Abstract：
BACKGROUND: Psychotic bipolar depression (PBD) is a prevalent yet understudied psychiatric illness, and there are no specific guidelines or Food and Drug Administration-approved medications for its treatment. Recent studies suggest that some antipsychotics and mood stabilizers may be effective in managing bipolar depression; however, their effectiveness for PBD remains unclear. Given the urgent need for more focused research for managing PBD, we conducted a literature review to summarize the existing literature on PBD.
METHODS: We conducted an electronic literature search from the 1960s to 2023, utilizing PubMed, MEDLINE, EMBASE, and Google, and selected studies based on their relevance to PBD.
RESULTS: PBD is a complex disorder, with 50%-75% of patients with bipolar disorder exhibiting psychotic features. This likelihood increases among those with a history of psychotic mania. Treatment guidelines often recommend a combination of mood stabilizers, antipsychotics, or electroconvulsive therapy, but they do not specify a first-line treatment. PBD symptoms can be masked by mixed high mood and energy feelings, potentially delaying diagnosis and treatment while increasing suicide risk. Limited research has evaluated outcomes of various treatments for PBD, and despite the lack of evidence for superior efficacy, in clinical practice, antipsychotics are frequently prescribed. Notably, combining an antipsychotic with selective noradrenaline reuptake inhibitors or tricyclic antidepressants may be effective, but including a mood stabilizer is necessary.
CONCLUSIONS: PBD poses a significant challenge in mental health due to its severity and the lack of consensus on optimal treatment approaches. There is a critical need for more dedicated clinical trials and research to answer key questions about the effective treatment of acute PBD, ideal follow-up care, traits of responders to different therapies, and decision models for subsequent treatments.
METHODS: We conducted an electronic literature search from the 1960s to 2023, utilizing PubMed, MEDLINE, EMBASE, and Google, and selected studies based on their relevance to PBD.
RESULTS: PBD is a complex disorder, with 50%-75% of patients with bipolar disorder exhibiting psychotic features. This likelihood increases among those with a history of psychotic mania. Treatment guidelines often recommend a combination of mood stabilizers, antipsychotics, or electroconvulsive therapy, but they do not specify a first-line treatment. PBD symptoms can be masked by mixed high mood and energy feelings, potentially delaying diagnosis and treatment while increasing suicide risk. Limited research has evaluated outcomes of various treatments for PBD, and despite the lack of evidence for superior efficacy, in clinical practice, antipsychotics are frequently prescribed. Notably, combining an antipsychotic with selective noradrenaline reuptake inhibitors or tricyclic antidepressants may be effective, but including a mood stabilizer is necessary.
CONCLUSIONS: PBD poses a significant challenge in mental health due to its severity and the lack of consensus on optimal treatment approaches. There is a critical need for more dedicated clinical trials and research to answer key questions about the effective treatment of acute PBD, ideal follow-up care, traits of responders to different therapies, and decision models for subsequent treatments.
摘要：
背景：精神病性双相抑郁（PBD）是一种普遍存在但尚未得到充分研究的精神疾病，并且没有具体的指南或食品和药物管理局批准的治疗药物。最近的研究表明，一些抗精神病药和心境稳定剂可能是有效的管理双相抑郁;然而，它们对PBD的有效性尚不清楚.鉴于迫切需要更集中的研究来管理PBD，我们进行了文献综述，以总结PBD的现有文献。
方法：我们从20世纪60年代到2023年进行了一次电子文献检索，利用PubMed，MEDLINE,EMBASE,和谷歌,并根据它们与PBD的相关性选择研究。
结果：PBD是一种复杂的疾病，50％-75％的双相情感障碍患者表现出精神病特征。在有精神病性躁狂症史的人群中，这种可能性增加。治疗指南通常建议使用情绪稳定剂的组合，抗精神病药,或者电休克疗法,但他们没有指定一线治疗。PBD症状可以被混合的高情绪和能量感觉掩盖，可能会延迟诊断和治疗，同时增加自杀风险。有限的研究评估了PBD各种治疗方法的结果，尽管缺乏良好疗效的证据,在临床实践中，抗精神病药经常被处方。值得注意的是,抗精神病药物与选择性去甲肾上腺素再摄取抑制剂或三环类抗抑郁药联合使用可能有效,但是包括情绪稳定剂是必要的。
结论：PBD由于其严重程度和对最佳治疗方法缺乏共识，对心理健康构成了重大挑战。迫切需要更多专门的临床试验和研究，以回答有关急性PBD的有效治疗的关键问题。理想的后续护理，不同疗法的反应者的特征，和后续治疗的决策模型。
方法：我们从20世纪60年代到2023年进行了一次电子文献检索，利用PubMed，MEDLINE,EMBASE,和谷歌,并根据它们与PBD的相关性选择研究。
结果：PBD是一种复杂的疾病，50％-75％的双相情感障碍患者表现出精神病特征。在有精神病性躁狂症史的人群中，这种可能性增加。治疗指南通常建议使用情绪稳定剂的组合，抗精神病药,或者电休克疗法,但他们没有指定一线治疗。PBD症状可以被混合的高情绪和能量感觉掩盖，可能会延迟诊断和治疗，同时增加自杀风险。有限的研究评估了PBD各种治疗方法的结果，尽管缺乏良好疗效的证据,在临床实践中，抗精神病药经常被处方。值得注意的是,抗精神病药物与选择性去甲肾上腺素再摄取抑制剂或三环类抗抑郁药联合使用可能有效,但是包括情绪稳定剂是必要的。
结论：PBD由于其严重程度和对最佳治疗方法缺乏共识，对心理健康构成了重大挑战。迫切需要更多专门的临床试验和研究，以回答有关急性PBD的有效治疗的关键问题。理想的后续护理，不同疗法的反应者的特征，和后续治疗的决策模型。
