CADE Clinic, Royal North Shore Hospital, Sydney, NSW
CADE Clinic, Royal North Shore Hospital, Sydney, NSW.
Med J Aust. 2018 Mar 19;208(5):219-225. doi: 10.5694/mja17.00658.
In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management. Main recommendations: The guidelines address the main phases of bipolar disorder with a particular emphasis on long term management, and provide specific clinical recommendations. Mania: All physicians should be able to detect its early signs so that treatment can be initiated promptly. At the outset, taper and cease medications with mood-elevating properties and institute measures to reduce stimulation, and transfer the patient to specialist care. Bipolar depression: Treatment is complicated and may require trialling treatment combinations. Monotherapy with mood-stabilising agents or second generation antipsychotics has demonstrated efficacy but using combinations of these agents along with antidepressants is sometimes necessary to achieve remission. Commencing adjunctive structured psychosocial treatments in this phase is benign and likely effective. Long term management: Physicians should adjust treatment to prevent the recurrence of manic and/or depressive symptoms and optimise functional recovery. Closely monitor the efficacy of pharmacological and psychological treatments, adverse effects and compliance. Changes in management as a result of the guidelines: The guidelines position bipolar disorder as part of a spectrum of mood disorders and provide a longitudinal perspective for assessment and treatment. They provide new management algorithms for the maintenance phase of treatment that underscore the importance of ongoing monitoring to achieve prophylaxis. As a first line treatment, lithium remains the most effective medication for the prevention of relapse and potential suicide, but requires nuanced management from both general practitioners and specialists. The guidelines provide clarity and simplicity for the long term management of bipolar disorder, incorporating the use of new medications and therapies alongside established treatments.
2015 年 12 月，澳大利亚和新西兰皇家精神科医学院发布了一套全面的心境障碍临床实践指南，供精神科医生、心理学家和心理健康专业人员使用。本指南摘要广泛针对初级保健医生，是一个缩写版本，重点关注双相情感障碍。它旨在帮助初级保健医生与精神科医生合作，对这种复杂疾病进行管理，以实现长期成功管理。主要建议：指南针对双相情感障碍的主要阶段进行了阐述，特别强调了长期管理，并提供了具体的临床建议。躁狂症：所有医生都应该能够发现其早期迹象，以便及时开始治疗。在发病初期，减少或停止使用具有提升情绪作用的药物，并采取措施减少刺激，将患者转介给专家治疗。双相抑郁：治疗较为复杂，可能需要尝试治疗组合。心境稳定剂或第二代抗精神病药物的单一疗法已证明有效，但有时需要联合这些药物和抗抑郁药来实现缓解。在这一阶段开始辅助结构化心理社会治疗是良性且可能有效的。长期管理：医生应调整治疗以预防躁狂和/或抑郁症状的复发，并优化功能恢复。密切监测药物和心理治疗的疗效、不良反应和依从性。根据指南进行的管理变化：该指南将双相情感障碍定位为心境障碍谱的一部分，并为评估和治疗提供了纵向视角。它们为治疗的维持阶段提供了新的管理算法，强调了持续监测以实现预防的重要性。作为一线治疗，锂仍然是预防复发和潜在自杀的最有效药物，但需要全科医生和专家进行细致的管理。该指南为双相情感障碍的长期管理提供了清晰性和简洁性，同时纳入了新的药物和治疗方法以及既定的治疗方法。
