Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Bipolar Disorders - Tập 20 Số 2 - Trang 97-170 - 2018
Lakshmi N. Yatham1, Sidney H. Kennedy2, Sagar V. Parikh3, Ayal Schaffer2, David J. Bond4, Benício N. Frey5, Verinder Sharma6, Benjamin I. Goldstein2, Soham Rej7, Serge Beaulieu7, Martin Alda8, Glenda MacQueen9, Roumen Milev10, Arun Ravindran2, Claire O’Donovan8, Diane McIntosh1, Raymond W. Lam1, Gustavo Vázquez10, Flávio Kapczinski5, Roger S. McIntyre2, Jan‐Marie Kozicky11, Shigenobu Kanba12, Beny Lafer13, Trisha Suppes14, Joseph R. Calabrese15, Eduard Vieta16, Gin S. Malhi17, Robert M. Post18, Michael Berk19
1Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
2Department of Psychiatry, University of Toronto, Toronto, ON, Canada
3Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
4Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
5Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
6Departments of Psychiatry and Obstetrics & Gynaecology Western University London ON Canada
7Department of Psychiatry, McGill University, Montreal, QC, Canada
8Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
9Department of Psychiatry, University of Calgary, Calgary, AB, Canada
10Departments of Psychiatry and Psychology Queen's University Kingston ON Canada
11School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
12Department of Neuropsychiatry Kyushu University Fukuoka Japan
13Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
14Bipolar and Depression Research Program VA Palo Alto Department of Psychiatry & Behavioral Sciences Stanford University Stanford CA USA
15Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
16Bipolar Unit Institute of Neuroscience Hospital Clinic University of Barcelona IDIBAPS, CIBERSAM Barcelona Catalonia Spain
17Department of Psychiatry, University of Sydney, Sydney, NSW, Australia
18Department of Psychiatry, George Washington University, Washington DC, USA
19Deakin Univeristy IMPACT Strategic Research Centre School of Medicine, Barwon Health Geelong Vic. Australia

Tóm tắt

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Bipolar Disorders

Tập 20 Số 2

97-170

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