Page 43 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
substance use disorder
substance use disorder
substance use disorder
unipolar depression
unipolar depression
unipolar depression
Family history of BD, especially if the parents developed BD early in life and the young person
Family history of BD, especially if the parents developed BD early in life and the young person
Family history of BD, especially if the parents developed BD early in life and the young person
has a history of prominent mood lability, depression/anxiety and subsyndromal
has a history of prominent mood lability, depression/anxiety and subsyndromal
has a history of prominent mood lability, depression/anxiety and subsyndromal
118, level III
manic/hypomanic symptoms suggest a risk of developing BD.
manic/hypomanic symptoms suggest a risk of developing BD.
118, level III
manic/hypomanic symptoms suggest a risk of developing BD. 118, level III
Proper clinical assessment by a psychiatrist is important to rule out co-morbidities in
Proper clinical assessment by a psychiatrist is important to rule out co-morbidities in
Proper clinical assessment by a psychiatrist is important to rule out co-morbidities in
children and adolescents presenting with symptoms of BD.
children and adolescents presenting with symptoms of BD.
children and adolescents presenting with symptoms of BD.
The role of pharmacotherapy in paediatric mental health remains the object of debate and
The role of pharmacotherapy in paediatric mental health remains the object of debate and
The role of pharmacotherapy in paediatric mental health remains the object of debate and
controversy. Careful consideration of treatment options should be given after weighing the
controversy. Careful consideration of treatment options should be given after weighing the
controversy. Careful consideration of treatment options should be given after weighing the
benefits and risks.
benefits and risks.
benefits and risks.
In a meta-analysis of RCTs on the use of lithium vs active comparators/placebo for acute
In a meta-analysis of RCTs on the use of lithium vs active comparators/placebo for acute
In a meta-analysis of RCTs on the use of lithium vs active comparators/placebo for acute
119, level I
mania in children with BD, it was shown that:
mania in children with BD, it was shown that: 119, level I
119, level I
mania in children with BD, it was shown that:
lithium was less effective than risperidone in treating manic/mixed episodes among
lithium was less effective than risperidone in treating manic/mixed episodes among
lithium was less effective than risperidone in treating manic/mixed episodes among
young people aged 6 - 15 years (SMD= 0.85, 95% CI 0.54 to 1.15) but had NS difference
young people aged 6 - 15 years (SMD= 0.85, 95% CI 0.54 to 1.15) but had NS difference
young people aged 6 - 15 years (SMD= 0.85, 95% CI 0.54 to 1.15) but had NS difference
vs valproate or placebo
vs valproate or placebo
vs valproate or placebo
majority of the AEs were described as mild to moderate
majority of the AEs were described as mild to moderate
majority of the AEs were described as mild to moderate
high rates of psychiatric co-morbidity across all studies with the highest being ADHD
high rates of psychiatric co-morbidity across all studies with the highest being ADHD
high rates of psychiatric co-morbidity across all studies with the highest being ADHD
There was a potential high or unclear risk of bias in the included primary papers based on
There was a potential high or unclear risk of bias in the included primary papers based on
There was a potential high or unclear risk of bias in the included primary papers based on
RoB.
RoB.
RoB.
