bipolar affective disorder
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Introduction
A major mood disorder characterized by episodes of major depression & mania or hypomania, formerly called manic-depressive psychosis, circular type.
Epidemiology
- affects ~8 million people in U.S., ~40 million worldwide[45]
- PREVALENCE 9.8% IN ONE STUDY[5]; LOWER IN OTHER POPULATIONS
- 20% OF NON-RESPONDERS TO ANTI-DEPRESSANTS[12]
Genetics
- polymorphism in tph2 gene associated with bipolar disorder[11]
- pdlim5 is commonly increased in the brain of patients with bipolar disorder, schizophrenia, & major depression
- overexpression of RIC3 in brains from patients with bipolar disease or schizophrenia
- associated with variations in cacna1c & cacnb2[19]
- other implicated genes: CPLX2
Clinical manifestations
- episode may be manic, depressed, hypomanic, or mixed manic type
- mixed episodes: manic (irritable, talkative) but depressed rather than euphoric
- elevated, expansive or irritable mood > 1 week, grandiosity, decreased need for sleep
- symptoms causing disruption of social or occupational functioning
- impulsive behavior
- spending sprees[2]
- manic episode may be presenting feature of bipolar 1 disorder
- increased goal-directed activity
- impulsive behavior
- increased sexual activity
- aggression
- patients with bipolar 1 disorder may never have a major depressive episode[29]
- chronic disorder, does not resolve with age[37]
Diagnostic criteria
- bipolar I disorder requires one or more episodes of mania
- bipolar II disorder requires one or more episodes of hypomania & is excluded by the history or presence of a manic episode.
Laboratory
- thyroid function tests
- anti-nuclear antibody
- urine drug screen (patients presenting with manic episode)
Complications
- suicide rate, 10-15% if untreated[2]
- substance abuse increase risk of mania with antidepressants
- adverse pregnancy outcomes, regardless of treatment[17]
- increased risk of dementia; lithium carbonate may be protective[38]
- increased risk of mortality
- largely due to
- possible a result of
- lifestyle of the mentally ill
- adverse effects of medications[16]
- other contributions from
- diabetes mellitus
- accidents
- colon cancer (women only)[21]
- disease interaction(s) of bipolar disorder with frontotemporal dementia
- disease interaction(s) of bipolar disorder with anxiety
Differential diagnosis
- hyperthyroidism, thyrotoxicosis
- partial-complex seizures
- systemic lupus erythematosus
- adverse effects of corticosteroids
- schizophrenia spectrum disorders[35]
- personality disorders[35]
- drug abuse, alcohol abuse[35]
- attention deficit hyperactivity disorder[35]
Management
- mood stabilizer
- not initial therapy for patients presenting with mania or depression
- lithium carbonate
- most effect mood stabilizer
- patients on lithium 3 times less likely to attempt suicide than patients on valproate[3]
- diminishes risk of suicide (odds ratio = 0.13) & all-cause mortality (odds ratio = 0.38) in patients with bipolar disease or unipolar depression[20]
- initiation of lithium carbonate with 24 hours of delivery prevents postpartum psychosis[18]
