Page 32 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
f.
f. Bright light therapy
Bright light therapy
Adjunct bright light therapy on adults with bipolar depression showed:
Bright light therapy
f.
f. Adjunct bright light therapy on adults with bipolar depression showed:
Bright light therapy
Adjunct bright light therapy on adults with bipolar depression showed:
Bright light therapy
f. higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
Adjunct bright light therapy on adults with bipolar depression showed:
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
Bright light therapy
f. higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
Adjunct bright light therapy on adults with bipolar depression showed:
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
f. higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
Bright light therapy
68, level I
and sleep disturbance; no manic switch was reported
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
Adjunct bright light therapy on adults with bipolar depression showed:
higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
68, level I
and sleep disturbance; no manic switch was reported
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
Adjunct bright light therapy on adults with bipolar depression showed:
higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
68, level I
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
and sleep disturbance; no manic switch was reported HAM-D score reduction (p<0.01)
higher response rate (p<0.01) and improvement in
higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
68, level I
and sleep disturbance; no manic switch was reported
higher response rate (p<0.01) and improvement in HAM-D score reduction (p<0.01)
69, level I
6-week RCT with no AEs including manic switch reported
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
68, level I
and sleep disturbance; no manic switch was reported
69, level I
6-week RCT with no AEs including manic switch reported
higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
compared with control in a 2-week RCT while reported AEs included dizziness, fatigue
higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
69, level I
6-week RCT with no AEs including manic switch reported
68, level I
and sleep disturbance; no manic switch was reported
68, level I compared with control in a
g. higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08)
69, level I
6-week RCT with no AEs including manic switch reported
and sleep disturbance; no manic switch was reported
Magnetic seizure therapy
g. higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
6-week RCT with no AEs including manic switch reported
69, level I
Magnetic seizure therapy
higher rate of remission (OR=12.64, 95% CI 2.16 to 74.08) compared with control in a
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
Magnetic seizure therapy
g.
6-week RCT with no AEs including manic switch reported
69, level I
69, level I
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
Magnetic seizure therapy
g.
6-week RCT with no AEs including manic switch reported
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
Magnetic seizure therapy
g.
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
g.
Magnetic seizure therapy
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
Magnetic seizure therapy
g.
70, level II-3
were hypomanic episode and hospitalisation due to fall.
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
were hypomanic episode and hospitalisation due to fall.
70, level II-3
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
A pre-post study on adults with treatment-resistant bipolar depression showed that adjunct
70, level II-3
were hypomanic episode and hospitalisation due to fall.
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
were hypomanic episode and hospitalisation due to fall.
70, level II-3
magnetic seizure therapy led to a reduction in HAM-D scores (Cohen’s d=1.25, 95% CI 0.42
Vagus nerve stimulation
h.
to 1.57) with a response rate of 38.5% and a remission
70, level II-3
were hypomanic episode and hospitalisation due to fall. rate of 23.1%. Serious AEs reported
h.
Vagus nerve stimulation
to 1.57) with a response rate of 38.5% and a remission rate of 23.1%. Serious AEs reported
In a 5-year cohort study involving patients with treatment-resistant bipolar depression,
Vagus nerve stimulation
h.
In a 5-year cohort study involving patients with treatment-
70, level II-3
were hypomanic episode and hospitalisation due to fall.
70, level II-3resistant bipolar depression,
h.
Vagus nerve stimulation
were hypomanic episode and hospitalisation due to fall.
cumulative percentages of
adjunctive vagus nerve stimulation showed significant higher
In a 5-year cohort study involving patients with treatment-resistant bipolar depression,
Vagus nerve stimulation
h.
adjunctive vagus nerve stimulation showed significant higher cumulative percentages of
In a 5-year cohort study involving patients with treatment-resistant bipolar depression,
response based on MADRS scores from 12 months to 60 months compared with TAU.
adjunctive vagus nerve stimulation showed significant higher cumulative percentages of
Vagus nerve stimulation
h.
In a 5-year cohort study involving patients with treatment-resistant bipolar depression,
response based on MADRS scores from 12 months to 60 months compared with TAU.
71, level
Vagus nerve stimulation
adjunctive vagus nerve stimulation showed significant higher cumulative percentages of
h.
II-2.
71, level
response based on MADRS scores from 12 months to 60 months compared with TAU.
II-2. a 5-year cohort study involving patients with treatment-resistant bipolar depression,
In
adjunctive vagus nerve stimulation showed significant higher cumulative percentages of
71, level
response based on MADRS scores from 12 months to 60 months compared with TAU.
