Page 47 - e-book CPG - Bipolar Disorder
P. 47
CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
Specific attention is drawn to the role of lithium in preventing suicidal behaviour in BD. A
30, level I in preventing suicidal behaviour in BD. A
Specific attention is drawn to the role of lithium
systematic review of adults with BD showed:
30, level I in preventing suicidal behaviour in BD. A
Specific attention is drawn to the role of lithium
systematic review of adults with BD showed:
combination of olanzapine and lithium significantly reduced suicidal item score of HAM-
Specific attention is drawn to the role of lithium in preventing suicidal behaviour in BD. A
systematic review of adults with BD showed:
combination of olanzapine and lithium significantly reduced suicidal item score of HAM-
30, level I
D vs lithium alone
systematic review of adults with BD showed: 30, level I
combination of olanzapine and lithium significantly reduced suicidal item score of HAM-
D vs lithium alone
combination of olanzapine and lithium significantly reduced suicidal item score of HAM-
lithium and valproate were equally effective in reducing suicide ideation among suicidal
D vs lithium alone
lithium and valproate were equally effective in reducing suicide ideation among suicidal
D vs lithium alone
attempters
lithium and valproate were equally effective in reducing suicide ideation among suicidal
attempters
no definitive evidence on anti-suicidal effect of lithium
lithium and valproate were equally effective in reducing suicide ideation among suicidal
attempters
no definitive evidence on anti-suicidal effect of lithium
attempters
A meta-analysis of RCTs on adults with mood disorders showed NS difference between lithium
no definitive evidence on anti-suicidal effect of lithium
A meta-analy sis of RCTs on adults with mood disorders showed NS difference between lithium
and placebo in suicide and non-fatal suicidal behaviour
no definitive evidence on anti-suicidal effect of lithium between the groups.
The
137, level I
A meta-analy
sis of RCTs on adults with mood disorders showed NS difference between lithium
137, level I
The
and placebo in suicide and non-fatal suicidal behaviour between the groups.
A meta-analysis of RCTs on adults with mood disorders showed NS difference between lithium
primary papers were of moderate quality based on RoB.
and placebo in suicide and non-fatal suicidal behaviour between the groups.
137, level I
The
primary pape
rs were of moderate quality based on RoB.
137, level I
primary papers were of moderate quality based on RoB.
primary papers were of moderate quality based on RoB.
While there is no robust evidence for the anti-suicidal effect of lithium, it remains an
and placebo in suicide and non-fatal suicidal behaviour between the groups. The
While there is no robust evidence for the anti-suicidal effect of lithium, it remains an
effective treatment option in BD patients with suicidal risk. Its use is guided by individual
While there is no robust evidence for the anti-suicidal effect of lithium, it remains an
effective treatment option in BD patients with suicidal risk. Its use is guided by individual
While there is no robust evidence for the anti-suicidal effect of lithium, it remains an
patient factors (e.g. treatment response, monitoring and risk of lethal overdose).
effective treatment option in BD patients with suicidal risk. Its use is guided by individual
patient factors (e.g. treatment response, monitoring and risk of lethal overdose).
patient factors (e.g. treatment response, monitoring and risk of lethal overdose).
effective treatment option in BD patients with suicidal risk. Its use is guided by individual
patient factors (e.g. treatment response, monitoring and risk of lethal overdose).
In a cohort study on patients >10 years of age with BD, ECT reduced suicide risk in depressive
In a cohort study on patients >10 years of age with BD, ECT reduced suicide risk in depressive
state (HR=0.805, 95% CI 0.514 to 0.987) but not in mania or mixed states compared with
In a cohort study on patients >10 years of age with BD, ECT reduced suicide risk in depressive
state (HR=0.805, 95% CI 0.514
138, level II-2 to 0.987) but not in mania or mixed states compared with
In a cohort study on patients >10 years of age with BD, ECT reduced suicide risk in depressive
psychopharmacotherapy.
138, level II-2 to 0.987) but not in mania or mixed states compared with
state (HR=0.805, 95% CI 0.514
psychopharmacotherapy.
state (HR=0.805, 95% CI 0.514 to 0.987) but not in mania or mixed states compared with
psychopharmacotherapy.
138, level II-2
138, level II-2
psychopharmacotherapy.small RCT on the effectiveness of IV ketamine vs placebo in bipolar
In a systematic review, a
In a systematic review, a small RCT on the effectiveness of IV ketamine vs placebo in bipolar
depression found that suicidal ideation scores in MADRS reduced within 40 minutes in
In a systematic review, a small RCT on the effectiveness of IV ketamine vs placebo in bipolar
depression found that suicidal ideation scores in MADRS reduced within 40 minutes in
In a systematic review, a small RCT on the effectiveness of IV ketamine vs placebo in bipolar
subjects of the ketamine arm (Cohen’s d=0.98, 95% CI 0.64 to 1.33) and remained significant
depression found that suicidal ideation scores in MADRS reduced within 40 minutes in
subjects of the ketamine arm (Cohen’s d=0.98, 95% CI 0.64 to 1.33) and remained significant
depression found that suicidal ideation scores in MADRS reduced within 40 minutes in
139, level I
to Day 3.
subjects of the ketamine arm (Cohen’s d=0.98, 95% CI 0.64 to 1.33) and remained significant
139, level I
to Day 3.
subjects of the ketamine arm (Cohen’s d=0.98, 95% CI 0.64 to 1.33) and remained significant
to Day 3.
