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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46833

RESUMO

Founded in 1979, the Anxiety and Depression Association of America (ADAA) is an international nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research.


Assuntos
Ansiedade , Depressão , Transtorno de Pânico , Suicídio , Transtornos Dismórficos Corporais , Transtornos da Alimentação e da Ingestão de Alimentos , Transtorno Obsessivo-Compulsivo , Transtornos de Estresse Pós-Traumáticos , Transtorno Bipolar , Agorafobia , Mutismo , Transtornos do Sono-Vigília , Fobia Social , Transtornos Fóbicos
3.
Medicine (Baltimore) ; 98(33): e16851, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415415

RESUMO

BACKGROUND: Studies aimed at understanding the higher risk profiles for self-inflicted violence in individuals with BD become essential as a possible predictive risk measure for the presence of suicidal behavior, corroborating the expressive reduction of suicide deaths in young people who are in psychic suffering. METHODS: The protocol was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA-P) and the research question was constructed using guidelines from the Population Intervention Comparator Outcome Setting (PICOS) strategy. A third reviewer will be contacted, and two studies will be included in the selection, analysis and inclusion phases of the articles, in case of divergence, a third reviewer will be contacted. (1) methodological design studies of cohorts, case-control and cross-sectional; (2) Diagnosis of Bipolar disorder according to Diagnostic and statistical Manual of mental disorders V; (3) Studies with adult population and (4) Studies that consider at least one type of self-inflicted violence as a variable. The articles considered eligible will be analyzed by New Castle - Ottawa quality assessment scale/cross section studies (NOS) to evaluate the quality of the studies. RESULTS: The identification of the characteristics of self-harm may subsidize professionals who work in the treatment of bipolar disorder with greater attention to these practices and monitoring of possible suicidal behaviors. CONCLUSION: This study may represent one of the initial measures of evaluation on these correlations, which will allow to protocol the guidelines in the field of practice and contribute to improvements in public health indexes.


Assuntos
Transtorno Bipolar/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Humanos , Medição de Risco , Revisão Sistemática como Assunto
4.
Psychiatr Hung ; 34(2): 185-198, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31417007

RESUMO

Sylvia Plath was one of the most famous American poets in the twentieth century. Plath was diagnosed with depression after her first suicide attempt when she was 20 years old. Her major depression (without psychotic symptoms) recurred several times. Plath never had a manic episode, but there were probable hypomanic periods in her life. She died by violent suicide when she was 30. Sylvia Plath took a bottle of sleeping pills and stuck her head in a gas oven. Several factors may have contributed to Plath's psychiatric disorder and suicide. The author reviews the etiological factors and course of psychiatric disorder based on the Unabridged Journals of Sylvia Plath and the literature. Her family history was positive and her premorbid personality was vulnerable to depression. There were histrionic, narcissistic and borderline features in her personality. The probable diagnoses of Plath were bipolar II. affective disorder and mixed personality disorder.


Assuntos
Transtorno Bipolar/história , Transtorno Depressivo Maior/história , Transtorno Depressivo Maior/psicologia , Pessoas Famosas , Transtornos do Humor/história , Transtornos da Personalidade/história , Feminino , História do Século XX , Humanos , Literatura Moderna/história , Personalidade , Suicídio/história
5.
Psychiatr Hung ; 34(2): 214-236, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31417009

RESUMO

To clarify the relationship between literature and psychiatry we can call on the help of the American-English writer Sylvia Plath, who was given electroconvulsive therapy and psychotherapy on a number of occasions for psychiatric illness and later took her own life. This study seeks an answer to five questions. Did Sylvia Plath suffer from psychiatric illness? Did she show signs of the bipolar triad (bipolar affective disorder, trait aggression, substance or behavioural dependence)? Did her activity as a writer have a therapeutic effect? What was the nature of her "confessionalism"? To what extent does her oeuvre reflect her life? Sylvia Plath very probably suffered from a psychiatric illness, namely bipolar 2 affective disorder. The unsuitable treatment of her illness and the interruption of intensive psychotherapy could have contributed to her early death. Together with the bipolar affective disorder, she was also characterised by serious dispositional aggression and emotional dependence. For her, writing was both a source of stress, because her dysthymia intensified her inhibitions, and at the same time self-healing and a self-fulfilling prophecy. The roots of her confessionalism can be found in her personality development suspended in the stage of becoming an adult, and the failure to work through her traumas. Unlike Goethe and Salinger who killed their heroes, having them commit suicide in The Sorrows of Young Werther and A Perfect Day for Bananafish, while both writers recovered from their crisis, Sylvia Plath described a positive development in The Bell Jar and in Ariel, her verse cycle, then put her head in the gas oven. Would she have stayed alive if she had followed the patterns of Goethe and Salinger?


