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Evidence-Based Treatment Targets, Selection, and Strategies for Acute Manic and Mixed Episodes of Bipolar I Disorder
When should you rely on top-ranked treatment options for acute bipolar mania, and when should you skip down to lower-ranked options? Dr Suppes discusses.
Abstract
Too many patients receive incorrect treatment for bipolar disorder; prescribing seems to differ more by clinician than by patient characteristics. New treatment guidelines are available for the management of acute manic episodes and can help clinicians make treatment decisions tailored to their patients’ individual symptom clusters and illness characteristics, leading to greater chances of lasting remission. However, many clinicians lack familiarity with these symptom targeting best practices. Therefore, clinicians need education on how to manage bipolar I disorder symptoms with evidence-based treatment options. In addition, as new treatment targets are identified, clinicians need education on psychopharmacologic and pharmacokinetic advances.
From the Series: Strategies for Acute and Maintenance Treatment of Bipolar I Disorder
To cite: Suppes T. Evidence-based treatment targets, selection, and strategies for acute manic and mixed episodes of bipolar I disorder. J Clin Psychiatry. 2020;81(1):OT18053BR1C.
To share: https://doi.org/10.4088/JCP.OT18053BR1C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
- Psychiatrists
- Primary care clinicians
- Nurse practitioners
- Physician assistants
Learning Objectives
After completing this educational activity, you should be able to:
- Select evidence-based treatment for acute manic or mixed episodes of bipolar I disorder by considering patient characteristics and treatment mechanism of action
Support Statement
Supported by an educational grant from Otsuka America Pharmaceutical, Inc., and Lundbeck.
Learning Objective
After completing this educational activity, you should be able to:
- Select evidence-based treatment for acute manic or mixed episodes of bipolar I disorder by considering patient characteristics and treatment mechanism of action
Release, Review, and Expiration Dates
This brief report activity was published in December 2019 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2021. The latest review of this material was November 2019.
Statement of Need and Purpose
Too many patients receive incorrect treatment for bipolar disorder; prescribing seems to differ more by clinician than by patient characteristics. Third-generation antipsychotics target the symptoms of bipolar disorder in a novel way and may help patients avoid side effects associated with other antipsychotics. However, many clinicians lack familiarity with these medications’ pharmacologic attributes. Therefore, clinicians need education on how to manage bipolar I disorder symptoms with evidence-based treatment options. In addition, as new treatment targets are identified, clinicians need education on psychopharmacologic and pharmacokinetic advances.
The treatment of bipolar disorder requires that both manic and depressive symptoms be controlled, and the therapeutic effect must be maintained after an acute mood episode has resolved. Although numerous treatments are available, many patients are unable to maintain recovery. Consequently, clinicians need updated information on best practices for addressing not only acute treatment of bipolar disorder but also maintenance treatment, including weighing the evidence about the utility of oral versus long-acting injectable agents, measurement-based care, and strategies for promoting adherence and functional improvement.
This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on bipolar I disorder.
Disclosure of Off-Label Usage
Dr Suppes has determined that, to the best of her knowledge, chlorpromazine, clonazepam, clozapine, haloperidol, lorazepam, loxapine, midazolam, oxcarbazepine, promethazine, rTMS, and tamoxifen are not approved by the US Food and Drug Administration for the treatment of bipolar disorder mania.
Review Process
The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by a peer reviewer who is without conflict of interest.
Acknowledgment
This activity is derived from the planning teleconference series “Strategies for Acute and Maintenance Treatment of Bipolar I Disorder,” which was held in July and August 2019 and supported by an educational grant from Otsuka America Pharmaceutical, Inc., and Lundbeck. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Faculty Affiliation
Trisha Suppes, MD, PhD
Stanford University School of Medicine and the US Department of Veterans Affairs Palo Alto Health Care System, California
Financial Disclosure
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Suppes is a consultant for Allergan, Impel NeuroPharma, and Sunovion; has received grant/research support from Merck, National Institutes of Health, National Institute on Drug Abuse, Palo Alto Health Sciences, Stanley Medical Research Institute, the US Department of Veterans Affairs (VA) Cooperative Studies Program, and the VA Office of Research & Development PRIME Care Study; and has received other financial or material support from Jones and Bartlett, Wolters Kluwer Health (UpToDate), and Hogrefe Publishing.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
MOC APPROVAL STATEMENT
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, Evidence-Based Treatment Targets, Selection, and Strategies for Acute Manic and Mixed Episodes of Bipolar I Disorder has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC PART II CME ACTIVITY
Psychiatry and Neurology
Available Credit
- 0.50 AMA PRA Category 1 Credit™
- 0.50 Participation