Abilify lithium discussion paper

Abilify lithium discussion paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Abilify lithium discussion paper Please answer the following questions for medications below: Abilify (aripiprazole) Lithobid (Lithium) and risperidone- answer questions below for each medication Introduction Why is this good medication for bipolar with mania? What is your rationale for choosing this medication? Abilify lithium discussion paper Are there any contraindications or safety issues associated with this medication? Please answer for each medication separately. Please include in text citations within the last 10 years. And references. you may search additonal than the ones below. 2 pages. canmat_and_isbd_bipolar_guidelines__yatham_et_al_2018.pdf bipolar_utd.pdf DOI: 10.1111/bdi.12609 ORIGINAL ARTICLE Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder Lakshmi N Yatham1 | Sidney H Kennedy2 4 David J Bond 7 5 | Benicio N Frey 7 | Serge Beaulieu Soham Rej 10 | Sagar V Parikh3 | Ayal Schaffer2 6 | Verinder Sharma 8 2 | Benjamin I Goldstein 9 | Martin Alda | 2 | Glenda MacQueen 8 | | Diane McIntosh1 | Roumen V Milev | Arun Ravindran Raymond W Lam1 | Gustavo Vazquez10 | Flavio Kapczinski5 | Roger S McIntyre2 11 Jan Kozicky 12 | Shigenobu Kanba 15 Joseph R Calabrese | Claire O’Donovan | 13 14 | Beny Lafer 16 | Eduard Vieta | Trisha Suppes 17 | Gin Malhi 18 | Robert M Post | | | 19 Michael Berk 1 Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada 2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada 3 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA 4 Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA 5 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada 6 Departments of Psychiatry and Obstetrics & Gynaecology, Western University, London, ON, Canada 7 Department of Psychiatry, McGill University, Montreal, QC, Canada 8 Department of Psychiatry, Dalhousie University, Halifax, NS, Canada 9 Department of Psychiatry, University of Calgary, Calgary, AB, Canada 10 Departments of Psychiatry and Psychology, Queen’s University, Kingston, ON, Canada 11 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada 12 Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan 13 Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil 14 Bipolar and Depression Research Program, VA Palo Alto, Department of Psychiatry & Behavioral Sciences Stanford University, Stanford, CA, USA 15 Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA 16 Bipolar Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain 17 Department of Psychiatry, University of Sydney, Sydney, NSW, Australia 18 Department of Psychiatry, George Washington University, Washington, DC, USA 19 Deakin Univeristy, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia Correspondence Lakshmi N Yatham, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. Email: [email protected] Bipolar Disorders. 2018;20:97–170. wileyonlinelibrary.com/journal/bdi © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd | 97 98 | YATHAM et al. 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).Abilify lithium discussion paper 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 first­and 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. 1 | INTRODUCTION of the range of interventions available for this complex and varied illness, with the goal of providing clear, easy to use recommendations In the 20 years since the Canadian Network for Mood and Anxiety for clinicians to improve outcomes in their patients. Treatments (CANMAT) first published guidelines on the management Given that 13 years have elapsed since the publication of the last of BD (BD),1 there has been an explosion of research on treatment of full edition in 2005, the objective of these 2018 CANMAT and ISBD this illness. During this time period, CANMAT has strived to translate Bipolar Disorder Management Guidelines is to provide a compre- advances in research into international consensus on evidence-­based hensive, up-to-date review of research evidence on the treatment clinical management; first by publishing 2005 guidelines accompanied of various phases of BD, translated into clinical recommendations by expert commentaries, then by providing updates in 2007,2 20093 for evidence-­based management. Updated principles related to di- and 20134 in collaboration with the International Society for Bipolar agnosis and management are also included, in response to signif- Disorders (ISBD). Abilify lithium discussion paper The main objective of these publications was to syn- icant changes made in the 5th edition of the American Psychiatric thesize the wealth of evidence on the efficacy, safety, and tolerability Association Diagnostic and Statistical Manual for Mental Disorders | YATHAM et al. (DSM-­5).5 With increased research into various treatments for BD, TABLE 2 the evidence ratings have also been modified to increase rigor; for instance, minimum sample sizes are now specified for randomized controlled trials (RCTs) at each level of evidence (Table 1). Definitions for line of treatment ratings Line Evidence level First Level 1 or level 2 evidence for efficacy plus clinical support for safety/tolerability and no risk of treatment-­emergent switcha Second Level 3 or higher evidence for efficacy plus clinical support for safety/tolerability and low risk of treatment-­emergent switcha Third Level 4 evidence or higher for efficacy plus clinical support for safety/tolerability Not recommended Level 1 evidence for lack of efficacy, or level 2 evidence for lack of efficacy plus expert opinion As with previous editions of CANMAT guidelines, clinical support for efficacy was an important consideration in arriving at the final treatment recommendations (Table 2). Major conflicting data are addressed in blue text boxes (figures) to clarify the rationale