Assuntos
Ira , Pessoas Famosas , Imaginação , Literatura Moderna/história , Suicídio/história , Suicídio/psicologia , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Feminino , História do Século XX , Humanos , Psicoterapia , Redação/história
7.
Expert Opin Drug Metab Toxicol ; 15(8): 619-631, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271537

RESUMO

Introduction: The comorbidity between obsessive-compulsive disorder (OCD) and bipolar disorders (BDs) is a frequent and severe condition characterized by a chronic course, high suicidal risk and tendency towards chronicity and treatment non-response. It represents a real challenge to psychiatrists, while requiring a careful and appropriate therapeutic management consisting in the combination of serotonergic antidepressants (ADs), such as serotonin reuptake inhibitors (SRIs), with mood stabilizers. This combination, like any other, raises the problems related to drug interactions that may lead to pharmacokinetic and pharmacodynamic changes, resulting in the modification of the pharmacologic effect and safety profile of a given compound. Areas covered: The aim of the present paper was to review the literature on the pharmacokinetic and pharmacodynamic changes resulting from the interactions of the different drugs prescribed in the OCD-BD comorbidity. Expert opinion: The literature data on pharmacokinetic and pharmacodynamic changes due to interactions of drugs commonly prescribed in the treatment of the OCD-BD comorbidity are extremely limited, and the information is inferred by findings gathered in psychiatric patients suffering from other disorders. This represents a gap in psychopharmacology that should be filled by specific studies on this important topic.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Antimaníacos/administração & dosagem , Antimaníacos/farmacocinética , Antimaníacos/farmacologia , Antipsicóticos/administração & dosagem , Antipsicóticos/farmacocinética , Antipsicóticos/farmacologia , Transtorno Bipolar/complicações , Interações de Medicamentos , Humanos , Transtorno Obsessivo-Compulsivo/complicações , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/farmacocinética , Inibidores de Captação de Serotonina/farmacologia
8.
Artigo em Russo | MEDLINE | ID: mdl-31317897

RESUMO

The author analyzes K. Conrad's concept of constitutional types based on the suggested differences in ontogenetic development of picnic and leptosomic physique, athletics and asthenics and also dysplastics. K. Conrad's typology is compared with the typology of Italian school of clinical anthropometry and E. Kretschmer's concept of constitutions. K. Conrad's criteria for the division of primary and secondary constitutions are delineated, one of the basic criteria are set by the differences in the physique proportions and tissue development. The different physiological characteristics of picnic and leptosomic constitutions as well as their cardinal mental differences are described. The special description of mental characteristics of the asthenic-hypoplastic type and some dysplastic constitutions is presented. Manic-depressive psychosis is considered by K. Conrad as a diathesis because due to the conservative constitutional development the mental disease in picnics is capable for compensation, schizophrenia is related to the system diseases, the normal leptosomic constitution is a 'milieu' which contributes to the manifestation of schizophrenia due to the peculiarities of ontogenetic constitutional development designated by K. Conrad as propulsive. As a result of this, the disease leads to the defect.


