Review

. 2020 Dec;22(8):805-821.

doi: 10.1111/bdi.13036.

The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary

Gin S Malhi^{1

2

3}, Erica Bell^{1

2

3}, Philip Boyce^{4

5}, Darryl Bassett⁶, Michael Berk^{7

8}, Richard Bryant⁹, Michael Gitlin¹⁰, Amber Hamilton^{1

2

3}, Philip Hazell⁵, Malcolm Hopwood¹¹, Bill Lyndon¹, Roger S McIntyre¹², Grace Morris^{1

2

3}, Roger Mulder¹³, Richard Porter¹³, Ajeet B Singh¹⁴, Lakshmi N Yatham¹⁵, Allan Young^{16

17}, Greg Murray¹⁸

Affiliations

¹ Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
³ CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
⁴ Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.
⁵ Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁶ Consultant Psychiatrist, Perth, WA, Australia.
⁷ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
⁸ Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
⁹ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
¹⁰ Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹¹ Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia.
¹² Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
¹³ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
¹⁴ The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁵ Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁷ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
¹⁸ Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 33296123
DOI: 10.1111/bdi.13036

Review

The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary

Gin S Malhi et al. Bipolar Disord. 2020 Dec.

. 2020 Dec;22(8):805-821.

doi: 10.1111/bdi.13036.

Authors

Affiliations

¹ Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
³ CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
⁴ Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.
⁵ Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁶ Consultant Psychiatrist, Perth, WA, Australia.
⁷ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
⁸ Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
⁹ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
¹⁰ Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹¹ Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia.
¹² Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
¹³ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
¹⁴ The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁵ Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁷ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
¹⁸ Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 33296123
DOI: 10.1111/bdi.13036

Abstract

Objectives: To provide a succinct, clinically useful summary of the management of bipolar disorder, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg²⁰²⁰ ).

Methods: To develop the MDcpg²⁰²⁰ , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg²⁰²⁰ , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on bipolar disorder. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of bipolar disorder.

Results: The bipolar disorder summary provides a systematic approach to diagnosis, and a logical clinical framework for management. It addresses the acute phases of bipolar disorder (mania, depression and mixed states) and its longer-term management (maintenance and prophylaxis). For each phase it begins with Actions, which include important strategies that should be implemented from the outset wherever possible. These include for example, lifestyle changes, psychoeducation and psychological interventions. In each phase, the summary advocates the use of Choice medications for pharmacotherapy, which are then used in combinations along with additional Alternatives to manage acute symptoms or maintain mood stability and provide prophylaxis. The summary also recommends the use of electroconvulsive therapy (ECT) for each of the acute phases but not for maintenance therapy. Finally, it briefly considers bipolar disorder in children and its overlap in adults with borderline personality disorder.

Conclusions: The bipolar disorder summary provides up to date guidance regarding the management of bipolar disorder, as set out in the MDcpg²⁰²⁰ . The recommendations are informed by evidence and clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians but will be of interest to anyone involved in the management of patients with bipolar disorder.

Keywords: bipolar disorder; guideline; mood disorders; treatment.

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Comment in

Recognising the relevance of cognitive dysfunction in the clinical management of bipolar disorder.
Van Rheenen TE, Miskowiak K, Burdick KE. Van Rheenen TE, et al. Bipolar Disord. 2021 Jun;23(4):414-415. doi: 10.1111/bdi.13063. Epub 2021 Mar 2. Bipolar Disord. 2021. PMID: 33624386 No abstract available.
Changing gears in the treatment of bipolar disorder through integrated use of electronic devices.
Panchal P, Kim JA, Sankar A, Goldman D, Villa LM, Millard H, Carrubba E, Lecza B, Merikangas KR, Silverman WK, Swartz HA, Blumberg HP. Panchal P, et al. Bipolar Disord. 2021 Jun;23(4):418-419. doi: 10.1111/bdi.13065. Epub 2021 Mar 5. Bipolar Disord. 2021. PMID: 33638233 Free PMC article. No abstract available.
Major depressive disorders and bipolar disorders in older adults: Commentary on the RANCZP mood disorders guideline summaries.
Forbes M, Berk M, Reynolds C. Forbes M, et al. Bipolar Disord. 2021 Jun;23(4):416-417. doi: 10.1111/bdi.13068. Epub 2021 Mar 9. Bipolar Disord. 2021. PMID: 33638272 No abstract available.
Beyond evidence and toward long-term and individualized management of bipolar disorder in real-world practice.
Dargél AA. Dargél AA. Bipolar Disord. 2021 Aug;23(5):511-512. doi: 10.1111/bdi.13072. Epub 2021 Mar 16. Bipolar Disord. 2021. PMID: 33690964 No abstract available.
Commentary on "The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary".
Solé B, Martínez-Aran A, Vieta E, Torrent C. Solé B, et al. Bipolar Disord. 2021 Aug;23(5):513-514. doi: 10.1111/bdi.13073. Epub 2021 Mar 21. Bipolar Disord. 2021. PMID: 33706410 No abstract available.

References

REFERENCES

1. Malhi GS, Bell E, Bassett D, et al. The Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders. Aust N Z J Psychiatry. 2021;55(1):7-117.
1. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. NHMRC. 2009.
1. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatry. 2007;64(5):543-552.
1. McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. The Lancet. 2020;396(10265):1841-1856.
1. Yatham LN, Kennedy SH, Parikh SV, et al. 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. Bipolar Disord. 2018;20(2):97-170.

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The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary

Affiliations

The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous