Page 27 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
stabilisers and placebo (RR=0.51, 95% CI 0.41 to 0.64 with I of 70.03%). There was good to
stabilisers and placebo (RR=0.51, 95% CI 0.41 to 0.64 with I of 70.03%). There was good to
2 2
moderate quality of primary papers based on risk of bias (RoB) assessment. 28, level I
143, level I
stabilisers and placebo (RR=0.51, 95% CI 0.41 to 0.64 with I of 70.03%). There was good to
moderate quality of primary papers based on risk of bias (RoB) assessment.
2
stabilisers and placebo (RR=0.51, 95% CI 0.41 to 0.64 with I of 70.03%). There was good to
2
moderate quality of primary papers based on risk of bias (RoB) assessment.
28, level I
moderate quality of primary papers based on risk of bias (RoB) assessment. 28, level I
In a systematic review of five international clinical guidelines on long-term pharmacological
In a systematic review of five international clinical guidelines on long-term pharmacological
management of BD I in adults, the recommended treatments are summarised below: 50
In a systematic review of five international clinical guidelines on long-term pharmacological
management of BD I in adults, the recommended treatments are summarised below:
50
In a systematic review of five international clinical guidelines on long-term pharmacological
50
management of BD I in adults, the recommended treatments are summarised below:
Pharmacological Prevention of any Prevention of manic Prevention of 50
Prevention of manic Prevention of
Pharmacological Prevention of any
management of BD I in adults, the recommended treatments are summarised below:
episode
agents mood episode episode depressive episode
agents
depressive episode
mood episode
Pharmacological Prevention of any
Prevention of manic Prevention of
Prevention of manic Prevention of
Pharmacological Prevention of any episode depressive episode
agents
mood episode
First line:
First line:
agents Lithium, valproate, Lithium, valproate, Lithium, valproate,
episode
depressive episode
mood episode
Lithium, valproate,
Lithium, valproate,
Monotherapy
Monotherapy
Lithium, valproate,
First line:
First line:
Monotherapy lamotrigine, quetiapine, lamotrigine,
lamotrigine,
Lithium, valproate,
lamotrigine,
quetiapine,
Lithium, valproate,
Lithium, valproate,
quetiapine,
olanzapine,
Monotherapy Lithium, valproate, Lithium, valproate, Lithium, valproate,
olanzapine,
quetiapine,
quetiapine,
quetiapine,
lamotrigine,
quetiapine,
lamotrigine,
aripiprazole,
olanzapine,
lamotrigine, quetiapine, lamotrigine,
olanzapine,
olanzapine,
aripiprazole,
quetiapine,
olanzapine,
olanzapine,
quetiapine,
quetiapine, olanzapine, quetiapine,
aripiprazole,
asenapine,
asenapine
aripiprazole,
asenapine ,
olanzapine
aripiprazole,
olanzapine,
asenapine,
asenapine,
asenapine,
olanzapine, aripiprazole, olanzapine,
paliperidone,
paliperidone,
aripiprazole,
asenapine
asenapine,
aripiprazole, asenapine, asenapine
paliperidone,
aripiprazole LAI
aripiprazole LAI
asenapine,
paliperidone,
paliperidone,
aripiprazole LAI
aripiprazole LAI
asenapine, paliperidone,
paliperidone,
aripiprazole LAI
paliperidone, aripiprazole LAI
(long-acting
aripiprazole LAI
(long-acting
injectable/LAI)
aripiprazole LAI
(long-acting
injectable/LAI)
(long-acting
injectable/LAI)
injectable/LAI)
Combination Lithium or valproate + Lithium or valproate + Lithium or valproate +
Combination
Lithium or valproate + Lithium or valproate + Lithium or valproate +
quetiapine
therapy quetiapine quetiapine quetiapine
quetiapine
therapy
Combination
Lithium or v
quetiapine alproate + Lithium or valproate + Lithium or valproate +
Combination
therapy Lithium or valproate + Lithium or valproate + Lithium or valproate +
Lithium + aripiprazole Lithium + aripiprazole
Lithium + aripiprazole Lithium + aripiprazole quetiapine
quetiapine
quetiapine
quetiapine
quetiapine
therapy Lithium + aripiprazole Lithium + aripiprazole quetiapine
Second line: Lithium + aripiprazole Lithium + aripiprazole
Second line:
Monotherapy Carbamazepine, Carbamazepine, Carbamazepine,
Carbamazepine,
Carbamazepine,
Second line:
Monotherapy
Carbamazepine,
Second line: ziprasidone, lamotrigine, clozapine
clozapine
lamotrigine,
Carbamazepine,
Monotherapy
Carbamazepine,
ziprasidone, ine,
Carbamazep
Monotherapy Carbamazepine, Carbamazepine, Carbamazepine,
clozapine, risperidone ziprasidone,
clozapine
lamotrigine,
ziprasidone,
clozapine, risperidone ziprasidone,
clozapine, risperidone
clozapine, risperidone
ziprasidone, lamotrigine, clozapine
LAI
cloz
LAI apine, risperidone ziprasidone,
clozapine, risperidone ziprasidone,
LAI LAI
cloz
LAI apine, risperidone
LAI
LAI clozapine, risperidone
Valproate +
Combination Valproate + LAI Olanzapine fluoxetine
Combination
Valproate +
Valproate +
