Parker G B, Graham R K, Tavella G
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Black Dog Institute, Sydney, NSW, Australia.
Acta Psychiatr Scand. 2017 Jun;135(6):515-526. doi: 10.1111/acps.12717. Epub 2017 Mar 5.
To examine the level of agreement across professionally auspiced evidence-based guidelines for managing the bipolar disorders.
A literature search in PubMed, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews and PsycInfo was undertaken using the search terms 'bipolar disorder' and 'guidelines', generating 11 evidence-based guidelines published by professional organisations over the 2002-2015 period. Each guideline was reviewed by two independent reviewers and key themes extracted via qualitative analyses.
There was agreement on issues such as the first-line treatment of mania where mood-stabilising and/or an antipsychotic medication together with tapering or ceasing antidepressant medications was most commonly recommended. Differences included the extent to which (i) the different bipolar disorders were defined or not, (ii) there were separate recommendations for bipolar I and bipolar II disorders vs. non-differentiating general bipolar management strategies, (iii) 'general' vs. severity-based recommendations were made, and (iv) narrow vs. broad sets of candidate medications were nominated, while there was variable consideration of treatments such as electroconvulsive therapy (ECT).
While there was some consistency across guidelines on key recommendations, there was also substantial inconsistencies, limiting the generation of any 'meta-consensus' model for managing the bipolar disorders.
检验专业认可的双相情感障碍管理循证指南之间的一致程度。
在PubMed、国家指南库、Cochrane系统评价数据库和PsycInfo中进行文献检索，检索词为“双相情感障碍”和“指南”，共检索到专业组织在2002年至2015年期间发布的11项循证指南。由两名独立评审员对每项指南进行评审，并通过定性分析提取关键主题。
在一些问题上达成了共识，如躁狂发作的一线治疗，最常推荐使用心境稳定剂和/或抗精神病药物，并逐渐减少或停用抗抑郁药物。差异包括：（i）对不同双相情感障碍的定义程度；（ii）对双相I型和双相II型障碍有单独推荐，还是采用非区分性的一般双相管理策略；（iii）做出“一般”推荐还是基于严重程度的推荐；（iv）提名的候选药物范围窄还是宽，同时对电休克治疗（ECT）等治疗方法的考虑也各不相同。
虽然指南在关键推荐方面存在一些一致性，但也存在大量不一致之处，限制了生成任何用于双相情感障碍管理的“元共识”模型。