for arriving at a specific level of evidence for efficacy. In the current edition, an additional distinction is made between safety and tolerability, and a consensus rating is assigned to each medication on these two measures when used in both the acute and maintenance phase. Further, a rating is also assigned to each medication for its propensity to switch patients into mania or depression (treatment-emergent switch). More information on these ratings can be found in the respective treatment sections, as well 99 a The text will specifically note when lack of clinical support for safety/ tolerability or risk of treatment-emergent switch has impacted recommendations. as in Section 8. The final grading of recommendations into first, second, or third- previous ongoing treatment was partially effective, and the addition of line considers levels of evidence for efficacy, clinical support based the new agent will provide benefits in either an additive or synergistic on experience, and consensus ratings of safety, tolerability, and risk manner. In contrast, agents specifically listed as adjunctive therapy may of treatment-­emergent switch. In addition, hierarchical rankings were have no evidence for efficacy as monotherapy, and/or may have safety created and are listed in the tables for first­and second line recom- concerns if prescribed as monotherapy (eg. antidepressants), and are mendations for acute mania, depression and maintenance treatment only recommended for use in combination with other evidence-­based in bipolar I disorder (BDI). This hierarchy was created by considering agents. the impact of each treatment across all phases of illness (Figure 1). As with previous editions, these guidelines also have a “not rec- The rationale for the hierarchical approach is that BD is a chronic ommended” category which includes treatments that have clearly lifetime condition with recurrent mood episodes and subsyndromal been shown to be ineffective in double-­blind RCTs. Further, we have mood symptoms, and most if not all patients will require maintenance included another category called “no specific recommendation/agents treatment. Since treatments that are prescribed for an acute mood ep- that require further study” to list treatments with insufficient evidence isode are usually continued into maintenance treatment, maintenance or clinical experience to make a recommendation, or where there is a efficacy should be considered when choosing acute-­phase treatments. reason to believe that negative trials failed because of methodologi- Treatments that have demonstrated efficacy across the spectrum cal problems-especially when the results are inconsistent with what is of the illness should thus be tried first before treatments that have expected based on the pharmacological properties of treatment and demonstrated efficacy for only selective phases of the disorder. As an clinical experience. Abilify lithium discussion paper Inclusion in this category means the efficacy of example, if two treatments are shown to be similarly effective in acute these agents is unknown at this time. mania, and if only one of these treatments has demonstrated efficacy As in previous editions, these guidelines are organized into eight for maintenance treatment, the treatment with evidence for mainte- sections (Table 3), including the Introduction. Foundations of man- nance would be placed higher in the hierarchical ranking. agement (Section 2) discusses the epidemiology of BD, screening Of note, when a treatment is listed as a monotherapy, that implies and diagnostic considerations, the importance of monitoring risk for that it may be used on its own or in combination with other ongoing suicide, the chronic disease management model and patient-­centred treatments, even if there are no specific studies demonstrating the ef- care (including shared decision making), as well the importance of ficacy of that combination. In this situation, the assumption is that the incorporating psychoeducation and other psychosocial treatment TABLE 1 Definitions for level of evidence ratings Level Evidence 1 Meta-­analysis with narrow confidence interval or replicated double-­blind (DB), randomized controlled trial (RCT) that includes a placebo or active control comparison (n ? 30 in each active treatment arm) 2 Meta-­analysis with wide confidence interval or one DB RCT with placebo or active control comparison condition (n ? 30 in each active treatment arm) 3 At least one DB RCT with placebo or active control comparison condition (n = 10-­29 in each active treatment arm) or health system administrative data 4 Uncontrolled trial, anecdotal reports, or expert opinion 100 | YATHAM et al. What are hierarchical rankings? Hierarchical rankings of treatment op ons are new to the 2018 Guidelines. They were created for first and second line treatment recommenda ons for acute mania, depression, and maintenance treatment of bipolar I disorder; and will further assist clinicians in making evidence based treatment decisions. These orders were created by considering the efficacy of each treatment across all phases, as well as acute and maintenance safety and tolerability and the risk for treatment emergent switch. Thus, for example if two treatments were shown to be similarly effec ve in acute mania, and if only one of these treatments has demonstrated efficacy for maintenance treatment, or had be€er safety or tolerability, that treatment would be placed higher in the hierarchical recommenda on. When making treatment decisions, we recommend that agents listed higher in the hierarchy be tried first, unless there are pa ent-specific reasons for choosing an agent lower in the order (such as pa ent preference, prior treatment non/response, or clinical features which favor treatments lower in the ranking). F I G U R E 1 Hierarchical