In a 5-year cohort study involving patients with treatment-resistant bipolar depression,
II-2.
response based on MADRS scores from 12 months to 60 months compared with TAU.es of
adjunctive vagus nerve stimulation showed significant higher cumulative percentag 71, level
71, level
II-2.
adjunctive vagus nerve stimulation showed significant higher cumulative percentages of
There is no retrievable evidence on the comparison of physical therapies.
response based on MADRS scores from 12 months to 60 months compared with TAU.
II-2.
There is no retrievable evidence on the comparison of physical therapies. 71, level
response based on MADRS scores from 12 months to 60 months compared with TAU.
71, level
There is no retrievable evidence on the comparison of physical therapies.
II-2.
II-2.
There is no retrievable evidence on the comparison of physical therapies.
There is no retrievable evidence on the comparison of physical therapies.
The use of ECT in the maintenance phase of BD should be individualised based on a
The use of ECT in the maintenance phase of BD should be individualised based on a
There is no retrievable evidence on the comparison of physical therapies.
thorough risk vs benefit analysis, given the current limited robust evidence.
The use of ECT in the maintenance phase of BD should be individualised based on a
There is no retrievable evidence on the comparison of physical therapies.
thorough risk vs benefit analysis, given the current limited robust evidence.
The use of ECT in the maintenance phase of BD should be individualised based on a
thorough risk vs benefit analysis, given the current limited robust evidence.
The use of ECT in the maintenance phase of BD should be individualised based on a
thorough risk vs benefit analysis, given the current limited robust evidence.
The use of ECT in the maintenance phase of BD should be individualised based on a
thorough risk vs benefit analysis, given the current limited robust evidence.
The use of ECT in the maintenance phase of BD should be individualised based on a
Recommendation 6
thorough risk vs benefit analysis, given the current limited robust evidence.
Recommendation 6
thorough risk vs benefit analysis, given the current limited robust evidence.
Electroconvulsive therapy should be considered in both bipolar manic and depressive
Recommendation 6
Electroconvulsive therapy should be considered in both bipolar manic and depressive
Recommendation 6
episodes with the following indications:
Electroconvulsive therapy should be considered in both bipolar manic and depressive
Recommendation 6
episodes with the following indications:
Electroconvulsive therapy should be considered in both bipolar manic and depressive
o rapid definitive response is required
episodes with the following indications:
Recommendation 6
Electroconvulsive therapy should be considered in both bipolar manic and depressive
o rapid definitive response is required
episodes with the
Recommendation 6 following indications:
o risk of other alternatives outweighs risk of ECT
o rapid definitive response is required
Electroconvulsive therapy should be considered in both bipolar manic and depressive
episodes with the following indications:
o risk of other alternatives outweighs risk of ECT
o rapid definitive response is required
Electroconvulsive therapy should be considered in both bipolar manic and depressive
o previous good response to ECT
o risk of other alternatives outweighs risk of ECT
o rapid definitive response is required
episodes with the following indications:
o previous good response to ECT
o risk of other alternatives outweighs risk of ECT
episodes with the following indications:
o patient’s preference
o previous good response to ECT
o rapid definitive response is required
o risk of other alternatives outweighs risk of ECT
o patient’s preference
o previous good response to ECT
o rapid definitive response is required
o treatment-resistant cases
o patient’s preference
o previous good response to ECT
o risk of other alternatives outweighs risk of ECT
o treatment-resistant cases
o patient’s preference
Repetitive transcranial magnetic stimulation may
o risk of other alternatives outweighs risk of ECT be considered in the treatment of
o treatment-resistant cases
o previous good response to ECT
o patient’s preference magnetic
o previous good response to ECT stimulation may be considered in the treatment of
Repetitive transcranial
o treatment-resistant cases
bipolar depression.
Repetitive transcranial magnetic stimulation may be considered in the treatment of
o patient’s preference
o treatment-resistant cases
bipolar depression.
o patient’s preference magnetic stimulation may be considered in the treatment of
Repetitive transcranial
bipolar depression.
o treatment-resistant cases
Repetitive transcranial magnetic stimulation may be considered in the treatment of
bipolar depression.
o treatment-resistant cases
4.2.2. Psychosocial intervention
bipolar depression.
Repetitive transcranial magnetic stimulation may be considered in the treatment of
Repetitive transcranial magnetic stimulation may be considered in the treatment of
4.2.2. Psychosocial intervention
bipolar depression.
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
4.2.2. Psychosocial intervention
bipolar depression.