- 1st line agent[34]
- may be 1st line agent in elderly[24]
- lamotrigine may better than lithium in the elderly[37]
- NEJM favors lithium over lamotrigine[43]
- lithium more effective than divalproex for reducing manic symptoms in elderly[32]
- may be 1st line agent in elderly[24]
- early treatment may improve response rate[25]
- valproic acid (drug of choice for mixed episodes)[2]
- combination of lithium carbonate plus valproate may be better than either alone for preventing relapse[13]
- lamotrigine may better than valproic acid in the elderly[37]
- other mood stabilizers[2]
- carbamazepine
- oxcarbazepine (Trileptal)
- lamotrigine (Lamictal) for depressive episodes[9]
- preferable to valproic acid, carbamazepine & lithium in the elderly[37]
- long-acting gabapentin injection prevents psychiatric rehospitalization (RR=0.6)[34]
- adjunctive levothyroxine may be of benefit[36]
- life-long therapy with mood stabilizer[23]
- patients presenting with severe mania or psychosis
- hospitalize if possible for high-risk behaviors[43]
- antipsychotics (1st line) better than anticonvulsants for manic episodes[15]
- quetiapine
- olanzapine (Zyprexa)
- risperidone (Risperdal)
- long-acting risperidone injection prevents psychiatric rehospitalization (RR=0.6)[34]
- aripiprazole (Abilify)[14]
- long-acting perphenazine injection prevents psychiatric rehospitalization (rr=0.6) [34]
- haloperidol
- most effective agent[15]
- significantly more effective than all other agents except risperidone & olanzapine[15]
- sublingual dexmedetomidine 120 ug or 180 ug reduces mild to moderate agitation 42]
- patients presenting in the depressive phase
- fluoxetine/olanzapine (symbyax) fda-approved for treatment of bipolar depression[9][12]
- quetiapine monotherapy also fda-approved for treatment of bipolar depression[12]
- lumateperone (Caplyta) FDA-approved to treat with depressive episodes associated with bipolar 1 disorder & bipolar 2 disorder as monotherapy or adjunctive therapy with lithium or valproate[41]
- antidepressants
- add to lithium or lamotrigine for severe depression
- do not use SSRIs (or other antidepressants) alone; may trigger manic attack[14]
- Symbyax, 1st FDA approved agent for bipolar depression[4]
- adjunctive antidepressants may be stopped after remission of depression in bipolar 1 disorder[44]
- intensive clinical management
- adjunctive psychotherapy in addition to medication[40]
- education, sleep hygiene, non-specific support
- attention to physical symptoms &/or interpersonal & social rhythms therapy (ipsrt) may be of benefit[6]
- bright light mid-day (noon) may improve depression[33]
- elecroconvulsive treatment may benefit patients with treatment-resistant depression[26][28]
- number needed to treat to benefit 1 person = 3[26]
- omega 3 fatty acids, 1-2 g/day may be of benefit[7]
- screening: mood disorder questionnaire
More general terms
More specific terms
Additional terms
References
- ↑ PRESCRIBER'S LETTER 7(7):41 2000
- ↑ 2.0 2.1 2.2 2.3 2.4 PRESCRIBER'S LETTER 9(6):33 2002