Olanzapine fluoxetine
therapy
therapy aripiprazole aripiprazole combination
combination
aripiprazole
aripiprazole
Valproate +
Valproate +
Olanzapine fluoxetine
Combination
Combination
Lithium or valproate + Lithium or valproate + Lithium or valproate +
aripiprazole
therapy Valproate + Valproate + Olanzapine fluoxetine
aripiprazole
combination
Lithium or valproate + Lithium or valproate + Lithium or valproate +
therapy aripiprazole aripiprazole combination
olanzapine
olanzapine
olanzapine
olanzapine
olanzapine
Lithium or v
olanzapine alproate + Lithium or valproate + Lithium or valproate +
Lithium or valproate + Lithium or valproate + Lithium or valproate +
Lithium or valproate + Lithium or valproate + Lithium or valproate +
olanzapine
olanzapine
olanzapine
Lithium or valproate + Lithium or valproate + Lithium or valproate +
olanzapine olanzapine olanzapine
ziprasidone
ziprasidone
lurasidone
lurasidone
ziprasidone
Lithium or valproate + Lithium or valproate + Lithium or valproate +
ziprasidone
Lithium or valproate + Lithium or valproate + Lithium or valproate +
Lithium or valproate + Lithium or valproate + Lithium or valproate +
Lithium or valproate + Lithium or valproate + Lithium or valproate +
lurasidone
ziprasidone
ziprasidone
ziprasidone ziprasidone lurasidone
risperidone LAI
lamotrigine
lurasidone
lamotrigine alproate +
risperidone LAI
lurasidone
Lithium or valproate + Lithium or valproate + Lithium or v
Lithium or valproate + Lithium or valproate + Lithium or valproate +
Lithium or valproate + Lithium + valproate
Lithium or valproate + Lithium + valproate
risperidone LAI
lurasidone
lamotrigine
lurasidone risperidone LAI lamotrigine
risperidone LAI
risperidone LAI
Lithium or valproate + Lithium + valproate
Lithium or valproate + Lithium + valproate
Lithium + valproate
risperidone LAI
Lithium + valproate
risperidone LAI
Lithium + valproate
Lithium + valproate
The same systematic review on BD I recommended lithium or quetiapine as the best
The same systematic review on BD I recommended lithium or quetiapine as the best
monotherapy option in the maintenance phase. For combination therapy, lithium + quetiapine
The same systematic review on BD I recommended lithium or quetiapine as the best
monotherapy option in the maintenance phase. For combination therapy, lithium + quetiapine
The same systematic review on BD I recommended lithium or quetiapine as the best
or lithium + aripiprazole is the first-line treatment. It also mentioned that antidepressant
monotherapy option in the maintenance phase. For combination therapy, lithium + quetiapine
or lithium + aripiprazole is the first-line treatment. It also mentioned that antidepressant
monotherapy option in the maintenance phase. For combination therapy, lithium + quetiapine
monotherapy and first-generation antipsychotics (FGA) should be avoided in the maintenance
monotherapy and first-generation antipsychotics (FGA) should be avoided in the maintenance
or lithium + aripiprazole is the first-line treatment. It also mentioned that antidepressant
or lithium + aripiprazole is the first-line treatment. It also mentioned that antidepressant
phase. Clozapine may be considered in treatment-resistant BD.
phase. Clozapine may be considered in treatment-resistant BD.
monotherapy and first-generation antipsychotics (FGA) should be avoided in the maintenance
monotherapy and first-generation antipsychotics (FGA) should be avoided in the maintenance
phase. Clozapine may be considered in treatment-resistant BD.
phase. Clozapine may be considered in treatment-resistant BD. mood stabilisers or APs as
A large network meta-analysis (NMA) of 41 RCTs assessed
A large network meta-analysis (NMA) of 41 RCTs assessed mood stabilisers or APs as
monotherapy or combination therapy vs placebo in the maintenance phase of BD (mean study
A large network meta-analysis (NMA) of 41 RCTs assessed mood stabilisers or APs as
monotherapy or combination therapy vs placebo in the maintenance phase of BD (mean study
A large network meta-analysis (NMA) of 41 RCTs assessed mood stabilisers or APs as
duration of 70.5 ± 36.6 weeks). Two categorical NMA were performed and showed the
duration of 70.5 ± 36.6 weeks). Two categorical NMA were performed and showed the
monotherapy or combination therapy vs placebo in the maintenance phase of BD (mean study
monotherapy or combination therapy vs placebo in the maintenance phase of BD (mean study
28, level I
following results:
28, level I
duration of 70.5
following results: ± 36.6 weeks). Two categorical NMA were performed and showed the
duration of 70.5 ± 36.6 weeks). Two categorical NMA were performed and showed the
28, level I
following results:
following results: 28, level I
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