DOCSLIB.ORG

Canadian Network for Mood and Anxiety Treatments (CANMAT)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Canadian Network for Mood and Anxiety Treatments (CANMAT) Author Manuscript This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bdi.12609 This article is protected by copyright. All rights reserved DR. BENJAMIN GOLDSTEIN (Orcid ID : 0000-0003-0340-349X) DR. SOHAM REJ (Orcid ID : 0000-0002-3908-9124) PROF. ROGER S MCINTYRE (Orcid ID : 0000-0003-4733-2523) DR. JAN KOZICKY (Orcid ID : 0000-0003-0697-0342) DR. EDUARD VIETA (Orcid ID : 0000-0002-0548-0053) DR. ROBERT POST (Orcid ID : 0000-0002-4246-524X) Article type : Original Article Canadian Network for Mood and Anxiety Treatments (CANMAT)/ International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder Lakshmi N. Yatham1, Sidney H. Kennedy2, Sagar V. Parikh3, Ayal Schaffer2, David J. Bond4, Benicio N. Frey5, Verinder Sharma6, Benjamin I. Goldstein2, Soham Rej7, Serge Beaulieu7, Martin Alda8, Glenda MacQueen9,, Roumen V. Milev10, Arun Ravindran2, Claire O’Donovan8, Diane McIntosh1, Raymond W. Lam1, Gustavo Vazquez10, Flavio Kapczinski6, Roger S. McIntyre2, Jan Kozicky11, Shigenobu Kanba12, Beny Lafer13, Trisha Suppes14, Joseph R. Calabrese15, Eduard Vieta16, Gin Malhi17, Robert M. Post18, Michael Berk19 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 Arbour MI, USA 4: Department of Psychiatry, University of Minnesota, Minneapolis MN USA 5: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada Author Manuscript 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 This article is protected by copyright. All rights reserved CANMAT/ISBD 2018 BIPOLAR GUIDELINES 9: Department of Psychiatry, University of Alberta, Edmonton AB Canada 10: Department of Psychiatry and Psychology, Queens 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, United States 16: Bipolar Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain 17: Department of Psychiatry, University of Sydney, Sydney Australia 18: Department of Psychiatry, George Washington University, Washington DC USA 19: Department of Psychiatry, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, Australia and Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia Corresponding Author: Lakshmi N. Yatham, MBBS, FRCPC, MRCPsych(UK) Professor, Department of Psychiatry, University of British Columbia Room 2C7-2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1 T: +1 604 822 7325 F: +1 604 822 7922 [email protected] Author Manuscript Page 1 of 250 This article is protected by copyright. All rights reserved CANMAT/ISBD 2018 BIPOLAR GUIDELINES Abstract The Canadian Network for Mood and Anxiety Treatments (CANMAT) has 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/ISBD Bipolar Treatment Guidelines represent the significant advances to 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, as well as consensus ratings of safety, tolerability, and treatment emergent switch risk. New to these guidelines, a hierarchical order was created for first and second line treatments recommended for acute mania, acute depression and maintenance treatment in bipolar I disorder. Created by considering 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 monotherapy or combination treatment with quetiapine, lamotrigine, lithium, or lurasidone. While medications which have been shown effective for the acute phase should generally be continued for the maintenance phase in bipolar I Author Manuscript disorder, there are some exceptions (such as with antidepressants); and available data suggest Page 2 of 250 This article is protected by copyright. All rights reserved CANMAT/ISBD 2018 BIPOLAR GUIDELINES 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 and recommendations surrounding 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, as well as older adults. There is also discussions on the impact 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/ISBD group hopes that these guidelines become a valuable tool for practitioners across the globe. Author Manuscript Page 3 of 250 This article is protected by copyright. All rights reserved CANMAT/ISBD 2018 BIPOLAR GUIDELINES Table of Contents Abstract .......................................................................................................................................... 2 Table of Contents .......................................................................................................................... 4 Section 1: Introduction ................................................................................................................. 7 Section 2: Foundations of Management .................................................................................... 11 Epidemiology ............................................................................................................................ 11 Prevalence .............................................................................................................................. 11 Age of Onset .......................................................................................................................... 12 Burden of Illness .................................................................................................................... 13 Diagnostic Assessment .............................................................................................................. 14 DSM-5 Diagnostic Criteria .................................................................................................... 14 DSM-5 Specifiers for Bipolar and Related Disorders ........................................................... 15 Staging Bipolar Disorder ....................................................................................................... 15 Screening and Diagnosis of Bipolar Disorder ....................................................................... 16 Comorbidities and Mimics .................................................................................................... 18 Suicide Risk............................................................................................................................... 19 Chronic Disease Management ................................................................................................... 20 Dealing with Stigma .................................................................................................................. 22 Psychosocial Interventions ........................................................................................................ 22 Psychoeducation .................................................................................................................... 23 Cognitive-Behavioral Therapy .............................................................................................. 25 Family Focussed Therapy (FFT) ..........................................................................................
