Journal
ASIAN JOURNAL OF PSYCHIATRY
Volume 82, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.ajp.2023.103480
Keywords
Bipolar disorder; TSBPN; Pharmacological treatment; Guideline; Ketamine; Repetitive transcranial magnetic stimulation
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This paper presents the updated consensus on pharmacological treatment for bipolar disorder in Taiwan, considering the changes in diagnostic criteria and emerging pharmacological evidence. The recommendations include treatment options for bipolar disorder with mixed features and emphasize the use of long-acting injectable antipsychotics in the maintenance phase.
Background: Bipolar disorder is a mood dysregulation characterized by recurrent symptoms and episodes of mania, hypomania, depression, and mixed mood. The complexity of treating patients with bipolar disorder prompted the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) to publish the first Taiwan consensus on pharmacological treatment of bipolar disorders in 2012. This paper presents the updated consensus, with changes in diagnostic criteria (i.e., mixed features) and emerging pharmacological evidence published up to April 2022. Methods: Our working group systemically reviewed the clinical research evidence and international guidelines and determined the levels of evidence for each pharmacological treatment on the basis of the most recent World Federation of Societies of Biological Psychiatry grading system. Four clinical-specific issues were proposed. The current TSBPN Bipolar Taskforce then discussed research evidence and clinical experience related to each treatment option in terms of efficacy and acceptability and then appraised final recommendation grades through anonymous voting.Results: In the updated consensus, we include the pharmacological recommendations for bipolar disorder with mixed features considering its high prevalence, the severe clinical prognosis, and the absence of approved medications. Cariprazine, lurasidone, repetitive transcranial magnetic stimulation, and ketamine are incorporated as treatment options. In the maintenance phase, the application of long-acting injectable antipsychotics is emphasized, and the hazards of using antidepressants and conventional antipsychotics are proposed.Conclusions: This updated Taiwan consensus on pharmacological treatment for bipolar disorder provides concise evidence-based and empirical recommendations for clinical psychiatric practice. It may facilitate treatment outcome improvement in patients with bipolar disorder.
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