Assessment， management and treatment recommendation for suicide risk of bipolar disorder with mixed features / 四川精神卫生

The purpose of this article is to provide references for understanding the current provision of bipolar disorder with mixed features as well as future efforts in clinical practice. The article is to review the profile of assessment， management and treatment of suicide risk in bipolar disorder with mixed features. And this review also provides a theoretical framework toward future targeted therapeutic interventions and guidance for bipolar disorder with mixed features.

Korean Medication Algorithm for Bipolar Disorder 2018 : Mixed Features / 우울ㆍ조울병

OBJECTIVES: The Korean Medication Algorithm for Bipolar Disorder 2018 (KMAP-BP 2018) has been revised again as a result of a consensus of opinions among experts. The mixed episode was changed to mixed features in DSM-5. In this study, we will describe the preference and recommendation of KMAP-BP 2018 for the treatment of mood episodes with mixed features.METHODS: Out of 84 members of the review committee, 61 completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing.RESULTS: The preferred first-step strategies for mixed features with more manic symptoms were a combination of mood stabilizers (MS), atypical antipsychotics (AAP), and AAP monotherapy. For mixed features with more depressive symptoms, a combination of MS and lamotrigine (LTG), a combination of MS and AAP, and a combination of AAP and LTG were preferred. For mixed features with manic and depressive symptoms, a combination of MS and AAP, and AAP monotherapy were preferred.CONCLUSION: For mixed features, a combination of MS and AAP was generally preferred, and lamotrigine was preferred for depressive symptoms. We hope this KMAP-BP 2018 to be helpful for clinicians that treat patients with bipolar disorder in Korea.

Pharmacological Treatment of Major Depressive Episodes with Mixed Features: A Systematic Review

We reviewed clinical studies investigating the pharmacological treatment of major depressive episodes (MDEs) with mixed features diagnosed according to the dimensional criteria (more than two or three [hypo]manic symptoms+principle depressive symptoms). We systematically reviewed published randomized controlled trials on the pharmacological treatment of MDEs with mixed features associated with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases through December 2017 with the following key word combinations linked with the word OR: (a) mixed or mixed state, mixed features, DMX, mixed depression; (b) depressive, major depressive, MDE, MDD, bipolar, bipolar depression; and (c) antidepressant, antipsychotic, mood stabilizer, anticonvulsant, treatment, medication, algorithm, guideline, pharmacological. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found few randomized trials on pharmacological treatments for MDEs with mixed features. Of the 36 articles assessed for eligibility, 11 investigated MDEs with mixed features in mood disorders: six assessed the efficacy of antipsychotic drugs (lurasidone and ziprasidone) in the acute phase of MDD with mixed features, although four of these were post hoc analyses based on large randomized controlled trials. Four studies compared antipsychotic drugs (olanzapine, lurasidone, and ziprasidone) with placebo, and one study assessed the efficacy of combination therapy (olanzapine+fluoxetine) in the acute phase of BD with mixed features. Pharmacological treatments for MDEs with mixed features have focused on antipsychotics, although evidence of their efficacy is lacking. Additional well-designed clinical trials are needed.