尽管临床上高度相关,在最近的指南中,对双相混合状态的识别和治疗仅占次要地位。本WFSBP指南旨在提供有关成人双相混合状态急性和长期治疗的所有科学证据的系统概述。
用于这些指南的材料是基于使用各种数据库的系统文献检索。他们的科学严谨性分为六个证据级别(A-F),并分配了不同等级的建议,以确保实用性。我们检查了双相混合患者躁狂和抑郁症状的急性治疗数据,以及与预防任何类型的指数发作后混合复发有关的数据,或混合指数发作后任何类型的复发。
双相混合状态的躁狂症状似乎对几种非典型抗精神病药物的治疗有反应,用奥氮平休息的最佳证据。对于抑郁症状,加齐拉西酮照常治疗可能是有益的;然而,与治疗躁狂症状相比,证据基础要有限得多。除了奥氮平和喹硫平,丙戊酸和锂也应考虑用于预防复发。
混合状态的概念随着时间的推移而改变,最近随着DSM-5的发布变得更加全面。因此,在双相混合患者中的研究针对的是略有不同的双相亚群.此外,近年来,在急性和维持治疗方面的试验设计也随着法规的要求而进步.
目前的治疗建议仍基于有限的证据,并且对于采用具有混合特征概念的DSM-5说明符的确认研究有明确的需求。
Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent
guidelines. This WFSBP
guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults.
Material used for these
guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A-F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode.
Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention.
The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands.
Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.