Load more

Recommended publications
  • Eduard Vieta Is Professor of Psychiatry, Head of The
    Eduard Vieta is Professor of Psychiatry at the University of Barcelona and Chair of the Department of Psychiatry and Psychology at the Hospital Clinic, where he also leads the Bipolar Disorders Program in Barcelona, Catalonia, Spain. The Bipolar Unit is one of the worldwide leaders in clinical care, teaching and research on bipolar disorder. Dr. Vieta is the current Director of the Bipolar Research Program at the Spanish Research Network on Mental Diseases (CIBERSAM), funded by the Spanish Ministry of Economy and Competitiveness. Professor Vieta has received several awards, including the Aristotle award (2005), the Mogens Schou award (2007), the Strategic Research award of the Spanish Society of Biological Psychiatry (2009), the Official College of Physicians award to Professional Excellence (2011), the Colvin Price on Outstanding Achievement in Mood Disorders Research by the Brain and Behaviour Research Foundation (2012), and the Clinical Neuroscience Lilly award by the International College of Neuropsychopharmacology (CINP 2014). He is currently the treasurer of the European College of Neuropsychopharmacology (ECNP). He has made significant contributions to many of the published bipolar disorder treatment guidelines and has authored more than 500 original articles, 350 book chapters and 30 complete books. His H index is 70 and has over 18000 citations, which makes him the most cited scientist worldwide in the field of bipolar disorder over the last 5 years and one of the world’s most influential scientific minds, according to Thompson Reuters. Furthermore, he is on the editorial board of a range of international scientific journals and has served as invited professor at McLean Hospital and Harvard University and as neuroscience scientific advisor to the European Presidency.
    [Show full text]
  • The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONIC‐BD)
    DOI: 10.1111/bdi.12748 EDITORIAL The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONIC‐BD) Bipolar disorder (BD) is the fourth leading cause of disability world‐ are associated with more pronounced cognitive impairment indica‐ wide among young people of age range 10‐24 years. Although the tive of a neuroprogressive course; however, each individual study has diagnosis is largely defined by the mood episodes associated with been small and thereby unable to address specific questions such as the illness, cognitive deficits are among the most persistent and dis‐ whether the polarity of prior episodes, duration of illness, or medica‐ abling symptoms of illness and have a profound impact on clinical tion effects are relevant to cognitive outcome. Interestingly, very few course and functional outcome. Specifically, trait‐like impairment is studies have adequately addressed one of the most basic questions common in the domains of attention, verbal learning, and executive in BD—how does current symptom severity affect the nature and ex‐ function; these deficits contribute to functional disability and are tent of cognitive impairment and is this a bidirectional effect? Many targets for emerging treatments and preventions. Although consid‐ other illness‐related factors are likely to contribute to cognitive and erable progress has been made over the past two decades, our un‐ functional outcomes in BD (eg, sleep, obesity, comorbid medical and derstanding of the underlying causes of the cognitive deficits in BD psychiatric
    [Show full text]
  • The International Consortium Investigating
