Long‐term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms
Autor: | Michele Muscas, Mauricio Tohen, Andrea Murru, Heinz Grunze, André F. Carvalho, Eduard Vieta, Isabella Pacchiarotti, Norma Verdolini, Allan H. Young, Diego Hidalgo-Mazzei, Alberto Aedo, Laura Del Matto, Ludovic Samalin |
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Jazyk: | angličtina |
Předmět: |
medicine.medical_specialty
Bipolar Disorder MEDLINE Relapse prevention law.invention Treatment of bipolar disorder Quetiapine Fumarate 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Humans Medicine Bipolar disorder Intensive care medicine Biological Psychiatry business.industry Valproic Acid medicine.disease 030227 psychiatry 3. Good health Psychiatry and Mental health Quetiapine Observational study medicine.symptom business Mania Algorithms 030217 neurology & neurosurgery Antipsychotic Agents medicine.drug |
Zdroj: | Bipolar Disorders |
ISSN: | 1399-5618 1398-5647 |
DOI: | 10.1111/bdi.13040 |
Popis: | Objectives This systematic review aimed at providing a critical, comprehensive synthesis of international guidelines' recommendations on the long-term treatment of bipolar disorder type I (BD-I). Methods MEDLINE/PubMed and EMBASE databases were searched from inception to January 15th, 2019 following PRISMA and PICAR rules. International guidelines providing recommendations for the long-term treatment of BD-I were included. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation-AGREE II. Results The final selection yielded five international guidelines, with overall good quality. The evaluation of applicability was the weakest aspect across the guidelines. Differences in their updating strategies and the rating of the evidence, particularly for meta-analyses, randomized clinical trials (RCTs) and observational studies, could be responsible of some level of heterogeneity among recommendations. Nonetheless, the guidelines recommended lithium as the 'gold standard' in the long-term treatment of BD-I. Quetiapine was another possible first-line option as well as aripiprazole (for the prevention of mania). Long-term treatment should contemplate monotherapy, at least initially. Clinicians should check regularly for efficacy and side effects and if necessary, switch to first-line alternatives (i.e. Valproate), combine first-line compounds with different mechanisms of action or switch to second-line options or combinations. Conclusions The possibility to monitor improvements in long-term outcomes, namely relapse prevention and inter-episode subthreshold depressive symptoms, based on the application of their recommendations is an unmet need of clinical guidelines. In terms of evidence of clinical guidelines, there is a need for more efficacious treatment strategies for the prevention of bipolar depression. |
Databáze: | OpenAIRE |
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