Page 40 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
105, level III
organisation support and linkage to community resources. Refer to Appendix 8 for
organisation support and linkage to community resources. 105, level III Refer to Appendix 8 for
Collaborative Care Model Core Elements. 105, level III Refer to Appendix 8 for
organisation support and linkage to community resources.
Collaborative Care Model Core Elements.
Collaborative Care Model Core Elements.
In a systematic review of six RCTs comparing the effectiveness of collaborative care with TAU
In a systematic review of six RCTs comparing the effectiveness of collaborative care with TAU
106, level I
In a systematic review of six RCTs comparing the effectiveness of collaborative care with TAU
on adults with BD, the findings were:
on adults with BD, the findings were: 106, level I
NS difference in 2-year relapse rate o
on adults with BD, the findings were: 106, level If manic/hypomanic and depressive episodes
NS difference in 2-year relapse rate of manic/hypomanic and depressive episodes
mixed effects on depression, mania and functionality
NS difference in 2-year relapse rate of manic/hypomanic and depressive episodes
mixed effects on depression, mania and functionality
The RCTs assessed by the Cochrane RoB tool were of mixed quality.
mixed effects on depression, mania and functionality
The RCTs assessed by the Cochrane RoB tool were of mixed quality.
The RCTs assessed by the Cochrane RoB tool were of mixed quality.
A recent RCT compared collaborative care model vs TAU using telepsychiatry services in
A recent RCT compared collaborative care model vs TAU using telepsychiatry services in
primary care over a 12-months period on adult patients. Adults with BD showed improvement
A recent RCT compared collaborative care model vs TAU using telepsychiatry services in
primary care over a 12-months period on adult patients. Adults with BD showed improvement
107, level I
in the following outcomes with NS differences between groups: 107, level I
primary care over a 12-months period on adult patients. Adults with BD showed improvement
in the following outcomes with NS differences between groups:
mental health QoL (measured with Veterans RAND 12-Item
107, level I Health Survey Mental
mental health QoL (measured with Veterans RAND
in the following outcomes with NS differences between groups: 12-Item Health Survey Mental
Health Component Summary)
mental health QoL (measured with Veterans RAND 12-Item Health Survey Mental
Health Component Summary)
depression (measured with Hopkins Symptom Checklist Depression Scale)
Health Component Summary)
depression (measured with Hopkins Symptom Checklist Depression Scale)
anxiety (measured with GAD-7)
depression (measured with Hopkins Symptom Checklist Depression Scale)
anxiety (measured with GAD-7)
anxiety (measured with GAD-7)
8. SPECIAL POPULATION
8. SPECIAL POPULATION
8.1. Pregnancy and Lactation
8.
8.1. Pregnancy and Lactation
SPECIAL POPULATION
8.1. Pregnancy and Lactation
There is a high risk of relapse of BD during pregnancy or the post-partum period especially in
There is a high risk of relapse of BD during pregnancy or the post-partum period especially in
patients not on treatment. There is, however, the issue of specific considerations to be given
patients not on treatment. There is, however, the issue of specific considerations to be given
There is a high risk of relapse of BD during pregnancy or the post-partum period especially in
on the use of medications during these periods based on the new Pregnancy and Lactation
patients not on treatment. There is, however, the issue of specific considerations to be given
on the use of medications during these periods based on the new Pregnancy and Lactation
Labelling Final Rule of the US Food and Drug Administration (FDA) as shown in Appendix 9.
on the use of medications during these periods based on the new Pregnancy and Lactation
Labelling Final Rule of the US Food and Drug Administration (FDA) as shown in Appendix 9.
If medications are deemed necessary, preference should be given to monotherapy using the
If medications are deemed necessary, preference should be given to monotherapy using the
Labelling Final Rule of the US Food and Drug Administration (FDA) as shown in Appendix 9.
40
If medications are deemed necessary, preference should be given to monotherapy using the
lowest effective dose. 40
lowest effective dose.
lowest effective dose. 40
Given the complexity of BD management in this group of women, it is advisable to co-manage
Given the complexity of BD management in this group of women, it is advisable to co-manage
them with the obstetrics team. Risks-benefits analysis of medications on both women and the
Given the complexity of BD management in this group of women, it is advisable to co-manage
them with the obstetrics team. Risks-benefits analysis of medications on both women and the
developing foetus and infant should be done with the patients using a shared decision-making
developing foetus and infant should be done with the patients using a shared decision-making
them with the obstetrics team. Risks-benefits analysis of medications on both women and the
approach.
developing foetus and infant should be done with the patients using a shared decision-making
approach.
approach.
The Guidelines on Pre-Pregnancy Care in MOH Specialist Hospital suggest that all women of
The Guidelines on Pre-Pregnancy Care in MOH Specialist Hospital suggest that all women of
reproductive age with BD should be referred to a pre-pregnancy care team to optimise their
The Guidelines on Pre-Pregnancy Care in MOH Specialist Hospital suggest that all women of
reproductive age with BD should be referred to a pre-pregnancy care team to optimise their
108
mental health condition before conception, pregnancy and lactation. 108
mental health condition before conception, pregnancy and lactation.
reproductive age with BD should be referred to a pre-pregnancy care team to optimise their
mental health condition before conception, pregnancy and lactation. 108
In a large meta-analysis of six cohort studies, the use of lithium in pregnancy showed NS
In a large meta-analysis of six cohort studies, the use of lithium in pregnancy showed NS
109, level II-2
In a large meta-analysis of six cohort studies, the use of lithium in pregnancy showed NS
difference in risk of: 109, level II-2
difference in risk of:
diabetes in pregnancy
difference in risk of: 109, level II-2
diabetes in pregnancy
pre-eclampsia
pre-eclampsia
diabetes in pregnancy
small for gestational age
pre-eclampsia
small for gestational age
major malformations including cardiac malformations
major malformations including cardiac malformations
small for gestational age
foetal distress
major malformations including cardiac malformations
foetal distress
caesarean section
foetal distress
caesarean section
preterm birth
caesarean section
preterm birth
low birth weight
preterm birth
low birth weight
post-partum hemorrhage
post-partum hemorrhage
low birth weight
However, there was a small risk of neonatal admission to a special care baby unit prior to 28
However, there was a small risk
post-partum hemorrhage of neonatal admission to a special care baby unit prior to 28
days of age (OR=1.28, 95% CI 1.12 to 2.33). There was no mention on quality assessment of
However, there was a small risk of neonatal admission to a special care baby unit prior to 28
days of age (OR=1.28, 95% CI 1.12 to 2.33). There was no mention on quality assessment of
the primary papers.
the primary papers.
days of age (OR=1.28, 95% CI 1.12 to 2.33). There was no mention on quality assessment of
the primary papers.
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