Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain.
FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Spain.
Acta Psychiatr Scand. 2018 Sep;138(3):196-222. doi: 10.1111/acps.12896. Epub 2018 May 13.
This systematic review provided a critical synthesis and a comprehensive overview of guidelines on the treatment of mixed states.
The MEDLINE/PubMed and EMBASE databases were systematically searched from inception to March 21st, 2018. International guidelines covering the treatment of mixed episodes, manic/hypomanic, or depressive episodes with mixed features were considered for inclusion. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation-AGREE II.
The final selection yielded six articles. Despite their heterogeneity, all guidelines agreed in interrupting an antidepressant monotherapy or adding mood-stabilizing medications. Olanzapine seemed to have the best evidence for acute mixed hypo/manic/depressive states and maintenance treatment. Aripiprazole and paliperidone were possible alternatives for acute hypo/manic mixed states. Lurasidone and ziprasidone were useful in acute mixed depression. Valproate was recommended for the prevention of new mixed episodes while lithium and quetiapine in preventing affective episodes of all polarities. Clozapine and electroconvulsive therapy were effective in refractory mixed episodes. The AGREE II overall assessment rate ranged between 42% and 92%, indicating different quality level of included guidelines.
The unmet needs for the mixed symptoms treatment were associated with diagnostic issues and limitations of previous research, particularly for maintenance treatment.
本系统评价对混合状态治疗指南进行了批判性综合和全面概述。
从建库到 2018 年 3 月 21 日，系统检索了 MEDLINE/PubMed 和 EMBASE 数据库。纳入了涵盖混合发作、躁狂/轻躁狂或伴有混合特征的抑郁发作治疗的国际指南。使用评估指南研究与评估工具-AGREE II 进行方法学质量评估。
最终选择产生了 6 篇文章。尽管它们存在异质性，但所有指南都同意中断抗抑郁单药治疗或添加心境稳定剂。奥氮平似乎对急性混合轻躁狂/躁狂/抑郁状态和维持治疗有最佳证据。阿立哌唑和帕利哌酮可能是急性混合轻躁狂/躁狂状态的替代药物。鲁拉西酮和齐拉西酮在急性混合性抑郁症中有用。丙戊酸钠被推荐用于预防新的混合发作，而锂和喹硫平用于预防所有极性的情感发作。氯氮平电抽搐治疗对难治性混合发作有效。AGREE II 的总体评估率在 42%至 92%之间，表明纳入指南的质量水平不同。
混合症状治疗的未满足需求与诊断问题和先前研究的局限性有关，特别是维持治疗。