- ↑ 3.0 3.1 PRESCRIBER'S LETTER 10(12):70 2003 DETAIL-DOCUMENT#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=191211&pb=PRL (SUBSCRIPTION NEEDED) HTTP://WWW.PRESCRIBERSLETTER.COM
- ↑ 4.0 4.1 PRESCRIBER'S LETTER 11(2):10 2004 DETAIL-DOCUMENT#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200207&pb=PRL (SUBSCRIPTION NEEDED) HTTP://WWW.PRESCRIBERSLETTER.COM
- ↑ 5.0 5.1 JOURNAL WATCH 25(7):57, 2005 DAS AK, OLFSON M, GAMEROFF MJ, PILOWSKY DJ, BLANCO C, FEDER A, GROSS R, NERIA Y, LANTIGUA R, SHEA S, WEISSMAN MM. SCREENING FOR BIPOLAR DISORDER IN A PRIMARY CARE PRACTICE. JAMA. 2005 FEB 23;293(8):956-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15728166
- ↑ 6.0 6.1 FRANK E, KUPFER DJ, THASE ME, MALLINGER AG, SWARTZ HA, FAGIOLINI AM, GROCHOCINSKI V, HOUCK P, SCOTT J, THOMPSON W, MONK T. TWO-YEAR OUTCOMES FOR INTERPERSONAL AND SOCIAL RHYTHM THERAPY IN INDIVIDUALS WITH BIPOLAR I DISORDER. ARCH GEN PSYCHIATRY. 2005 SEP;62(9):996-1004. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16143731
- ↑ 7.0 7.1 FRANGOU S ET AL, EFFICACY OF ETHYL-EICOSAPENTAENOIC ACID IN BIPOLAR DEPRESSION: RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL. BR J PSYCHIATRY 2006, 188:46 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16388069
- ↑ NIERENBERG AA, OSTACHER MJ, CALABRESE JR, KETTER TA, MARANGELL LB, MIKLOWITZ DJ, MIYAHARA S, BAUER MS, THASE ME, WISNIEWSKI SR, SACHS GS. TREATMENT-RESISTANT BIPOLAR DEPRESSION: A STEP-BD EQUIPOISE RANDOMIZED EFFECTIVENESS TRIAL OF ANTIDEPRESSANT AUGMENTATION WITH LAMOTRIGINE, INOSITOL, OR RISPERIDONE. AM J PSYCHIATRY. 2006 FEB;163(2):210-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16449473
- ↑ 9.0 9.1 9.2 BROWN EB ET AL, A 7-WEEK, RANDOMIZED, DOUBLE-BLIND TRIAL OF OLANZAPINE/ FLUOXETINE COMBINATION VERSUS LAMOTRIGINE IN THE TREATMENT OF BIPOLAR I DEPRESSION. J CLIN PSYCHIATRY 2006, 67:1025 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16889444
BELMAKER RH. TREATMENT OF BIPOLAR DEPRESSION. N ENGL J MED. 2007 APR 26;356(17):1771-3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17392296 - ↑ MANWANI SG ET AL, SUBSTANCE USE DISORDER AND OTHER PREDICTORS OF ANTIDEPRESSANT- INDUCED MANIA: A RETROSPECTIVE CHART REVIEW. J CLIN PSYCHIATRY 2006, 67:1341 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17017819
- ↑ 11.0 11.1 VAN DEN BOGAERT A ET AL, ASSOCIATION OF BRAIN-SPECIFIC TRYPTOPHAN HYDROXYLASE, TPH2, WITH UNIPOLAR AND BIPOLAR DISORDER IN A NORTHERN SWEDISH, ISOLATED POPULATION. ARCH GEN PSYCHIATRY 2006, 63:1103 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17015812
- ↑ 12.0 12.1 12.2 12.3 MEDICAL KNOWLEDGE SELF ASSESSMENT PROGRAM (MKSAP) 14, 15, 17, 18. AMERICAN COLLEGE OF PHYSICIANS, PHILADELPHIA 2006, 2009, 2015, 2018.
MEDICAL KNOWLEDGE SELF ASSESSMENT PROGRAM (MKSAP) 19 BOARD BASICS. AN ENHANCEMENT TO MKSAP19. AMERICAN COLLEGE OF PHYSICIANS, PHILADELPHIA 2022 - ↑ 13.0 13.1 THE BALANCE INVESTIGATORS AND COLLABORATORS LITHIUM PLUS VALPROATE COMBINATION THERAPY VERSUS MONOTHERAPY FOR RELAPSE PREVENTION IN BIPOLAR I DISORDER (BALANCE): A RANDOMISED OPEN-LABEL TRIAL LANCET. 2010 JAN 30;375(9712):385-95. EPUB 2010 JAN 19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20092882 DOI:10.1016/S0140-6736(09)61828-6 HTTP://WWW.THELANCET.COM/JOURNALS/LANCET/ARTICLE/PIIS0140-6736%2809%2961828-6/ABSTRACT
