The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines

Abstract

Background:This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity.Methods:The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines.Results:The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option.Conclusion:The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.

Are antidepressants useful in bipolar disease?

“…This is one of the signs of effervescence in the treatment of this affection leading to publication of consensus in North America and the United Kingdom which often don't deal with clinical realities [1]. These publications systematically evaluate best practices, validate fi rst choices and point out areas where there is not enough literature to produce best clinical practices [2]. The treatment of bipolar depression is certainly an area where a large number of randomized, double-blind studies and a strong evidencebased treatment algorithm produce data to refi ne our practices.…”

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

“…Despite these different pharmacological options, long‐term treatment of BD with a conventional agent (Li, VA, or CBZ) monotherapy often fails (Bromet et al, ; Fekadu et al, ; Li, Chen, Qiu, & Yang, ; Simhandl, König, & Amann, ). So clinicians, according to some international guidelines for the treatment of BD (Fountoulakis et al, ; Grunze et al, ), often utilize polypharmacy to improve the outcome (Lin, Mok, & Yatham, ). Nevertheless, evidence‐supported criteria for selecting Li monotherapy, anticonvulsant monotherapy, or polypharmacy are scant, and no compelling data suggesting that polypharmacy works better than Li monotherapy are available (BALANCE investigators and collaborators, Geddes et al, ; Goodwin et al, ; Grunze et al, ; Kemp et al, ; Kessing et al, ).…”

“…Clinical predictors of good response to Li prophylaxis are BD-I diagnosis, manic index polarity, pure mania, full interepisodic remission, few previous psychiatric hospitalizations, low somatic comorbidity, and positive response to lithium in first-degree relatives (Gershon, Chengappa, & Malhi, 2009;Grof, 2010;Grof et al, 2002;Kleindienst, Engel, & Greil, 2005;Licht, 2012). In 1990s, two anticonvulsants, valproate (VA) and carbamazepine (CBZ), were approved for BD prophylaxis (for a review, see Fountoulakis et al, 2016;Goodwin et al, 2016). Clinical predictors of good response to VA or CBZ are the presence of mixed or psychotic features (Fountoulakis et al, 2012;Goodwin & Consensus Group of the British Association for Psychopharmacology, 2009; Grunze et al, 2009;Masi et al, 2010;Swann et al, 1997;Tundo et al, 2013;Yatham et al, 2013) and of anxiety disorders comorbidity (Malhi, McAulay, Das, & Fritz, 2015).…”

“…However, there is some evidence that does not support the efficacy of VA or CBZ monotherapy in the maintenance treatment of BD or their efficacy advantages over lithium monotherapy (Hartong et al, 2003;Hayes et al, 2016;Kessing et al, 2018Kessing et al, , 2011. The better response to VA or CBZ than to Li monotherapy in patients with rapid cycling course BD is still disputed (Fountoulakis et al, 2016;Post et al, 2016). Despite these different pharmacological options, longterm treatment of BD with a conventional agent (Li, VA, or CBZ) monotherapy often fails (Bromet et al, 2005;Fekadu et al, 2006;Li, Chen, Qiu, & Yang, 2014;Simhandl, König, & Amann, 2014).…”

“…Despite these different pharmacological options, longterm treatment of BD with a conventional agent (Li, VA, or CBZ) monotherapy often fails (Bromet et al, 2005;Fekadu et al, 2006;Li, Chen, Qiu, & Yang, 2014;Simhandl, König, & Amann, 2014). So clinicians, according to some international guidelines for the treatment of BD (Fountoulakis et al, 2016;Grunze et al, 2013), often utilize polypharmacy to improve the outcome (Lin, Mok, & Yatham, 2006 Geddes et al, 2010;Goodwin et al, 2007;Grunze et al, 2013;Kemp et al, 2009;Kessing et al, 2018). Therefore, real-world studies investigating the prescription patterns in psychiatric centers specialized in mood disorders might contribute to identify the best long-term treatment for BD.…”