Assuntos
Transtorno da Personalidade Antissocial , Transtorno Bipolar , Esquizofrenia , Esportes , Transtorno da Personalidade Antissocial/diagnóstico , Astenia , Transtorno Bipolar/diagnóstico , Humanos , Esquizofrenia/diagnóstico
9.
Nord J Psychiatry ; 73(6): 372-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31304832

RESUMO

Background: Currently, increasing evidence supports the hypothesis that alterations in the immune-inflammatory system are critical for the pathophysiology of bipolar disorder (BD). Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and mean platelet volume (MPV) have recently been investigated as inexpensive and simple inflammatory markers. Aims: The aim of this study is to compare NLR, PLR, MLR, and MPV in depressive, manic, and euthymic patients with BD and healthy controls, and to evaluate whether values of NLR, PLR, MLR, and MPV are possible state or trait biomarkers in BD. Methods: This retrospective study was conducted with 341 patients with BD (100 patients in a depressive state, 141 patients in a manic state, and 100 patients in a euthymic state) and 114 healthy controls. Results: We found that patients with BD in manic states had higher levels of MPV, NLR, and MLR, and patients with BD in depressive states had higher levels of MPV than the controls. Moreover, MPV predicted all states of BD, while NLR and MLR predicted the manic state of BD. Conclusions: NLR, MLR, and MPV obtained from simple and inexpensive blood tests were significantly higher in patients with BD than in healthy controls, which each imply low-grade inflammation. MPV may serve as a possible trait biomarker of BD, while NLR and MLR may both serve as possible state biomarkers of the manic state.


Assuntos
Transtorno Bipolar/sangue , Inflamação/sangue , Linfócitos/citologia , Volume Plaquetário Médio , Monócitos/citologia , Neutrófilos/citologia , Adulto , Biomarcadores/sangue , Plaquetas/citologia , Plaquetas/fisiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
10.
Psychiatr Danub ; 31(2): 157-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31291219

RESUMO

Schizophrenia and bipolar disorders are serious psychiatric disorders with substantial health risks. Asenapine is a new second-generation antipsychotic, available as a sublingual tablet, approved in Europe for the treatment of moderate-to-severe manic episodes in adults, and in US for manic or mixed episodes of bipolar I disorder in adults and adolescents. In this review, we searched the available literature to appreciate the role of asenapine in the management of psychiatric conditions such as bipolar disorders and schizophrenia and describe its mechanism of action, efficacy and tolerability. Asenapine has demonstrated efficacy in the management of bipolar disorders and schizophrenia, while a possible role in the management of borderline personality disorder and agitation needs further research. Asenapine has favourable side effects profile and combining with other pharmacological treatment in post-traumatic stress disorder has shown promising results. Asenapine fulfils important requirements of efficacy and tolerability as an anti-psychotic. These findings should support psychiatrists and pharmacists in the care of their patients while on asenapine.


Assuntos
Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis/farmacologia , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/administração & dosagem , Transtorno da Personalidade Borderline/tratamento farmacológico , Europa (Continente) , Compostos Heterocíclicos de 4 ou mais Anéis/administração & dosagem , Humanos , Estados Unidos
11.
Harefuah ; 158(7): 458-462, 2019 Jul.
Artigo em Hebraico | MEDLINE | ID: mdl-31339246

RESUMO

INTRODUCTION: Simple logic would suggest that there should be some endophenotype for bipolar disorder. Possible endophenotypes could include specific variations in personality. Bagby and Ryder summarized the work up to that point by noting that the related personality traits of high neuroticism and harm avoidance seem to be associated with bipolar disorder as well as with unipolar depression, whereas higher novelty seeking may be associated only with bipolar patients. As these parameters are all very sensitive to the affective state, it is critical to examine the literature that pertains specifically to euthymic patients in order to evaluate the extent to which this signifies underlying personality (trait), and not primarily clinical status (state). Several important studies have been published since the Bagby and Ryder paper, which we review here. We restrict our current review to empirical studies which employed both adequate samples of euthymic (to minimize the state/trait dilemma) bipolar patients as well as healthy comparison subjects. This paper is restricted to frequently used explicit measures of personality - that is, self-report questionnaires: the Temperament and Character Inventory (TCI) based on Cloninger's psychobiological theory of temperament and character, the Revised NEO Personality Inventory based on the five-factor model of Costa & McCrae, and the Barratt Impulsiveness Scale (BIS-11) (23). No single dimension of 'personality' reviewed would qualify as a psychological marker for a bipolar disorder. Earlier findings as reviewed by Bagby and Ryder, of higher novelty seeking, were not replicated in these studies. Of the personality traits considered, the most promising candidate for marker or endophenotype would seem to be "impulsivity" as measured by the BIS-II.