- ↑ 14.0 14.1 14.2 PRESCRIBER'S LETTER 18(6): 2011 COMMENTARY: PHARMACOTHERAPY OF BIPOLAR DISORDER IN ADULTS CHART: COMPARISON OF ATYPICAL ANTIPSYCHOTICS GUIDELINES: MANAGEMENT OF BIPOLAR DISORDER IN ADULTS (BD) (2010) DETAIL-DOCUMENT#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270603&pb=PRL (SUBSCRIPTION NEEDED) HTTP://WWW.PRESCRIBERSLETTER.COM
- ↑ 15.0 15.1 15.2 15.3 CIPRIANI A ET AL. COMPARATIVE EFFICACY AND ACCEPTABILITY OF ANTIMANIC DRUGS IN ACUTE MANIA: A MULTIPLE-TREATMENTS META-ANALYSIS. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21851976 LANCET 2011 AUG 17 HTTP://WWW.THELANCET.COM/JOURNALS/LANCET/ARTICLE/PIIS0140-6736(11)60873-8/FULLTEXT
BERK M AND MALHI GS. SHOULD ANTIPSYCHOTICS TAKE POLE POSITION IN MANIA TREATMENT? LANCET 2011 AUG 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21851975 HTTP://WWW.THELANCET.COM/JOURNALS/LANCET/ARTICLE/PIIS0140-6736(11)61060-X/FULLTEXT - ↑ 16.0 16.1 HOANG U ET AL. MORTALITY AFTER HOSPITAL DISCHARGE FOR PEOPLE WITH SCHIZOPHRENIA OR BIPOLAR DISORDER: RETROSPECTIVE STUDY OF LINKED ENGLISH HOSPITAL EPISODE STATISTICS, 1999-2006. BMJ 2011 SEP 13; 343:D5422 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21914766
- ↑ 17.0 17.1 BODEN R ET AL RISKS OF ADVERSE PREGNANCY AND BIRTH OUTCOMES IN WOMEN TREATED OR NOT TREATED WITH MOOD STABILISERS FOR BIPOLAR DISORDER: POPULATION BASED COHORT STUDY. BMJ 2012;345:E7085 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23137820 HTTP://WWW.BMJ.COM/CONTENT/345/BMJ.E7085
GENTILE S BIPOLAR DISORDER IN PREGNANCY: TO TREAT OR NOT TO TREAT? BMJ 2012;345:E7367 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23144175 HTTP://WWW.BMJ.COM/CONTENT/345/BMJ.E7367 - ↑ 18.0 18.1 BERGINK V ET AL. PREVENTION OF POSTPARTUM PSYCHOSIS AND MANIA IN WOMEN AT HIGH RISK. AM J PSYCHIATRY 2012 MAR 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22407083
- ↑ 19.0 19.1 CROSS-DISORDER GROUP OF THE PSYCHIATRIC GENOMICS CONSORTIUM IDENTIFICATION OF RISK LOCI WITH SHARED EFFECTS ON FIVE MAJOR PSYCHIATRIC DISORDERS: A GENOME-WIDE ANALYSIS. LANCET, EARLY ONLINE PUBLICATION, 28 FEBRUARY 2013 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23453885 HTTP://WWW.THELANCET.COM/JOURNALS/LANCET/ARTICLE/PIIS0140-6736(12)62129-1/ABSTRACT
- ↑ 20.0 20.1 CIPRIANI A ET AL LITHIUM IN THE PREVENTION OF SUICIDE IN MOOD DISORDERS: UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS. BMJ 2013;346:F3646 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23814104 HTTP://WWW.BMJ.COM/CONTENT/346/BMJ.F3646
- ↑ 21.0 21.1 CRUMP C ET AL COMORBIDITIES AND MORTALITY IN BIPOLAR DISORDER. A SWEDISH NATIONAL COHORT STUDY. JAMA PSYCHIATRY. JULY 17, 2013 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23863861 HTTP://ARCHPSYC.JAMANETWORK.COM/ARTICLE.ASPX?ARTICLEID=1714400
- ↑ AZIZ R, LORBERG B, TAMPI RR. TREATMENTS FOR LATE-LIFE BIPOLAR DISORDER. AM J GERIATR PHARMACOTHER. 2006 DEC;4(4):347-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17296540
- ↑ 23.0 23.1 GERIATRIC REVIEW SYLLABUS, 8TH EDITION (GRS8) DURSO SC AND SULLIVAN GN (EDS) AMERICAN GERIATRICS SOCIETY, 2013
