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      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


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          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). 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 first and 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.

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          Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.

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            Global burden of disease in young people aged 10-24 years: a systematic analysis.

            Young people aged 10-24 years represent 27% of the world's population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden. We used data from WHO's 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups. The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%). The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention. None. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Shared Decision Making: A Model for Clinical Practice

              The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.

                Author and article information

                Bipolar Disord
                Bipolar Disord
                Bipolar Disorders
                John Wiley and Sons Inc. (Hoboken )
                14 March 2018
                March 2018
                : 20
                : 2 ( doiID: 10.1111/bdi.2018.20.issue-2 )
                : 97-170
                [ 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
                Author notes
                [*] [* ] Correspondence

                Lakshmi N Yatham, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.

                Email: yatham@ 123456mail.ubc.ca

                Author information
                © 2018 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                : 14 December 2017
                : 21 December 2017
                Page count
                Figures: 9, Tables: 24, Pages: 74, Words: 62815
                Funded by: Canadian Network for Mood and Anxiety Treatments
                Award ID: N/A
                Original Article
                Research Articles
                ORIGINAL ARTICLE
                Editor's Choice
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                March 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version= mode:remove_FC converted:11.05.2018



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