Ana González-Pinto, José Manuel Goikolea, Iñaki Zorrilla, Miquel Bernardo, Manuel Arrojo, Ruth Cunill, Xavi Castell, Elisardo Becoña, Ana López, Marta Torrens, Judit Tirado-Muñoz, Francina Fonseca, Belén Arranz, Marina Garriga, Pilar A Sáiz, Gerardo Flórez, Luis San
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Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.</p>","PeriodicalId":55560,"journal":{"name":"Adicciones","volume":"34 2","pages":"142-156"},"PeriodicalIF":2.2000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Clinical practice guideline on pharmacological and psychological management of adult patients with bipolar disorder and comorbid substance use.\",\"authors\":\"Ana González-Pinto, José Manuel Goikolea, Iñaki Zorrilla, Miquel Bernardo, Manuel Arrojo, Ruth Cunill, Xavi Castell, Elisardo Becoña, Ana López, Marta Torrens, Judit Tirado-Muñoz, Francina Fonseca, Belén Arranz, Marina Garriga, Pilar A Sáiz, Gerardo Flórez, Luis San\",\"doi\":\"10.20882/adicciones.1528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. 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Clinical practice guideline on pharmacological and psychological management of adult patients with bipolar disorder and comorbid substance use.
This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.
期刊介绍:
Adicciones publica artículos originales sobre el tratamiento, la prevención, estudios básicos y descriptivos en el campo de las adicciones, como son las drogas ilegales, el alcohol, el tabaco o cualquier otra adicción, procedentes de distintas disciplinas (medicina, psicología, investigación básica, investigación social, etc.). Todos los artículos son seleccionados después de pasar un proceso de revisión anónimo hecho por expertos en ese tema.