The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder

<strong>Objectives:</strong> Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the...

Popoln opis

Bibliografske podrobnosti
Main Authors: Grunze, H, Vieta, E, Goodwin, G, Bowden, C, Licht, R, Azorin, J, Yatham, L, Mosolov, S, Möller, H, Kasper, S
Format: Journal article
Izdano: Taylor and Francis 2017
_version_ 1826292071264157696
author Grunze, H
Vieta, E
Goodwin, G
Bowden, C
Licht, R
Azorin, J
Yatham, L
Mosolov, S
Möller, H
Kasper, S
author_facet Grunze, H
Vieta, E
Goodwin, G
Bowden, C
Licht, R
Azorin, J
Yatham, L
Mosolov, S
Möller, H
Kasper, S
author_sort Grunze, H
collection OXFORD
description <strong>Objectives:</strong> Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults. <strong>Methods:</strong> Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A–F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. <strong>Results:</strong> Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. <strong>Limitations:</strong> The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. <strong>Conclusions:</strong> Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.
first_indexed 2024-03-07T03:09:03Z
format Journal article
id oxford-uuid:b38b2ed6-a5ba-4280-bc39-7429a555ec1d
institution University of Oxford
last_indexed 2024-03-07T03:09:03Z
publishDate 2017
publisher Taylor and Francis
record_format dspace
spelling oxford-uuid:b38b2ed6-a5ba-4280-bc39-7429a555ec1d2022-03-27T04:19:59ZThe World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorderJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b38b2ed6-a5ba-4280-bc39-7429a555ec1dSymplectic Elements at OxfordTaylor and Francis2017Grunze, HVieta, EGoodwin, GBowden, CLicht, RAzorin, JYatham, LMosolov, SMöller, HKasper, S<strong>Objectives:</strong> Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults. <strong>Methods:</strong> Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A–F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. <strong>Results:</strong> Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. <strong>Limitations:</strong> The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. <strong>Conclusions:</strong> Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.
spellingShingle Grunze, H
Vieta, E
Goodwin, G
Bowden, C
Licht, R
Azorin, J
Yatham, L
Mosolov, S
Möller, H
Kasper, S
The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title_full The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title_fullStr The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title_full_unstemmed The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title_short The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder
title_sort world federation of societies of biological psychiatry wfsbp guidelines for the biological treatment of bipolar disorders acute and long term treatment of mixed states in bipolar disorder
work_keys_str_mv AT grunzeh theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT vietae theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT goodwing theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT bowdenc theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT lichtr theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT azorinj theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT yathaml theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT mosolovs theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT mollerh theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT kaspers theworldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT grunzeh worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT vietae worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT goodwing worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT bowdenc worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT lichtr worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT azorinj worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT yathaml worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT mosolovs worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT mollerh worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder
AT kaspers worldfederationofsocietiesofbiologicalpsychiatrywfsbpguidelinesforthebiologicaltreatmentofbipolardisordersacuteandlongtermtreatmentofmixedstatesinbipolardisorder