rankings of treatment recommendations: How were they arrived at? [Colour figure can be viewed at wileyonlinelibrary.com] TABLE 3 Sections Section 1: Introduction Section 2: Foundations of management Section 3: Acute management of bipolar mania Section 4: Acute management of bipolar I depression Section 5: Maintenance therapy for bipolar I disorder applicable for practitioners from across the globe. As with previous publications, CANMAT will strive to publish regular updates to these guidelines, incorporating new knowledge useful for practising clinicians. As not all medications included in these guidelines will be available in all countries, including Canada, clinicians are advised to follow the recommendations of local regulatory bodies. Abilify lithium discussion paper Section 6: Bipolar II disorder Section 7: Specific populations Section 8: Safety and monitoring strategies into treatment. Additional information on presentation and hierarchical rankings of treatment options for acute mania (Section 3) and depression (Section 4) are reviewed, and include descriptions of clinical features that may help direct treatment choices. The importance of long-­term maintenance treatment and promotion of treatment adherence for mood stability, as well as hierarchical rankings of treatment options are discussed in Section 5. An expert review of the available evidence for treatments of bipolar II disorder (BDII) and recommendations based on those findings are presented in Section 6. The management issues related to specific populations, including women at various stages of the reproductive cycle, children and adolescents, older adults, and those with psychiatric or medical comorbidity are each discussed in Section 7. Finally, 2 | FOUNDATIONS OF MANAGEMENT 2.1 | Epidemiology 2.1.1 | Prevalence Bipolar disorder is a common and disabling mental illness with significant morbidity and mortality. The estimates of prevalence of BD vary. The World Mental Health Survey Initiative reported total lifetime (and 12-­month) prevalence estimates of 2.4% (1.5%) across BDI, BDII and subthreshold BD subtypes. While the prevalence rates for each subtype varied across the nine countries studied, subthreshold BD was the most common at 1.4% (0.8%), followed by BDI at 0.6% (0.4%) and BDII at 0.4% (0.3%).6 While Canada was not included in this study, similar results were reported from the Canadian Community Health Survey-­Mental Health, which found the lifetime prevalence of BDI was 0.87% and that of BDII was 0.67%.7 the principles of medical monitoring and an overview of safety and tolerability concerns for recommended treatments are provided in Section 8. 2.1.2 | Age of onset For convenience and to avoid confusion, these guidelines also Bipolar disorder frequently manifests in late adolescence and include a table of commonly used terms (with an explanation of the young adulthood, with an overall average age of onset of 25 years. intended meaning) that may have overlapping definitions or criteria in Statistical models suggest the presence of three age of onset sub- the literature (Table 4). groups within BDI and these can be categorized into a large early-­ These guidelines are intended for use by psychiatrists and primary onset group (mean ± standard deviation (SD) 17.24 ± 3.20 years), care providers who care for patients with BD throughout the lifespan, and smaller middle-­ o nset (23.93 ± 5.12 years) and late-­ o nset supporting them to provide evidence-­based assessment, treatment of (32.20 ± 11.96 years) groups, with the proportion of individu- acute symptoms, prevention of episode recurrence, and management of als falling into each category being 41.7%, 24.7% and 33.6% comorbidities. These guidelines are not meant to replace clinical judge- of the total sample, respectively. 8 However, the ages of onset ment or define standards of care. While designed with Canadian physi- tend to differ somewhat depending upon the origins of sam- cians in mind, input from experts from the ISBD makes these guidelines ples analysed. For instance, a recent study showed that the | YATHAM et al. TABLE 4 101 Clarifying overlapping terminology Term Use Mood stabilizer Use in the literature is inconsistent, and so this term will not be used in these guidelines Divalproex Encompasses valproate, valpromide, valproic acid and divalproex sodium Conventional antipsychotics Include first-­generation antipsychotics with high affinity for dopamine D2 receptors. Note these are referred to as dopamine receptor antagonists (D2) in the new neuroscience-­based nomenclature Atypical antipsychotics Comprise second-­generation antipsychotics with affinity for dopamine D2 and serotonin 5-­HT2 receptors as well as those that have partial agonist effects at D2/D3 receptors. Note these are referred to as dopamine and serotonin receptor antagonists (D2 and 5-­HT2A), dopamine 2 partial agonists and serotonin receptor antagonists, and dopamine 2/3 partial agonists in the new neuroscience-­based nomenclature Recurrence Re-­emerging episode(s) of mania or depression whether it be within the previous episode or a new episode. Note that, while the literature may use “relapse” and “recurrence”, respectively, inconsistencies in how they are applied and their irrelevance to treatment decisions mean we will use “recurrence” to refer to both Maintenance Prophylactic therapy after stabilization of acute manic or depressive episodes mean age of onset for a USA sample was 20 years, with ages a systematic review addressing cost of illness studies, with findings of onset of 14.5 ± 4.9 years (63%), 26.5 ± 7.6 years (28.5%), demonstrating that the worldwide annual costs per person with BD and 39.5 ± 12.5 years (8.5%) for early-­, middle-­ and late- … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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