Observational study designs for bipolar disorder — What can they tell us about treatment in acute mania?

2009 ◽  
Vol 33 (4) ◽  
pp. 715-721 ◽  
Author(s):  
Catherine Reed ◽  
Diego Novick ◽  
Ana Gonzalez-Pinto ◽  
Jordan Bertsch ◽  
Josep Maria Haro
Keyword(s):  
Bipolar Disorder ◽  
Observational Study ◽  
Acute Mania ◽  
Study Designs

EVIDENCE, VALUES, AND DECISION MAKING

2014 ◽  
Vol 30 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Michael D. Rawlins
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Observational Study ◽  
Social Values ◽  
Clinical Excellence ◽  
Health Technology ◽  
Evidence Base ◽  
Social Value ◽  
Value Judgments ◽  
Study Designs

Background: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments.Methods: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE).Results: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society.Conclusions: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.

Divalproex Sodium Versus Olanzapine in the Treatment of Acute Mania in Bipolar Disorder

2003 ◽  
Vol 64 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Dennis A. Revicki ◽  
L. Clark Paramore ◽  
Kenneth W. Sommerville ◽  
Alan C. Swann ◽  
John M. Zajecka ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Acute Mania ◽  
Divalproex Sodium

The efficacy of valproate, lamotrigine and gabapentin in bipolar disorder; review of double-blind controlled studies

2000 ◽  
Vol 12 (3) ◽  
pp. 122-127 ◽  
Author(s):  
W.A. Nolen ◽  
R.W. Kupka
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Good Alternative ◽  
Effective Drug ◽  
Acute Mania ◽  
Sources Of Information ◽  
Double Blind ◽  
Proven Efficacy ◽  
Continuation Treatment

AbstractAims: The efficacy of the anticonvulsants valproate, lamotrigine and gabapentin in bipolar disorder is reviewed.Method: Using Medline ® and other sources of information, 12 double-blind controlled studies with either of these compounds were identified.Results: None of the compounds has been proven effective in the prophylaxis of bipolar disorder. Valproate has been found an effective drug in acute mania, while in continuation treatment after acute mania it proved to be save, i.e. not causing switches into depression. Lamotrigine is the only anticonvulsant with proven efficacy in acute bipolar depression. So far gabapentin has not been found effective.Conclusion: For the prophylaxis of bipolar disorder, lithium is still the treatment of choice. Carbamazepine and valproate are good alternatives, especially for patients not responding to lithium or not tolerating it. Lamotrigine may be a good alternative in bipolar depression.

The treatment of bipolar disorder in children and adolescents

2017 ◽  
Author(s):  
Philip Hazell
Keyword(s):  
Clinical Trial ◽  
Bipolar Disorder ◽  
Young People ◽  
Relapse Prevention ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Acute Mania ◽  
Clinical Trial Evidence ◽  
Second Generation Antipsychotic ◽  
Trial Evidence

The presentation of bipolar disorder in young people can be different from that of adults; therefore, the approach to treatment differs slightly. Treatment is described for early intervention, acute mania, bipolar depression, relapse prevention, and refractory bipolar disorder. A strong therapeutic alliance with the patient and engagement and involvement of the patient’s family is critical to successful intervention. The evidence informing treatment is limited, but there is emerging research focused on the management of acute mania favouring monotherapy with a second-generation antipsychotic (SGA) over a mood stabilizer. Preliminary data favour a combination of an SGA and antidepressant over monotherapy with an SGA for the treatment of bipolar depression. Guidelines endorse electroconvulsive therapy for refractory mania and bipolar depression but there is no clinical trial evidence to support this practice. The development of algorithms to guide the management of all phases of bipolar disorder is a work in progress.

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