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Newcastle University E-Prints DR. KATHERINE BURDICK (Orcid ID : 0000-0003-4417-4988) DR. CHRISTOPHER BOWIE (Orcid ID : 0000-0002-1983-8861) DR. ANDRE CARVALHO (Orcid ID : 0000-0001-5593-2778) DR. LARS KESSING (Orcid ID : 0000-0001-9377-9436) DR. BENY LAFER (Orcid ID : 0000-0002-6132-9999) DR. KATHRYN EVE LEWANDOWSKI (Orcid ID : 0000-0003-1477-6187) DR. ANABEL MARTINEZ-ARAN (Orcid ID : 0000-0002-0623-6263) PROF. ROGER S MCINTYRE (Orcid ID : 0000-0003-4733-2523) DR. KAMILLA WOZNICA MISKOWIAK (Orcid ID : 0000-0003-2572-1384) PROF. RICHARD PORTER (Orcid ID : 0000-0002-8695-3966) DR. TAMSYN VAN RHEENEN (Orcid ID : 0000-0003-3339-6665) Article Article type : Editorial The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONIC-BD) Katherine E. Burdick, PhD1*, Caitlin E. Millett, PhD1, Caterina del Mar Bonnín PhD2, Christopher Bowie, PhD3,4, Andre F. Carvalho, MD, PhD3,4, Lisa T Eyler, PhD5,6, Peter Gallagher, PhD7, Philip Harvey, PhD8, Lars Vedel Kessing, MD, DMSc9,10, Beny Lafer, MD, PhD11, Scott A. Langenecker, PhD12, Kathryn E. Lewandowski, PhD13, Carlos López- Jaramillo, MD, MSc, PhD14, David F. Marshall, PhD15, Anabel Martinez-Aran, PhD2, Melvin McInnis, MD15, Roger McIntyre, MD, FRCPC16, Kamilla W. Miskowiak, PhD9,10, Richard J. Porter, MD17, Scot Purdon PhD18, Kelly A Ryan, PhD15, Tomiki Sumiyoshi, MD, PhD19, Ivan J. Torres, PhD20, Tamsyn E Van Rheenen, PhD21,22, , Eduard Vieta, MD, PhD2, Neil Woodward, PhD23 Lakshmi N. Yatham, MBBS, DPM, FRCPC, MBA20, Allan Young, MB ChB, MPhil, PhD, FRCP (Edin), FRCPsych, FRCP(C), FRSB24, 25 1- Brigham and Women’s Hospital – Harvard Medical School, Boston, MA, USA 2- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.
    [Show full text]
  • Pros and Cons of Specialised Care in Bipolar Disorder: an International Perspective{ Eduard Vieta
    The British Journal of Psychiatry (2013) 202, 170–171. doi: 10.1192/bjp.bp.112.118588 Editorial Pros and cons of specialised care in bipolar disorder: an international perspective{ Eduard Vieta Summary Declaration of interest Highly specialised care may have both pros and cons. E.V. leads a specialist bipolar disorder care unit at a public Centralised expert treatment may be more effective than university hospital in Catalonia, Spain. standard community care for bipolar disorder. Rather than trying to solve the false dichotomy between specialised v. community care, the rational integration of both approaches may enhance quality of care and cost-effectiveness. specialised-care settings for a given condition or technique. Eduard Vieta is Professor of Psychiatry, Head of the Department and the Specialisation may be cost-effective in the public sector as long Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona in Catalonia, Spain. He is the current Director of the as the most appropriate level of care (i.e. tertiary v. community) Bipolar Research Program at the Spanish Research Network on Mental is provided for a given case. Psychiatry may be especially Diseases (CIBERSAM). His research focuses on the neurobiology, vulnerable to some policies that downgrade the importance of epidemiology and treatment of bipolar disorder. medical skills, including diagnosis, treatment and monitoring. In many instances, this has resulted in services that are better suited to delivering non-specific, psychosocial support rather than a process of thorough, broad-based diagnostic assessment with Specialisation in psychiatry formulation of aetiology, diagnosis and prognosis followed by specific treatments aimed at recovery with maintenance of Specialisation is inherent to the progress of medicine.
