The clinical management of bipolar disorder complexity using a stratified model

Malhi GS, Bargh DM, Cashman E, Frye MA, Gitlin M. The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disord 2012: 14 (Suppl. 2): 66–89. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective:  To provide practical and clinically mean...

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Veröffentlicht in:Bipolar disorders 2012-05, Vol.14 (s2), p.66-89
Hauptverfasser: Malhi, Gin S, Bargh, Danielle M, Cashman, Emma, Frye, Mark A, Gitlin, Michael
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container_end_page 89
container_issue s2
container_start_page 66
container_title Bipolar disorders
container_volume 14
creator Malhi, Gin S
Bargh, Danielle M
Cashman, Emma
Frye, Mark A
Gitlin, Michael
description Malhi GS, Bargh DM, Cashman E, Frye MA, Gitlin M. The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disord 2012: 14 (Suppl. 2): 66–89. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model. Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta‐analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper. Results:  In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence‐based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non‐response and alternative medication recommendations are provided. Conclusions:  Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high‐quality research in this area. The stratified model provides a means for conceptualizing the complexity of many bipolar disorder presentations and considering their management.
doi_str_mv 10.1111/j.1399-5618.2012.00993.x
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The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disord 2012: 14 (Suppl. 2): 66–89. © 2012 The Authors. Journal compilation © 2012 John Wiley &amp; Sons A/S. Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model. Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta‐analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper. Results:  In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence‐based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non‐response and alternative medication recommendations are provided. Conclusions:  Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high‐quality research in this area. 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The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disord 2012: 14 (Suppl. 2): 66–89. © 2012 The Authors. Journal compilation © 2012 John Wiley &amp; Sons A/S. Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model. Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta‐analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper. Results:  In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence‐based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non‐response and alternative medication recommendations are provided. Conclusions:  Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high‐quality research in this area. 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The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disord 2012: 14 (Suppl. 2): 66–89. © 2012 The Authors. Journal compilation © 2012 John Wiley &amp; Sons A/S. Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model. Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta‐analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper. Results:  In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence‐based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non‐response and alternative medication recommendations are provided. Conclusions:  Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high‐quality research in this area. The stratified model provides a means for conceptualizing the complexity of many bipolar disorder presentations and considering their management.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22510037</pmid><doi>10.1111/j.1399-5618.2012.00993.x</doi><tpages>24</tpages></addata></record>
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subjects acute treatment
Adult
Aged
Antidepressive Agents - therapeutic use
Antimanic Agents - therapeutic use
bipolar disorder
Bipolar Disorder - classification
Bipolar Disorder - drug therapy
Bipolar Disorder - psychology
evidence-based review
Female
guidelines
Humans
maintenance treatment
Male
Meta-Analysis as Topic
Middle Aged
Models, Theoretical
Randomized Controlled Trials as Topic
treatment
Young Adult
title The clinical management of bipolar disorder complexity using a stratified model
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