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
4.2.2. Psychosocial intervention
pharmacotherapy and psychosocial intervention has been recommended in the management
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
4.2.2. Psychosocial intervention
pharmacotherapy and psychosocial intervention has been recommended in the management
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
of BD.
39
pharmacotherapy and psychosocial intervention has been recommended in the management
4.2.2. Psychosocial intervention
of BD.
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
39
pharmacotherapy and psychosocial intervention has been recommended in the management
4.2.2. Psychosocial intervention
of BD.
39
39eatment of BD, psychosocial interventions may play a crucial role. A combination of
In the tr
pharmacotherapy and psychosocial intervention has been recommended in the management
of BD.
In the treatment of BD, psychosocial interventions may play a crucial role. A combination of
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
pharmacotherapy and psychosocial intervention has been recommended in the management
of BD.
39
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
pharmacotherapy and psychosocial intervention has been recommended in the management
compared with TAU/psychological placebo (non-specific or shared component of
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
39
of BD.
39
compared with TAU/psychological placebo (non-specific or shared component of
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
of BD.
psychological treatment) in reducing bipolar depression in adults. There was NS difference
compared with TAU/psychological placebo (non-specific or shared component of
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
psychological treatment) in reducing bipolar depression in adults. There was NS difference
compared with TAU/psychological placebo (non-specific or shared component of
between the intervention and comparators at post-treatment and 3 - 12 months follow-up.
psychological treatment) in reducing bipolar depression in adults. There was NS difference
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
compared with TAU/psychological placebo (non-specific or shared component of
between the intervention and comparators at post-treatment and 3 - 12 months follow-up.
psychological treatment) in reducing bipolar depression in adults. There was NS difference
A meta-analysis on 11 RCTs investigated the effectiveness of psychoeducation modules
GRADE assessment revealed low quality of evidence.
72, level I
compared with TAU/psychological placebo (non-specific
between the intervention and comparators at post-treatment or shared component of
psychological treatment) in reducing bipolar depression in adults. There was NS difference
GRADE assessment revealed low quality of evidence.
72, level I
between the intervention and comparators at post-treatment and 3 - 12 months follow-up.
compared with TAU/psychological placebo (non-specific or shared component of
GRADE assessment revealed low quality of evidence.
72, level I
psychological treatment) in reducing bipolar depression in adults. There was NS difference
between the intervention and comparators at post-treatment and 3 - 12 months follow-up.
GRADE assessment revealed low quality of evidence.
psychological treatment) in reducing bipolar depression in adults. There was NS difference
72, level I
In summary, established guidelines recommend psychoeducation in all phases of BD
between the intervention and comparators at post-treatment
and 3 - 12 months follow-up.
72, level I
GRADE assessment revealed low quality of evidence. psychoeducation in all phases of BD
In summary, established guidelines recommend
between the intervention and comparators at post-treatment and 3 - 12 months follow-up.
Refer to
39, 40, 73
In summary, established guidelines recommend psychoeducation in all
especially in the maintenance phase to patients and caregivers if appropriate. phases of BD
GRADE assessment revealed low quality of evidence.
72, level I
72, level I
Refer to
especially in the maintenance phase to patients and caregivers if appropriate.
39, 40, 73
In summary, established guidelines recommend
GRADE assessment revealed low quality of evidence. psychoeducation in all phases of BD
Appendix 6 on Psychoeducation for Bipolar Disorder.
Refer to
39, 40, 73
especially in the maintenance phase to patients and caregivers if appropriate.
In summary, established guidelines recommend psychoeducation in all phases of BD
Appendix 6 on Psychoeducation for Bipolar Disorder.
Refer to
39, 40, 73
especially in the maintenance phase to patients and caregivers if appropriate.
Appendix 6 on Psychoeducation for Bipolar Disorder.
especially in the maintenance phase to patients and caregivers if appropriate.phases of BD
In summary, established guidelines recommend psychoeducation in all
Refer to
39, 40, 73
Appendix 6 on Psychoeducation for Bipolar Disorder.
In summary, established guidelines recommend psychoeducation in all phases of BD
especially in the maintenance phase to patients and caregivers if appropriate.
39, 40, 73 Refer to
39, 40, 73
Appendix 6 on Psychoeducation for Bipolar Disorder.
especially in the maintenance phase to patients and caregivers if appropriate.
Refer to
Appendix 6 on Psychoeducation for Bipolar Disorder. and 3 - 12 months follow-up.
Appendix 6 on Psychoeducation for Bipolar Disorder.
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