加拿大情绪和焦虑治疗网络(CANMAT)和国际双相情感障碍协会(ISBD)对混合表现的双相情感障碍患者的管理建议

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2021-10-02 DOI:10.1111/bdi.13135

Lakshmi N. Yatham, Trisha Chakrabarty, David J. Bond, Ayal Schaffer, Serge Beaulieu, Sagar V. Parikh, Roger S. McIntyre, Roumen V. Milev, Martin Alda, Gustavo Vazquez, Arun V. Ravindran, Benicio N. Frey, Verinder Sharma, Benjamin I. Goldstein, Soham Rej, Claire O’Donovan, Valerie Tourjman, Jan-Marie Kozicky, Marcia Kauer-Sant’Anna, Gin Malhi, Trisha Suppes, Eduard Vieta, Flavio Kapczinski, Shigenobu Kanba, Raymond W. Lam, Sidney H. Kennedy, Joseph Calabrese, Michael Berk, Robert Post

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引用次数: 28

摘要

2018年加拿大情绪和焦虑治疗网络(CANMAT)和国际双相情感障碍学会(ISBD)指南为临床医生提供了实用的双相情感障碍(BD)治疗建议。虽然这些指南包括对混合特征如何指导治疗选择的评论，但没有提供具体的建议——这是当前更新旨在解决的一个关键空白。方法综述双相障碍混合性表现的研究，并采用改进的CANMAT/ISBD评分方法提出治疗建议。讨论了局限性，包括缺乏高质量的数据和对专家意见的依赖。结果没有药物达到DSM-5混合特征躁狂或抑郁发作一线治疗的阈值。对于躁狂症+混合特征，二线治疗方案包括阿塞那平、卡吡嗪、双丙戊酸和阿立哌唑。对于抑郁症+混合性特征，卡吡嗪和鲁拉西酮建议作为二线选择。对于DSM-IV定义的具有较长研究历史的混合性发作，阿塞那平和阿立哌唑是一线，奥氮平(单药或联合治疗)、卡马西平和双丙戊酸是二线。DSM-5混合表现后的维持治疗研究非常有限，基于专家意见的三线建议。对于DSM-IV混合发作后的维持治疗，喹硫平(单药或联合治疗)是一线，锂和奥氮平被确定为二线选择。结论:CANMAT和ISBD小组希望这些指南能为临床医生提供有价值的支持，帮助他们为患有混合症状的患者提供护理，并进一步影响研究投资，以改善这种常见而复杂的临床状态的诊断和治疗。

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations

Objectives

The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendations were not provided—a critical gap which the current update aims to address.

Method

Overview of research regarding mixed presentations in BD, with treatment recommendations developed using a modified CANMAT/ISBD rating methodology. Limitations are discussed, including the dearth of high-quality data and reliance on expert opinion.

Results

No agents met threshold for first-line treatment of DSM-5 manic or depressive episodes with mixed features. For mania + mixed features second-line treatment options include asenapine, cariprazine, divalproex, and aripiprazole. In depression + mixed features, cariprazine and lurasidone are recommended as second-line options. For DSM-IV defined mixed episodes, with a longer history of research, asenapine and aripiprazole are first-line, and olanzapine (monotherapy or combination), carbamazepine, and divalproex are second-line. Research on maintenance treatments following a DSM-5 mixed presentation is extremely limited, with third-line recommendations based on expert opinion. For maintenance treatment following a DSM-IV mixed episode, quetiapine (monotherapy or combination) is first-line, and lithium and olanzapine identified as second-line options.

Conclusion

The CANMAT and ISBD groups hope these guidelines provide valuable support for clinicians providing care to patients experiencing mixed presentations, as well as further influence investment in research to improve diagnosis and treatment of this common and complex clinical state.

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.