Assuntos
Transtorno Bipolar , Personalidade , Caráter , Humanos , Inventário de Personalidade , Autorrelato
12.
BMC Genomics ; 20(Suppl 7): 535, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31291891

RESUMO

BACKGROUND: Purpose of study is revealing significant differences in serum proteomes in schizophrenia and bipolar disorder (BD). RESULTS: Quantitative mass-spectrometry based proteomic analysis was used to quantify proteins in the blood serum samples after the depletion of six major blood proteins. Comparison of proteome profiles of different groups revealed 27 proteins being specific for schizophrenia, and 18 - for BD. Protein set in schizophrenia was mostly associated with immune response, cell communication, cell growth and maintenance, protein metabolism and regulation of nucleic acid metabolism. Protein set in BD was mostly associated with immune response, regulating transport processes across cell membrane and cell communication, development of neurons and oligodendrocytes and cell growth. Concentrations of ankyrin repeat domain-containing protein 12 (ANKRD12) and cadherin 5 in serum samples were determined by ELISA. Significant difference between three groups was revealed in ANKRD12 concentration (p = 0.02), with maximum elevation of ANKRD12 concentration (median level) in schizophrenia followed by BD. Cadherin 5 concentration differed significantly (p = 0.035) between schizophrenic patients with prevailing positive symptoms (4.78 [2.71, 7.12] ng/ml) and those with prevailing negative symptoms (1.86 [0.001, 4.11] ng/ml). CONCLUSIONS: Our results are presumably useful for discovering the new pathways involved in endogenous psychotic disorders.


Assuntos
Transtorno Bipolar/metabolismo , Proteoma/metabolismo , Esquizofrenia/metabolismo , Adulto , Antígenos CD/metabolismo , Caderinas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Nucleares/metabolismo , Adulto Jovem
13.
Nat Commun ; 10(1): 2417, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31160569

RESUMO

Accumulating evidence from genome wide association studies (GWAS) suggests an abundance of shared genetic influences among complex human traits and disorders, such as mental disorders. Here we introduce a statistical tool, MiXeR, which quantifies polygenic overlap irrespective of genetic correlation, using GWAS summary statistics. MiXeR results are presented as a Venn diagram of unique and shared polygenic components across traits. At 90% of SNP-heritability explained for each phenotype, MiXeR estimates that 8.3 K variants causally influence schizophrenia and 6.4 K influence bipolar disorder. Among these variants, 6.2 K are shared between the disorders, which have a high genetic correlation. Further, MiXeR uncovers polygenic overlap between schizophrenia and educational attainment. Despite a genetic correlation close to zero, the phenotypes share 8.3 K causal variants, while 2.5 K additional variants influence only educational attainment. By considering the polygenicity, discoverability and heritability of complex phenotypes, MiXeR analysis may improve our understanding of cross-trait genetic architectures.


Assuntos
Transtorno Bipolar/genética , Modelos Genéticos , Modelos Estatísticos , Herança Multifatorial , Esquizofrenia/genética , Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Desequilíbrio de Ligação
14.
Tijdschr Psychiatr ; 61(6): 384-391, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31243748

RESUMO

BACKGROUND: There is an average 10-year delay in diagnosing bipolar disorder, hampering the application of effective therapeutic interventions.
AIM: To investigate factors contributing to early recognition.
METHOD: We give a stage-oriented overview of the opportunities for early recognition.
RESULTS: Recognition in stage 0 (at-risk) and stage 1 (prodromal) is yet impossible. In stage 2 (syndromal) there are opportunities for better recognition in patients presenting with depression by conducting a thorough (collateral) psychiatric assessment, family history and by applying additional screening tools. CONCLUSIONS There are opportunities for better recognition of bipolar disorder in the syndromal stage.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Escalas de Graduação Psiquiátrica
15.
Expert Opin Drug Saf ; 18(8): 703-717, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31203678