    [Show full text]
  • Meet Our Editorial Board Member Current Drug Therapy, 2016, Vol
    Meet Our Editorial Board Member Current Drug Therapy, 2016, Vol. 11, No. 1 1 Meet Our Editorial Board Member Dr. Eduard Vieta Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic University of Barcelona, IDIBAPS, CIBERSAM Barcelona, Catalonia, Spain Eduard Vieta, M.D. and Ph.D., was born in 1963 in Barcelona and received his medical degree at the Autonomous University of Barcelona, and his Ph.D. with Extraordinary Doctoral Award at the University of Barcelona. Over the past 25 years, he and his team have made outstanding contributions to the understanding of the neurobiology, diagnosis, and treatment of one of the most common and disabling mental disorders, namely bipolar disorder. In fact, Dr. Vieta is currently ranked as the number 1 worldwide expert in this field by resources using objective ranking methods, such as www.expertscape.com. His contributions add up to 2500 impact factor points, more than 22.500 citations and H index of 77. But beyond those figures, Dr. Vieta and his team’s contributions have made a real impact on many patients’ lives. Not only by means of providing top-quality clinical care at the Bipolar Unit of the Hospital Clinic of Barcelona, but also by the many educational activities for the general public, mental health professionals and trainees, that have expanded the knowledge and management skills that come up from their research, which is extremely translational and oriented toward clinical practice. Examples of this are the impact of “Psychoeducation” [1], a specific therapy for bipolar disorder that emerged from their work, and which is nowadays the standard of care on top of medication for the management of the disease, as recognized across international treatment guidelines worldwide.
    [Show full text]
  • Detection of Early Psychotic Symptoms: Validation of the Spanish Version of the “Symptom Onset in Schizophrenia (SOS) Inventory”
    Author’s Accepted Manuscript Detection of early psychotic symptoms: validation of the Spanish version of the “Symptom Onset in Schizophrenia (SOS) inventory” Gisela Mezquida, Bibiana Cabrera, Anabel Martínez-Arán, Eduard Vieta, Miguel Bernardo www.elsevier.com/locate/psychres PII: S0165-1781(17)30463-8 DOI: https://doi.org/10.1016/j.psychres.2017.12.035 Reference: PSY11071 To appear in: Psychiatry Research Received date: 16 March 2017 Revised date: 13 December 2017 Accepted date: 13 December 2017 Cite this article as: Gisela Mezquida, Bibiana Cabrera, Anabel Martínez-Arán, Eduard Vieta and Miguel Bernardo, Detection of early psychotic symptoms: validation of the Spanish version of the “Symptom Onset in Schizophrenia (SOS) inventory”, Psychiatry Research, https://doi.org/10.1016/j.psychres.2017.12.035 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Detection of early psychotic symptoms: validation of the Spanish Detection of early psychotic symptoms: validation of the Spanish version of the “Symptom Onset in Schizophrenia (SOS) inventory” Gisela Mezquida a *, Bibiana Cabrera b *, Anabel Martínez-Arán c, Eduard Vieta c, d Miguel Bernardo ** a Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain b Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Catalonia, Spain.
    [Show full text]
  • Understanding the Real-World Cost and Burden of Mania: the MANACOR Study Hidalgo-Mazzei D., M.D
    Understanding the real-world cost and burden of mania: the MANACOR study Hidalgo-Mazzei D., M.D. 1; Undurraga J., M.D., Ph.D.1 2 ; Bonnin C.M., Psy., Ph.D. 1; Reinares M., Psy., Ph.D. 1 , Saez C., M.D 3, Mur M., M.D., Ph.D.4, Nieto E., M.D., Ph.D. 5; Vieta E., M.D., Ph.D.1 * 1 Bipolar Disorders Program, Department of Psychiatry, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain. 2 Department of Psychiatry, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile. 3 University Psychiatric Hospital, Institut Pere Mata, CIBERSAM, Reus, Catalonia, Spain 4 Mental Health Service, Santa Maria Hospital, IRB LLeida, University of LLeida, Catalonia, Spain. 5 Althaia, Xarxa Assistencial Universitária de Manresa, Catalonia, Spain. Background and Aims Baseline Even though the results of clinical trials show a high efficacy 40 6 months of antipsychotics and mood stabilizers on the treatment of 35 -26% mania1, few observational studies have reported the 30 effectiveness, security and burden of the disease of manic 25 patients in naturalistic conditions2. 20 15 The main objective of this study was to describe the general -75% 10 -3% burden and direct costs associated with manic episodes both -52% 5 in inpatients and outpatients in four University Hospitals in 0 Catalonia (Spain). YMRS HDRS-17 FAST SCIP Fig.3 Score change of the assessment scales at follow-up Methods The effectiveness of the treatment prescribed was acceptable We combined retrospective-prospective data and collected as expected. Mean days of hospitalization were 19.8 (11.6). information from medical records regarding Furthermore,11.9% of patients were readmitted during the sociodemographic and diagnostic variables.
