of mixed features is associated with poorer outcomes e.g. increased time in illness,
poorer response to treatment and suicidality. Management of mixed features is challenging
Mixed features are present in one-third of BD
42 in either manic or depressive episode. The
as it needs to address both mania/hypomania and depressive symptoms that occur
presence of mixed features is associated with poorer outcomes e.g. increased time in illness,
poorer response to treatment and suicidality. Management of mixed features is challenging
as it needs to address both mania/hypomania and depressive symptoms that occur
presence of mixed features is associated with poorer outcomes e.g. increased time in illness,
simultaneously. Despite its common prevalence in BD, there is a paucity of RCTs on
poorer response to treatment and suicidality. Management of mixed features is challenging
42
as it needs to address both mania/hypomania and depressive symptoms that occur
simultaneously. Despite its common prevalence in BD, there is a paucity of RCTs on
poorer response to treatment and suicidality. Management of mixed features is challenging
42
43
pharmacological intervention of mixed features.
as it needs to address both mania/hypomania and depressive symptoms that occur
simultaneously. Despite its common prevalence in BD, there is a paucity of RCTs on
pharmacological intervention of mixed features.
43
as it needs to address both mania/hypomania and depressive symptoms that occur
simultaneously. Despite its common prevalence in BD, there is a paucity of RCTs on
pharmacological intervention of mixed features.
43
simultaneously. Despite its common prevalence in BD, there is a paucity of RCTs on
In a systematic review of six international clinical guidelines on the treatment of mainly mixed
pharmacological intervention of mixed features.
43
In a systematic review of six international clinical guidelines on the treatment of mainly mixed
states in BD among the adult population, the recommended treatments are summarised in the
pharmacological intervention of mixed features.
43
In a systematic review of six international clinical guidelines on the treatment of mainly mixed
states in BD among the adult population, the recommended treatments are summarised in the
43
table below:
In a systematic review of six international clinical guidelines on the treatment of mainly mixed
states in BD among the adult population, the recommended treatments are summarised in the
43
table below:
In a systematic review of six international clinical guidelines on the treatment of mixed states
states in BD among the adult population, the recommended treatments are summarised in the
table below:
43
in mood disorders mainly BD among the adult population, the recommended treatments are
43
table below:
43
summarised in the table below:
9
9
9
9 9
9