RESUMO

INTRODUCTION: To compare common side effects of mood stabilizers (MSs) and antipsychotics in pediatric and adult bipolar disorder (BD). AREAS COVERED: MEDLINE, EMBASE, PsycINFO was searched for randomized, double-blind, placebo-controlled trials (RCTs) in the treatment of pediatric and adult BD. Twelve RCTs for pediatric patients and 30 for adult patients were included. The risk for the discontinuation due to adverse events, ≥7% weight gain, somnolence, akathisia, nausea and vomiting from a medication relative to placebo was estimated with absolute risk increase and the number needed to harm. The relative risk of these measures in pediatric and adult patients was compared. EXPERT OPINION: Overall, the relative risk for ≥7% weight gain, somnolence, nausea, or vomiting was higher, and akathisia was lower in pediatric patients than in adults. The magnitude of difference among MSs and antipsychotics and between pediatrics and adults varied widely. The risk for pediatric patients could be underestimated because in most pediatric studies, doses of studied medications were lower and flexibly dosed, and titration speeds were slower than in adult studies. Clinicians should pay attention to differences in study designs to understand the risk for common side effects when prescribing a medication for BD.


Assuntos
Antimaníacos/efeitos adversos , Antipsicóticos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Adulto , Fatores Etários , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Antimaníacos/administração & dosagem , Antipsicóticos/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Risco
16.
Lancet ; 394(10194): 240-248, 2019 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-31200992

RESUMO

BACKGROUND: Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. METHODS: In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. FINDINGS: We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. INTERPRETATION: The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. FUNDING: WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.


Assuntos
Transtornos Mentais/epidemiologia , Guerra , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Depressão/epidemiologia , Humanos , Prevalência , Esquizofrenia/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Organização Mundial da Saúde
17.
Expert Opin Drug Saf ; 18(9): 777-794, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31242784

RESUMO

Introduction: The standard of treatment of pediatric bipolar disorder (BPD) often requires life-long psychopharmacological management. Several pharmacological agents are approved by the US FDA for the treatment of pediatric BPD. However, each medication may cause adverse events (AEs). Provider awareness of AE profiles of common pharmacologic agents would serve to better inform patients and families in evaluating and selecting between treatment options. Areas covered: This review focuses on medications that, in our clinical experience, are commonly prescribed for youth with BPD and were evaluated in prospective clinical trials for the treatment of pediatric BPD. This paper highlights acute and long-term AEs described in these studies. Expert opinion: Most medications increase risk of AEs in youth with BPD. Treatment with lithium may lead to thyrotropin elevations, but generally does not cause significant weight gain. Divalproex may lead to weight gain; however, this finding was not consistent in comparison studies with lithium. Olanzapine, risperidone, quetiapine, and asenapine are associated with metabolic abnormalities and weight gain. Studies of ziprasidone, aripiprazole and lurasidone do not suggest significant metabolic AEs. More studies are needed to assess efficacy and safety of medications in managing pediatric BPD. Special focus on long-term maintenance trials is required to further identify long-term AEs in this population.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Ganho de Peso/efeitos dos fármacos , Adolescente , Antipsicóticos/efeitos adversos , Criança , Humanos , Tireotropina/metabolismo , Fatores de Tempo
19.
Bipolar Disord ; 21(5): 392-393, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31188518
20.
Cochrane Database Syst Rev ; 6: CD004048, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31152444