An RCT of lithium vs quetiapine for the treatment of acute mania in young people of 10 -17
An RCT of lithium vs quetiapine for the treatment of acute mania in young people of 10 -17
An RCT of lithium vs quetiapine for the treatment of acute mania in young people of 10 -17
120, level I
years of age with BD reported that quetiapine:
120, level I
years of age with BD reported that quetiapine:
120, level I
years of age with BD reported that quetiapine:
showed a greater reduction in YMRS score (-11.0 vs -13.2, p<0.001)
showed a greater reduction in YMRS score (-11.0 vs -13.2, p<0.001)
showed a greater reduction in YMRS score (-11.0 vs -13.2, p<0.001)
had a higher response rate (72% vs 49%, p=0.012)
had a higher response rate (72% vs 49%, p=0.012)
showed NS difference in remission rates
showed NS difference in remission rates
showed NS difference in remission rates
had more somnolence (p<0.001), dizziness (p<0.05) and weight gain (p=0.02)
had more somnolence (p<0.001), dizziness (p<0.05) and weight gain (p=0.02)
had more somnolence (p<0.001), dizziness (p<0.05) and weight gain (p=0.02)
had a higher response rate (72% vs 49%, p=0.012)
In an RCT in the treatment of adolescents with BD in manic or mixed episodes, compared
In an RCT in the treatment of adolescents with BD in manic or mixed episodes, compared
In an RCT in the treatment of adolescents with BD in manic or mixed episodes, compared
121, level I
with placebo, olanzapine:
with placebo, olanzapine: 121, level I
121, level I
with placebo, olanzapine:
showed a greater reduction in YMRS score (p<0.001)
showed a greater reduction in YMRS score (p<0.001)
showed a greater reduction in YMRS score (p<0.001)
had higher response (RR=2.19, 95% CI 1.28 to 3.74; NNT=3.80) and remission
had higher response (RR=2.19, 95% CI 1.28 to 3.74; NNT=3.80) and remission
had higher response (RR=2.19, 95% CI 1.28 to 3.74; NNT=3.80) and remission
(RR=3.17, 95% CI 1.43 to 7.04; NNT=4.14) rates
(RR=3.17, 95% CI 1.43 to 7.04; NNT=4.14) rates
(RR=3.17, 95% CI 1.43 to 7.04; NNT=4.14) rates
had shorter times-to-reach response (p=0.003) and remission (p=0.002) criteria
had shorter times-to-reach response (p=0.003) and remission (p=0.002) criteria
had shorter times-to-reach response (p=0.003) and remission (p=0.002) criteria
had significantly higher common AEs with a frequency ≥5% for increased appetite,
had significantly higher common AEs with a frequency ≥5% for increased appetite,
had significantly higher common AEs with a frequency ≥5% for increased appetite,
weight gain and somnolence and sedation
weight gain and somnolence and sedation
weight gain and somnolence and sedation
In a 3-week RCT on acute treatment of manic or mixed episodes in 10 - 17-year-old patients
In a 3-week RCT on acute treatment of manic or mixed episodes in 10 - 17-year-old patients
In a 3-week RCT on acute treatment of manic or mixed episodes in 10 - 17-year-old patients
with BD I, asenapine of three different doses was significantly more effective than placebo
with BD I, asenapine of three different doses was significantly more effective than placebo
with BD I, asenapine of three different doses was significantly more effective than placebo
(MDs for YMRS were -3.2, -5.3 and -6.2 for asenapine 2.5 mg, 5 mg and 10 mg bd
(MDs for YMRS were -3.2, -5.3 and -6.2 for asenapine 2.5 mg, 5 mg and 10 mg bd
(MDs for YMRS were -3.2, -5.3 and -6.2 for asenapine 2.5 mg, 5 mg and 10 mg bd
respectively). The treatment-emergent AEs (≥5%) were somnolence, sedation, oral
respectively). The treatment-emergent AEs (≥5%) were somnolence, sedation, oral
respectively). The treatment-emergent AEs (≥5%) were somnolence, sedation, oral
122, level I
hypoaesthesia/paraesthesia and increased appetite.
hypoaesthesia/paraesthesia and increased appetite. 122, level I An open-label extension study of
122, level I An open-label extension study of
hypoaesthesia/paraesthesia and increased appetite.
An open-label extension study of
the same RCT demonstrated that most AEs were mild or moderate in severity at 50 weeks.
the same RCT demonstrated that most AEs were mild or moderate in severity at 50 weeks.
the same RCT demonstrated that most AEs were mild or moderate in severity at 50 weeks.
The additional reported AEs (≥5%) were increased weight, headache, nausea, vomiting,
The additional reported AEs (≥5%) were increased weight, headache, nausea, vomiting,
The additional reported AEs (≥5%) were increased weight, headache, nausea, vomiting,
fatigue and upper abdominal pain.
123, level I
123, level I
fatigue and upper abdominal pain. 123, level I
fatigue and upper abdominal pain.
In a 30-week RCT on manic/mixed episode of 10-17-year-old patients with BD I, compared
In a 30-week RCT on manic/mixed episode of 10-17-year-old patients with BD I, compared
In a 30-week RCT on manic/mixed episode of 10-17-year-old patients with BD I, compared
with placebo, aripiprazole:
124, level I
with placebo, aripiprazole: 124, level I
124, level I
with placebo, aripiprazole:
was significantly more effective (mean change from baseline for YMRS was 14.1 and
was significantly more effective (mean change from baseline for YMRS was 14.1 and
was significantly more effective (mean change from baseline for YMRS was 14.1 and
14.9 for aripiprazole with daily doses of 10 mg and 30 mg respectively); the findings
14.9 for aripiprazole with daily doses of 10 mg and 30 mg respectively); the findings
14.9 for aripiprazole with daily doses of 10 mg and 30 mg respectively); the findings
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