加拿大情绪和焦虑治疗网络(CANMAT)先前于2005年发布了双相情感障碍的治疗指南,以及2007年,2009年和2013年的国际评论和后续更新。最近两次更新是与国际双相情感障碍协会(ISBD)合作发布的。这些2018年CANMAT和ISBD双极治疗指南代表了自2005年上一版发布以来该领域的重大进展,包括对诊断和管理的更新以及对药物和心理治疗的新研究。这些进步已转化为明确和易于使用的建议,第二,和第三线治疗,考虑到疗效的证据水平,基于经验的临床支持,和安全性的共识评级,耐受性,和治疗紧急转换风险。这些指南的新内容,为急性躁狂症推荐的一线和二线治疗创建了分级排名,急性抑郁症,和维持治疗双相I型障碍。通过考虑每种治疗对疾病各个阶段的影响而创建,这种层次结构将进一步帮助临床医生做出循证治疗决策.锂,喹硫平,双丙戊酸钠,阿塞那平,阿立哌唑,帕潘立酮,利培酮,和卡利拉嗪单独或联合使用被推荐作为急性躁狂症的一线治疗。双相I型抑郁症的一线选择包括喹硫平,鲁拉西酮加锂或双丙戊酸钠,锂,拉莫三嗪,Lurasidone,或辅助拉莫三嗪。虽然已被证明对急性期有效的药物通常应继续用于双相I型障碍的维持期,有一些例外(例如抗抑郁药);现有数据表明锂,喹硫平,双丙戊酸钠,拉莫三嗪,阿塞那平,对于在维持阶段开始或转换治疗的患者,应将阿立哌唑单药治疗或联合治疗视为一线治疗。除了解决双相情感障碍的问题,这些指南还概述了,和建议,双相II型障碍的临床管理,以及对特定人群的建议,例如处于生殖周期各个阶段的女性,儿童和青少年,和老年人。还讨论了特定的精神病和医学合并症的影响,例如使用药物,焦虑,和代谢紊乱。最后,提供了与安全和监控相关的问题的概述。CANMAT和ISBD小组希望这些指南成为全球从业者的宝贵工具。
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment
guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment
Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and
consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these
guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these
guidelines become a valuable tool for practitioners across the globe.