Second Generation Antipsychotics Monotherapy as Maintenance Treatment for Bipolar Disorder: a Systematic Review of Long-
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Second Generation Antipsychotics Monotherapy as Maintenance Treatment for Bipolar Disorder: a Systematic Review of Long-Term Studies Miguel Alfonso García Escudero 1 & Luis Gutiérrez-Rojas 2,3,4
& Guillermo Lahera
5,6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Atypical or so called second generation antipsychotics (SGA) are playing a role of increasing importance in treatment of bipolar disorder (BD). This study is aimed towards a systematic review of their efficacy when used as monotherapy in order to prevent relapses in the long term treatment. Publications about this subject were identified after a thorough bibliographic research in Medline, The Cochrane Library and Web of Science, employing the PICO method for the creation of a database search strategy and carrying out a critical read and analysis of the found evidence. 14 studies were found which informed about the results of randomized and controlled clinical trials (RCT) about the efficacy of these SGA in monotherapy for BD, when it comes to prevention of relapse, in adult patients diagnosed with either type I or II BD, with a minimum follow-up time of 6 months. Evidence of the use of SGAs for maintenance treatment in BD is limited. Amongst all antipsychotics assessed only aripiprazole, olanzapine, lurasidone, risperidone and quetiapine have been found to be competent for their use in monotherapy, according to RCT. Keywords Bipolar disorder . Treatment . Relapse . Antipsychotics
Introduction Bipolar disorder (BD) is classified as an affective disorder and is characterised by alternation of depression and manic phases. The last revision carried out by the American Psychiatric Association (DSM 5) [1] distinguishes four categories or forms of BD: type I, consists of the start of a manic episode, with or without previous major depression phases; type II,
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11126-02009753-2) contains supplementary material, which is available to authorized users.
* Luis Gutiérrez-Rojas [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
characterised by the presence of a hypomanic case in a patient with previous episodes of major depression, and the cyclothymic disorder which demands the presence of periods of hypomanic and depressive symptoms that do not follow the duration criteria of a major affective episode. The remaining category is focused on secondary BD, substance consumption, medical pathologies and non-specified BD. Between symptomatic phases, patients can present asymptomatic periods. BD is a chronic illness that comes together with a relevant disability charge which places it amongst the top 10 illnesses causing disability in 14 to 45-year-olds, according to WHO [2]. The appearance of successive relapses is common and these repeating episodes come together with a worsening of the illness’ prognosis, which makes it fundamental to have strategies for the treatment a
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