139, level I
139, level I
to Day 3. on psychological interventions for suicidal behaviour in BD population is limited.
Evidence
Evidence on psychological interventions for suicidal behaviour in BD population is limited.
Safety Planning is a personalised and prioritised list of coping strategies and resources to
Evidence on psychological interventions for suicidal behaviour in BD population is limited.
Safety Planning is a personalised and prioritised list of coping strategies and resources to
Evidence on psychological interventions for suicidal behaviour in BD population is limited.
reduce suicide risk and improve help-seeking.
Safety Planning is a personalised and prioritised list of coping strategies and resources to
reduce suicide risk and improve help-seeking.
Safety Planning is a personalised and prioritised list of coping strategies and resources to
reduce suicide risk and improve help-seeking.
reduce suicide risk and improve help-seeking.
Components of Safety Planning include:
Components of Safety Planning include:
140, level III
recognising warning signs of impending suicidal crisis
Components of Safety Planning include:
140, level III
recognising warning signs of impending suicidal crisis
Components of Safety Planning include: 140, level III
140, level III
identifying and employing internal coping strategies without needing to contact another
recognising warning signs of impending suicidal crisis
identifying and employing internal coping strategies without needing to contact another
recognising warning signs of impending suicidal crisis
person
identifying and employing internal coping strategies without needing to contact another
person
utilising contacts with people as a means of distraction from suicidal thoughts and urges
identifying and employing internal coping strategies without needing to contact another
person
utilising contacts with people as a means of distraction from suicidal thoughts and urges
person
contacting family members or friends who may help to resolve a crisis and with whom
utilising contacts with people as a means of distraction from suicidal thoughts and urges
contacting family members or friends who may help to resolve a crisis and with whom
utilising contacts with people as a means of distraction from suicidal thoughts and urges
suicidality can be discussed
contacting family members or friends who may help to resolve a crisis and with whom
suicidality can be discussed
contacting family members or friends who may help to resolve a crisis and with whom
contacting mental health professionals or agencies
suicidality can be discussed
contacting mental health professionals or agencies
suicidality can be discussed
reducing the potential use of lethal means
reducing the potential use of lethal means
contacting mental health professionals or agencies
contacting mental health professionals or agencies
reducing the potential use of lethal means
A meta-analysis of trials on safety planning
reducing the potential use of lethal means interventions (cognitive therapy and CBT for
A meta-analysis of trials on safety planning interventions (cognitive therapy and CBT for
suicide prevention) vs control (TAU or other treatment modalities) among adults with suicidal
A meta-analysis of trials on safety planning interventions (cognitive therapy and CBT for
suicide prevention) vs control (TAU or other treatment modalities) among adults with suicidal
behaviour (including those with affective disorders) showed mixed results where two RCTs
A meta-analysis of trials on safety planning interventions (cognitive therapy and CBT for
suicide prevention) vs control (TAU or other treatment modalities) among adults with suicidal
behaviour (including those with affective disorders) showed mixed results where two RCTs
suicide prevention) vs control (TAU or other treatment modalities) among adults with suicidal
found significant reduction in suicidal behaviour while another two did not. The overall bias of
behaviour (including those with affective disorders) showed mixed results where two RCTs
behaviour (including those with affective disorders) showed mixed results where two RCTs
141, level I
primary papers was considered high based on RoB2.
found significant reduction in suicidal behaviour while another two did not. The overall bias of
141, level I
primary papers was considered high based on RoB2.
found significant reduction in suicidal behaviour while another two did not. The overall bias of
141, level I
primary papers was considered high based on RoB2.
primary papers was considered high based on RoB2.
141, level I
Identifying risk factors for suicide in BD is important.
found significant reduction in suicidal behaviour while another two did not. The overall bias of
Identifying risk factors for suicide in BD is important.
Personalised, collaborative management of suicidal behaviour in BD including emerging
Identifying risk factors for suicide in BD is important.
Personalised, collaborative management of suicidal behaviour in BD including emerging
treatment options e.g. safety planning is advocated.
Identifying risk factors for suicide in BD is important.
Personalised, collaborative management of suicidal behaviour in BD including emerging
treatment options e.g. safety planning is advocated.
treatment options e.g. safety planning is advocated.
Personalised, collaborative management of suicidal behaviour in BD including emerging
treatment options e.g. safety planning is advocated.
10. IMPLEMENTING THE GUIDELINES
10. IMPLEMENTING THE GUIDELINES
10.1. Facilitating and Limiting Factors
10.1. Facilitating and Limiting Factors
10. IMPLEMENTING THE GUIDELINES
10.1. Facilitating and Limiting Factors
10.1. Facilitating and Limiting Factors
10. IMPLEMENTING THE GUIDELINES 33
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