Abstract：
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.
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.
摘要：
背景：双相情感障碍是一种以反复发作的症状和躁狂症为特征的情绪失调，轻躁狂,抑郁症,和混合的情绪。双相情感障碍患者治疗的复杂性促使台湾生物精神病学和神经精神药理学会（TSBPN）于2012年发表了第一个关于双相情感障碍药物治疗的台湾共识。本文提出了更新的共识，随着诊断标准的变化(即，混合特征)和截至2022年4月发布的新兴药理学证据。
方法：我们的工作组系统地审查了临床研究证据和国际指南，并根据最新的世界生物精神病学协会联合会分级系统确定了每种药物治疗的证据水平。提出了四个临床特异性问题。然后，当前的TSBPN双极工作组在疗效和可接受性方面讨论了与每种治疗方案相关的研究证据和临床经验，然后通过匿名投票评估最终建议等级。
结果：在更新的共识中，考虑到双相情感障碍的高患病率，我们包括针对具有混合特征的双相情感障碍的药理学建议，严重的临床预后，以及没有批准的药物。Cariprazine,Lurasidone,重复经颅磁刺激,和氯胺酮作为治疗选择。在维护阶段,强调长效注射抗精神病药的应用，并提出了使用抗抑郁药和常规抗精神病药的危害。
结论：关于双相情感障碍药物治疗的最新台湾共识为临床精神病学实践提供了简明的循证和经验建议。它可能有助于改善双相情感障碍患者的治疗结果。
方法：我们的工作组系统地审查了临床研究证据和国际指南，并根据最新的世界生物精神病学协会联合会分级系统确定了每种药物治疗的证据水平。提出了四个临床特异性问题。然后，当前的TSBPN双极工作组在疗效和可接受性方面讨论了与每种治疗方案相关的研究证据和临床经验，然后通过匿名投票评估最终建议等级。
结果：在更新的共识中，考虑到双相情感障碍的高患病率，我们包括针对具有混合特征的双相情感障碍的药理学建议，严重的临床预后，以及没有批准的药物。Cariprazine,Lurasidone,重复经颅磁刺激,和氯胺酮作为治疗选择。在维护阶段,强调长效注射抗精神病药的应用，并提出了使用抗抑郁药和常规抗精神病药的危害。
结论：关于双相情感障碍药物治疗的最新台湾共识为临床精神病学实践提供了简明的循证和经验建议。它可能有助于改善双相情感障碍患者的治疗结果。