RESUMO

BACKGROUND: Bipolar disorder is a common condition associated with high morbidity; developing efficacious, safe treatments is therefore essential. Lithium is an effective maintenance treatment for bipolar disorder. It acts as mood stabiliser and reduces the risk of suicide. However, evidence assessing the efficacy of lithium in the treatment of acute mania is less robust. Current evidence-based guidelines cite multiple anti-dopaminergic and mood-stabilising agents as initial treatments: more definite evidence is needed to decide if lithium should be the first-line therapy. OBJECTIVES: 1. To assess the effects of lithium in comparison with placebo or other active treatment in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder.2. To review the acceptability and tolerability of treatment with lithium in comparison with placebo or other active treatments in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, and PsycINFO. We also searched the World Health Organization trials portal (ICTRP) and ClinicalTrials.gov. We checked the reference lists of all included studies and relevant systematic reviews. We have incorporated studies from searches to 18 May 2018 into the current analyses. SELECTION CRITERIA: Prospective randomised controlled studies comparing lithium with placebo or alternative drug treatment in treatment of acute mania. We included anyone with bipolar disorder, male and female, of any age. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data and assessed methodological quality. We used odds ratios (ORs) to analyse binary efficacy outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuously distributed outcomes. We used a fixed-effect model unless heterogeneity was moderate or substantial, in which case we used a random-effects model. We used Review Manager 5 to analyse data. We assessed the certainty of evidence for individual outcomes using the GRADE approach. MAIN RESULTS: We found 36 randomised controlled studies comparing lithium with placebo, one of 12 drugs, or electroconvulsive therapy for treatment of acute mania. Studies included male and female participants (n = 4220), of all ages, who all fitted criteria for a manic episode within the context of a diagnosis of bipolar disorder.Risk of bias was variable; 12 studies had a high risk of bias in one domain and 27 gave inadequate information on randomisation leading to an 'unclear' rating for selection bias.Lithium versus placeboHigh-certainty evidence found that lithium was an effective treatment for acute mania and was more effective than placebo at inducing a response (OR 2.13, 95% confidence interval (CI) 1.73 to 2.63; participants = 1707; studies = 6; I2 = 16%; high-certainty evidence), or remission (OR 2.16, 95% CI 1.73 to 2.69; participants = 1597; studies = 5; I2 = 21%; high-certainty evidence).Lithium was more likely than placebo to cause tremor (OR 3.25, 95% CI 2.10 to 5.04; participants = 1241; studies = 6; I2 = 0%; high-certainty evidence), and somnolence (OR 2.28, 95% CI 1.46 to 3.58; participants = 1351; studies = 7; I2 = 0%; high-certainty evidence).There was insufficient evidence to determine the effect of lithium for all-cause dropouts (OR 0.76; 95% CI 0.46 to 1.25; participants = 1353; studies = 7; I2 = 75%; moderate-certainty evidence), and weight gain (OR 1.48, 95% CI 0.56 to 3.92; participants = 735, studies = 3; I2= 51%; moderate-certainty evidence).Lithium versus antipsychotics or mood stabilisersFor the outcome of inducing a response, there was only very low-certainty evidence regarding lithium compared to haloperidol (MD -2.40, 95% CI -6.31 to 1.50; participants = 80; studies = 3; I2 = 95%), quetiapine (OR 0.66, 95% CI 0.28 to 1.55; participants = 335; studies = 2; I2 = 71%), and carbamazepine (SMD 0.21, 95% CI -0.18 to 0.60; participants = 102; studies = 3; I2 = 0%).Lithium was probably less likely to induce a response than olanzapine (OR 0.44, 95% CI 0.20 to 0.94; participants = 180; studies = 2; I2 = 0%; moderate-certainty evidence).Lithium may be less likely to induce a response than risperidone (MD 7.28, 95% CI 5.22 to 9.34; participants = 241; studies = 3; I2 = 49%; low-certainty evidence).There was no evidence of a difference between lithium and valproate (OR 1.22, 95% CI 0.87 to 1.70; participants = 607; studies = 5; I2 = 22%; moderate-certainty evidence).There was moderate-certainty evidence that lithium was more effective than topiramate at treating acute mania (OR 2.28, 95% CI 1.63 to 3.20; participants = 660; studies = 1).Data on adverse events for these comparisons contained too few studies to provide high-certainty evidence. AUTHORS' CONCLUSIONS: This systematic review indicates that lithium is more effective than placebo as a treatment for acute mania but increases the risk for somnolence and tremor. Limited evidence suggests little or no difference between lithium and other mood stabilisers (valproate, carbamazepine) or antipsychotics (risperidone, quetiapine, haloperidol). Olanzapine may be an exception, as it is probably slightly more effective than lithium. There is uncertain evidence that risperidone may also be more effective than lithium. Lithium is probably more effective at treating acute mania than topiramate. When compared to placebo, lithium was more likely to cause adverse events. However, when compared to other drugs, too few studies provided data on adverse effects to provide high-certainty evidence. More, rigorously designed, large-scale studies are needed to definitively conclude if lithium is superior to other interventions in treating acute mania.


Assuntos
Antipsicóticos , Transtorno Bipolar , Compostos de Lítio , Doença Aguda , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Compostos de Lítio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido Valproico/uso terapêutico
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