    [Show full text]
  • Eduard Vieta Is Professor of Psychiatry, Head of The
    Eduard Vieta is Professor of Psychiatry and Chair at the University of Barcelona and Head of the Department of Psychiatry and Psychology at the Hospital Clinic, where he also leads the Bipolar and Depressive Disorders Program in Barcelona, Catalonia, Spain. His unit is one of the worldwide leaders in clinical care, teaching and research on affective disorders. Dr. Vieta is also the current Scientific Director of the Spanish Research Network on Mental Health (CIBERSAM). He has received the Aristotle award (2005), the Mogens Schou award (2007), the Strategic Research award of the Spanish Society of Biological Psychiatry (2009), the Official College of Physicians award to Professional Excellence (2011), the Colvin Price on Outstanding Achievement in Mood Disorders Research by the Brain and Behaviour Research Foundation (2012), the Clinical Neuroscience Lilly award by the International College of Neuropsychopharmacology (CINP 2014), the Simon Bolivar Award (American Psychiatric Association 2017) and the Research Price of the World Federation of Societies of Biological Psychiatry (WFSBP, 2017). He has been named twice best psychiatrist in Spain (Monitor sanitario, El Español), honorary member of the Spanish Society of Biological Psychiatry, and Doctor Honoris Causa by the University of Valencia. He has authored more than 900 original articles, 450 book chapters and 43 books. His h index is 127 and has over 59.000 citations (Google Scholar), which makes him the most cited scientist worldwide in the field of bipolar disorder over the last 8 years and one of the world’s most influential scientific minds, according to Clarivate Analytics ranking (Highly Cited). His papers have over 600.000 downloads.
    [Show full text]
  • Misunderstanding Precision Psychiatry
    Psychological Medicine Misunderstanding precision psychiatry cambridge.org/psm Eduard Vieta and Estela Salagre Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 08036, Barcelona, Invited Letter Rejoinder Catalonia, Spain Cite this article: Vieta E, Salagre E (2021). We thank van Os and Kohne for their reply to our commentary. It is true, we are in love with Misunderstanding precision psychiatry. Psychological Medicine 51, 1418–1419. https:// the concept of precision psychiatry. But we are not blindly in love. Our love for precision doi.org/10.1017/S0033291721001173 psychiatry is based on remarkable and rapid advances in biological psychiatry – closely linked to advances in technology – that support the potential of this paradigm shift. Received: 4 March 2021 Some of these advances were presented in our previous commentary (Salagre & Vieta, Revised: 11 March 2021 Accepted: 15 March 2021 2021). Yet, van Os and Kohne question the foundations of precision psychiatry. And, by First published online: 28 May 2021 doing so, they question the very foundations of current psychiatric practice and how we understand mental processes. Author for correspondence: Eduard Vieta, E-mail: [email protected] The mind–brain paradigm van Os and Kohne indirectly raise the question of the mind–brain paradigm, as they express their concern ‘if, how and to what degree mental phenomena are represented physically’. Although Descartes body–mind dualism postulated a world of material things and immater- ial minds, the contemporary belief is that world is material, and that mental states cannot occur independently of physical processes. From a scientific perspective, there is evidence that psychotropic drugs or inflammatory processes like anti-N-methyl-d-aspartate (NMDA) encephalitis can produce symptoms (such as hallucinations or delusional thoughts) that are indistinguishable from those observed in severe mental disorders by acting on something ‘physical’, that is, receptors in the brain.