- ↑ 24.0 24.1 SHULMAN KI. LITHIUM FOR OLDER ADULTS WITH BIPOLAR DISORDER: SHOULD IT STILL BE CONSIDERED A FIRST-LINE AGENT? DRUGS AGING. 2010 AUG 1;27(8):607-15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20658789
- ↑ 25.0 25.1 KESSING LV ET AL. STARTING LITHIUM PROPHYLAXIS EARLY V. LATE IN BIPOLAR DISORDER. BR J PSYCHIATRY 2014 JUL 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25012681 HTTP://BJP.RCPSYCH.ORG/CONTENT/205/3/214
- ↑ 26.0 26.1 26.2 SCHOEYEN HK ET AL. TREATMENT-RESISTANT BIPOLAR DEPRESSION: A RANDOMIZED CONTROLLED TRIAL OF ELECTROCONVULSIVE THERAPY VERSUS ALGORITHM-BASED PHARMACOLOGICAL TREATMENT. AM J PSYCHIATRY 2014 SEP 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25219389 HTTP://PSYCHIATRYONLINE.ORG/DOI/ABS/10.1176/APPI.AJP.2014.13111517
- ↑ FRYE MA. CLINICAL PRACTICE. BIPOLAR DISORDER--A FOCUS ON DEPRESSION. N ENGL J MED. 2011 JAN 6;364(1):51-9. REVIEW. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21208108
- ↑ 28.0 28.1 IRWIN KE, FREUDENREICH O, PEPPERCORN J ET AL CASE 30-2016 - A 63-YEAR-OLD WOMAN WITH BIPOLAR DISORDER, CANCER, AND WORSENING DEPRESSION. N ENGL J MED 2016; 375:1270-1281. SEPTEMBER 29, 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27682037 HTTP://WWW.NEJM.ORG/DOI/FULL/10.1056/NEJMCPC1609309
- ↑ 29.0 29.1 NEJM KNOWLEDGE+ QUESTION OF THE WEEK. AUG 15, 2017 HTTPS://KNOWLEDGEPLUS.NEJM.ORG/QUESTION-OF-WEEK/1288/
- ↑ GRANDE I ET AL. BIPOLAR DISORDER. LANCET 2016 APR 9; 387:1561
- ↑ GOODWIN GM ET AL. EVIDENCE-BASED GUIDELINES FOR TREATING BIPOLAR DISORDER: REVISED THIRD EDITION RECOMMENDATIONS FROM THE BRITISH ASSOCIATION FOR PSYCHOPHARMACOLOGY. J PSYCHOPHARMACOL 2016 JUN; 30:495.
- ↑ 32.0 32.1 YOUNG RC, MULSANT BH, SAJATOVIC M ET AL. GERI-BD: A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL OF LITHIUM AND DIVALPROEX IN THE TREATMENT OF MANIA IN OLDER PATIENTS WITH BIPOLAR DISORDER. AM J PSYCHIATRY 2017 AUG 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29088928 HTTP://AJP.PSYCHIATRYONLINE.ORG/DOI/10.1176/APPI.AJP.2017.15050657
- ↑ 33.0 33.1 SIT DK, MCGOWAN J, WILTROUT C ET AL. ADJUNCTIVE BRIGHT LIGHT THERAPY FOR BIPOLAR DEPRESSION: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL. AM J PSYCHIATRY 2017 OCT 3; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28969438 HTTP://AJP.PSYCHIATRYONLINE.ORG/DOI/10.1176/APPI.AJP.2017.16101200
- ↑ 34.0 34.1 34.2 34.3 34.4 LAHTEENVUO M, TANSKANEN A, TAIPALE H ET AL REAL-WORLD EFFECTIVENESS OF PHARMACOLOGIC TREATMENTS FOR THE PREVENTION OF REHOSPITALIZATION IN A FINNISH NATIONWIDE COHORT OF PATIENTS WITH BIPOLAR DISORDER. JAMA PSYCHIATRY. PUBLISHED ONLINE FEBRUARY 28, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29490359 HTTPS://JAMANETWORK.COM/JOURNALS/JAMAPSYCHIATRY/ARTICLE-ABSTRACT/2673379
LEUCHT S, DAVIS JM ENTHUSIASM AND SKEPTICISM ABOUT USING NATIONAL REGISTERS TO ANALYZE PSYCHOTROPIC DRUG OUTCOMES. JAMA PSYCHIATRY. 2018 FEB 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29490368 HTTPS://JAMANETWORK.COM/JOURNALS/JAMAPSYCHIATRY/FULLARTICLE/2673377 - ↑ 35.0 35.1 35.2 35.3 35.4 BIPOLAR DISORDER. THE NICE GUIDELINE ON THE ASSESSMENT AND MANAGEMENT OF BIPOLAR DISORDER IN ADULTS, CHILDREN AND YOUNG PEOPLE IN PRIMARY AND SECONDARY CARE. NICE GUIDELINE, NO. 185. NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH (UK). LEICESTER (UK): BRITISH PSYCHOLOGICAL SOCIETY. 2018 APR. HTTPS://WWW.NCBI.NLM.NIH.GOV/PUBMEDHEALTH/PMH0099268/PDF/PUBMEDHEALTH_PMH0099268.PDF
