Objectives Adaptation of CPGs for Treatment of Bipolar disorder in King Khalid University Hospital, Psychiatry Department
Methods The ADAPTE process for CPGs adaptation. Results: the final decision of the panel after full assessments of 3 source CPGs was full acceptance (adoption) of the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder (updated 2009).
Results Examples of Recommendations Lithium, valproate, and several atypical antipsychotics monotherapy is recommended to be used as first line treatments for acute mania, combination pharmacology with antipsychotics and mood stabiliser can be used as first line option. Paliperidone monotherapy and asenapine alone or in combination with lithium or divalproex can be used as a second line treatment; tamoxifen is suggested as a third line augmentation option. For the Management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI bupropion are first-line options. Adjunctive modafinil is recommended as a second-line option. lithium, lamotrigine, valoproate and olanzapine are first-line options for maintenance treatment of bipolar disorder.
Conclusion New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events.
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