Hammett Stephen, Youssef Nagy A
Department of Psychiatry and Health Behavior, The Medical College of Georgia, Augusta University, Augusta, GA, USA. E-mail:
Ann Clin Psychiatry. 2017 Nov;29(4):266-282.
To examine the similarities and differences among practice guidelines for managing bipolar disorders (BDs) in adults.
A literature search in PubMed/Medline was performed using multiple search terms and bibliographies for guidelines from July 2013 (since FDA approval of lurasidone) to June 2017.
Six treatment guidelines for BDs in adults were identified. These guidelines showed consensus on first-line treatment of mania (moodstabilizer and/or an antipsychotic), and most first-line medications for bipolar depression. However, beyond first-line treatments, the guidelines' recommendations showed major differences. Some guidelines did not specify a type of BD. In addition, there was variability in the stages when important treatments, such as electroconvulsive therapy, should be considered and in the recommended treatment-or lack of recommended treatment-for mixed episodes and features.
This review found consistency across guidelines on first-line recommendations for treating manic and depressive episodes, but wide differences for second- and third-line treatments and for other phases of BD, therefore limiting the generation of any "meta-consensus." We recommend creating an international workgroup to reconcile the evidence and develop more unified international recommendations.
探讨成人双相情感障碍（BD）管理实践指南之间的异同。
于2013年7月（自鲁拉西酮获得美国食品药品监督管理局批准以来）至2017年6月期间，在PubMed/Medline中使用多个检索词及指南的参考文献进行文献检索。
确定了6份成人BD治疗指南。这些指南在躁狂症的一线治疗（心境稳定剂和/或抗精神病药物）以及双相抑郁症的大多数一线药物方面达成了共识。然而，除一线治疗外，指南的建议存在重大差异。一些指南未明确BD的类型。此外，在应考虑重要治疗（如电休克治疗）的阶段以及混合发作和症状的推荐治疗（或缺乏推荐治疗）方面存在差异。
本综述发现，各指南在治疗躁狂和抑郁发作的一线推荐方面具有一致性，但在二线和三线治疗以及BD的其他阶段存在广泛差异，因此限制了任何“元共识”的形成。我们建议成立一个国际工作组，以协调证据并制定更统一的国际推荐。