- ↑ 36.0 36.1 WALSHAW PD, GYULAI L, BAUER M ET AL. ADJUNCTIVE THYROID HORMONE TREATMENT IN RAPID CYCLING BIPOLAR DISORDER: A DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF LEVOTHYROXINE (L-T4) AND TRIIODOTHYRONINE (T3). BIPOLAR DISORD 2018 JUN 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29869405 HTTPS://ONLINELIBRARY.WILEY.COM/DOI/ABS/10.1111/BDI.12657
- ↑ 37.0 37.1 37.2 37.3 37.4 GERIATRIC REVIEW SYLLABUS, 10TH EDITION (GRS10) HARPER GM, LYONS WL, POTTER JF (EDS) AMERICAN GERIATRICS SOCIETY, 2019
GERIATRIC REVIEW SYLLABUS, 11TH EDITION (GRS11) HARPER GM, LYONS WL, POTTER JF (EDS) AMERICAN GERIATRICS SOCIETY, 2022 - ↑ 38.0 38.1 VELOSA J, DELGADO A, FINGER E ET AL. RISK OF DEMENTIA IN BIPOLAR DISORDER AND THE INTERPLAY OF LITHIUM: A SYSTEMATIC REVIEW AND META-ANALYSES. ACTA PSYCHIATR SCAND 2020 JAN 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31954065 HTTPS://ONLINELIBRARY.WILEY.COM/DOI/ABS/10.1111/ACPS.13153
- ↑ ROTHAUS C BIPOLAR DISORDER, NEJM RESIDENT 360. JULY 1, 2020 HTTPS://RESIDENT360.NEJM.ORG/CLINICAL-PEARLS/BIPOLAR-DISORDER-6
- ↑ 40.0 40.1 MIKLOWITZ DJ, EFTHIMIOU O, FURUKAWA TA ET AL ADJUNCTIVE PSYCHOTHERAPY FOR BIPOLAR DISORDERA SYSTEMATIC REVIEW AND COMPONENT NETWORK META-ANALYSIS. JAMA PSYCHIATRY. PUBLISHED ONLINE OCTOBER 14, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33052390 PMCID: PMC7557716 HTTPS://JAMANETWORK.COM/JOURNALS/JAMAPSYCHIATRY/FULLARTICLE/2771207
GOLDSTEIN TR, HAFEMAN DM BEYOND EFFICACY AND TOWARD DISSEMINATION AND PERSONALIZATION OF PSYCHOTHERAPY FOR BIPOLAR DISORDER. JAMA PSYCHIATRY. PUBLISHED ONLINE OCTOBER 14, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33052387 HTTPS://JAMANETWORK.COM/JOURNALS/JAMAPSYCHIATRY/FULLARTICLE/2771204 - ↑ 41.0 41.1 BROOKS M FDA GRANTS NEW INDICATION TO LUMATEPERONE (CAPLYTA) FOR BIPOLAR DEPRESSION. MEDSCAPE. DECEMBER 20, 2021 HTTPS://WWW.MEDSCAPE.COM/VIEWARTICLE/965134
- ↑ PRESKORN SH, ZELLER S, CITROME L ET AL EFFECT OF SUBLINGUAL DEXMEDETOMIDINE VS PLACEBO ON ACUTE AGITATION ASSOCIATED WITH BIPOLAR DISORDER. A RANDOMIZED CLINICAL TRIAL. JAMA. 2022;327(8):727-736 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35191924 HTTPS://JAMANETWORK.COM/JOURNALS/JAMA/FULLARTICLE/2789315
- ↑ 43.0 43.1 43.2 NEJM KNOWLEDGE+ PSYCHIATRY
- ↑ 44.0 44.1 YATHAM LN, ARUMUGHAM SS, KESAVAN M ET AL. DURATION OF ADJUNCTIVE ANTIDEPRESSANT MAINTENANCE IN BIPOLAR I DEPRESSION. N ENGL J MED 2023 AUG 3; 389:430. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37530824 HTTPS://WWW.NEJM.ORG/DOI/10.1056/NEJMOA2300184
- ↑ 45.0 45.1 NIERENBERG AA, AGUSTINI B, KOHLER-FORSBERG O et al Diagnosis and Treatment of Bipolar Disorder. A Review. JAMA. 2023;330(14):1370-1380 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37815563 https://jamanetwork.com/journals/jama/fullarticle/2810502