    [Show full text]
  • Pros and Cons of Specialised Care in Bipolar Disorder: an International Perspective{ Eduard Vieta
    The British Journal of Psychiatry (2013) 202, 170–171. doi: 10.1192/bjp.bp.112.118588 Editorial Pros and cons of specialised care in bipolar disorder: an international perspective{ Eduard Vieta Summary Declaration of interest Highly specialised care may have both pros and cons. E.V. leads a specialist bipolar disorder care unit at a public Centralised expert treatment may be more effective than university hospital in Catalonia, Spain. standard community care for bipolar disorder. Rather than trying to solve the false dichotomy between specialised v. community care, the rational integration of both approaches may enhance quality of care and cost-effectiveness. specialised-care settings for a given condition or technique. Eduard Vieta is Professor of Psychiatry, Head of the Department and the Specialisation may be cost-effective in the public sector as long Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona in Catalonia, Spain. He is the current Director of the as the most appropriate level of care (i.e. tertiary v. community) Bipolar Research Program at the Spanish Research Network on Mental is provided for a given case. Psychiatry may be especially Diseases (CIBERSAM). His research focuses on the neurobiology, vulnerable to some policies that downgrade the importance of epidemiology and treatment of bipolar disorder. medical skills, including diagnosis, treatment and monitoring. In many instances, this has resulted in services that are better suited to delivering non-specific, psychosocial support rather than a process of thorough, broad-based diagnostic assessment with Specialisation in psychiatry formulation of aetiology, diagnosis and prognosis followed by specific treatments aimed at recovery with maintenance of Specialisation is inherent to the progress of medicine.
    [Show full text]
  • Patterns of Response to Antidepressants in Major Depressive Disorder: Drug Resistance Or Worsening of Depression Are Associated with a Bipolar Diathesis
    European Neuropsychopharmacology (2019) 29, 825–834 www.elsevier.com/locate/euroneuro Patterns of response to antidepressants in major depressive disorder: Drug resistance or worsening of depression are associated with a bipolar diathesis a b ,c a, b Giulio Perugi , Isabella Pacchiarotti , Cecilia Mainardi , b ,c ,d , e b ,d a Norma Verdolini , Giulia Menculini , Margherita Barbuti , f g h Jules Angst , Jean-Michel Azorin , Charles L. Bowden , i j b, c ,∗ Sergey Mosolov , Allan H. Young , Eduard Vieta , for the BRIDGE-II-MIX Study Group a Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy b Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain c CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain d Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy e FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain f Psychiatric Hospital, University of Zurich, Switzerland g AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France h Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA i Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia j Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London SE5 8AZ, United Kingdom Received 10 April 2019; received in revised form 27 May 2019; accepted 3 June 2019 ∗ Corresponding author at: Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036 Barcelona, Catalonia, Spain.
    [Show full text]
  • Research Lines
    BITRECS: Biomedicine international training research programme for excellent clinician- scientists CALL 2: RESEARCH LINES Version 2 (29-06-2018) RL1. Peptide-Major Histocompatibility Complex-based nanomedicines for the treatment of autoimmune disease (Dr. Pau Serra) ................................................................................................................................ 3 RL2. Mechanisms of progression in monoclonal gammopathies (Dr. Carlos Fernández de Larrea) ............ 4 RL3. Digital solutions for effective intervention to prevent alcohol and tobacco use in primary health care (Dr. Antoni Gual) ........................................................................................................................................... 5 RL4. Applied research in pulmonary diseases of critically-ill patients (Dr. Antoni Torres) ............................ 6 RL5. Cell cancer immunotherapy: chimeric antigen receptor (Dr. Manel Juan) ............................................ 8 RL6. Antibody-mediated diseases of the central nervous system (Dr. Josep Dalmau) ................................. 9 RL7. Molecular Pathology of Lymphoid Neoplasms (Dr. Elías Campo) ...................................................... 10 RL8. Understanding myocardial substrate for arrhythmia development (Dr. Marta Sitges) ........................ 11 RL9. Translational Research on Pulmonary Vascular Diseases (Dr. Isabel Blanco) .................................. 12 RL10. Portal hypertension and vascular liver diseases (Dr. Juan Carlos García-Pagán)
    [Show full text]