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Tratamiento de mantenimiento eficaz: romper el ciclo del trastorno bipolar

Published online by Cambridge University Press:  12 May 2020

Guy Goodwin
Affiliation:
Departamento de Psiquiatría, Hospital Warneford, Universidad de Oxford, Oxford, Reino Unido
Eduard Vieta
Affiliation:
Hospital Clínico, Universidad de Barcelona, Barcelona, España
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Resumen

Las directrices clínicas para el tratamiento y la investigation del trastorno bipolar se benefician mucho de la síntesis de datos de los estudios individuales. La Asociación Británica para la Psicofarmacología basa sus directrices en datos que van desde las opiniones (nivel D) hasta las revisiones sistemáticas de datos de ensayos primarios (nivel A). El informe detalla las conclusiones de su reunión de consenso de un día para el desarrollo de directrices que cubran el diagnóstico, el tratamiento clínico, la farmacoterapia para los episodios agudos, la prevención de recaídas y la interrupción del tratamiento. Se prefiere la monoterapia para el tratamiento a largo plazo, al haber reducido los efectos secundarios y las interacciones farmacológicas y mejorado el cumplimiento. Para los episodios agudos, se prefiere a menudo terapia de combinatión, utilizando antipsicóticos para la manía o antidepresivos para la depresión. El aumento de eficacia se puede atribuir a mecanismos múltiples de actión y las dosis potencialmente más bajas. En la práctica chínica, la monoterapia de mantenimiento tiene éxito limitado para los episodios crónicos y se utiliza con frecuencia la polifarmacia, aunque no está claro cuál es la mejor combinación. Se requiere un nuevo enfoque en colaboración basado en ensayos chínicos simples para cambiar la práctica médica actual.

Type
Artículo original
Copyright
Copyright © European Psychiatric Association 2006

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Footnotes

Goodwin G, Vieta E. Effective maintenance treatment — breaking the cycle of bipolar disorder. Eur Psychiatry 2005;20:365-371.

References

Colom, F, Vieta, E, Martínez-Arán, A, Reinares, M, Benabarre, A, Gasto, C. Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000; 61: 549–55.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Martínez-Arán, A, Reinares, M, Goikolea, JM, Benabarre, A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2004; 60: 402–7.Google Scholar
Delbello, MP, Schwiers, ML, Rosenberg, HL, Strakowski, SM. A double- blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002; 41: 1216–23.CrossRefGoogle ScholarPubMed
Denicoff, KD, Smith-Jackson, EE, Disney, ER, Ali, SO, Leverich, GS, Post, RM. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry 1997; 58: 470–8.CrossRefGoogle ScholarPubMed
Frye, MA, Ketter, TA, Leverich, GS, Huggins, T, Lantz, C, Denicoff, KD, et al. The use of combination therapy in patients with bipolar disorder appears to be increasing. J Clin Psychiatry 2000; 61: 915.Google Scholar
Goldberg, JF, Burdick, KE, Endick, CJ. Preliminary randomized, double- blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression. Am J Psychiatry 2004; 161: 564–6.CrossRefGoogle ScholarPubMed
Goodwin, GM. Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003; 17: 149–73.CrossRefGoogle ScholarPubMed
Goodwin, GM, Sachs, G. Fast facts: bipolar disorder. UK: Health press; 2004.Google Scholar
Maj, M, Pirozzi, R, Magliano, L, Bartoli, L. Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry 1998; 155: 30–5.CrossRefGoogle Scholar
Markar, HR, Mander, AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry 1989; 155: 496500.CrossRefGoogle ScholarPubMed
Muller-Oerlinghausen, B, Retzow, A, Henn, FA, Giedke, H, Walden, J. Valproate as an adjunct to neuroleptic medication for the treatment of acute episodes of mania: a prospective, randomized, doubleblind, placebo-controlled, multicenter study. European Valproate Mania Study Group. J Clin Psychopharmacol 2000; 20: 195203.CrossRefGoogle Scholar
Nakagami, T, Qiao, Q, Carstensen, B, Nhr-Hansen, C, Hu, G, Tuomilehto, J, et al. The DECODE DECODA-Study-Group. Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia 2003; 46: 1063–70.Google Scholar
Post, RM, Denicoff, KD, Leverich, GS, Altshuler, LL, Frye, MA, Suppes, TM, et al. Morbidity in 258 bipolar outpatients followed for I year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003; 64: 680–90.Google Scholar
Rendell, JM, Juszczak, E, Hainsworth, J, Gucht, EV, Healey, C, Morriss, R, et al. Developing the BALANCE trial—the role of the pilot study and start-up phase. Bipolar Disord 2004; 6: 2631.Google Scholar
Sabers, A, Dam, M, A-Rogvi-Hansen, B, Boas, J, Sidenius, P, Laue Friis M, et al. Epilepsy and pregnancy: lamotrigine as main drug used. Acta Neurol Scand 2004; 109: 913.Google Scholar
Sachs, GS, Grossman, F, Ghaemi, SN, Okamoto, A, Bowden, CL. Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of etficacy and safety. Am J Psychiatry 2002; 159: 1146–54.CrossRefGoogle ScholarPubMed
Tohen, M, Chengappa, KN, Suppes, T, Baker, RW, Zarate, CA, Bowden, CL, et al. Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry 2004; 184: 337–45.Google Scholar
Tohen, M, et al. Presented at: 41stACNP annual meeting. Puerto Rico: San Juan; 2002.Google Scholar
Tohen, M, Hennen, J, Zarate Jr. CM, Baldessarini RJ, Strakowski SM, Stoll AL, et al. Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry 2000; 157: 220–8.Google Scholar
Vieta, E. Atypical antipsychotics in the treatment of mood disorders. Curr Opin Psychiatry 2003; 16: 23–7.CrossRefGoogle Scholar
Vieta, E. Maintenance therapy for bipolar disorder: current and future management options. Expert Rev Neurother 2004; 6 (Suppl): 3542.Google Scholar
Vieta, E. Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry 2005; 66(Suppl l):24–9.Google ScholarPubMed
Vieta, E, Colom, F. Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach. Acta Psychiatr Scand Suppl 2004; 422(2004):34–8.CrossRefGoogle Scholar
Vieta, E, Sanchez-Moreno, J, Goikolea, JM, Colom, F, Martfnez-Aran, A, Benabarre, A, et al. Effects on weight and outcome of long-term olanzapine-topiramate combination treatment in bipolar disorder. J Clin Psychopharmacol 2004; 24: 374–8.Google Scholar
Yatham, LN, Grossman, F, Augustyns, I, Vieta, E, Ravindran, A. Mood stabilisers plus rispendone or placebo in the treatment of acute mania. International, double-blind, randomised controlled trial. Br J Psychiatry 2003; 182: 141–7.Google ScholarPubMed

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