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Guideline
双相障碍   BIPOLAR DISORDER
双相障碍(躁郁症)是指既有躁狂或轻躁狂发作,又有抑郁发作的一类心境障碍(情感障碍)。
- 一般呈发作性病程,躁狂/轻躁狂和抑郁反复循环或交替出现,也可混合存在。

双相情感障碍患者的起病年龄平均为20岁,患病率男女之比为1:1.2,这一趋势在各种文化和各种族人群中是一致的。据WHO统计,1990年双相情感障碍排在全球疾病总负担的第18位。在我国,双相情感障碍排在疾病总负担的第12位。
  查阅疾病用药指南
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医药新闻
2017年12月
2017年11月首次通过美国食品药品管理局新药审批的药物,包括新化学成份和新生物制剂。但未包括暂时审批的药物。药物通过新药审批后可能还需要补充申请批准。
2017年9月
研究发现,在自杀未遂的双相障碍青少年和年轻成人患者中,促进情绪调节的腹侧额叶边缘神经系统灰质较少,且结构和功能连接减少。
2017年4月
一项新研究显示,双相障碍患者如在使用哌甲酯的同时联合心境稳定剂,则不增加治疗引发躁狂的风险。鉴于高达20%的双相障碍患者并发注意缺陷多动障碍,该发现对临床有重要意义。
2017年4月
最近一项研究显示,锂盐、舍曲林单药以及锂盐-舍曲林联合方案用于双相II型抑郁患者,其转相率和治疗反应类似。此外,联合方案组脱落率较高,且未显示有快速起效优势。
2016年12月, Pearl Toh
最近一项研究显示,4类常见处方降压药与心境障碍如双向障碍、抑郁的调整后风险相关。
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药物信息

黛力新 Deanxit  [  丹麦灵北制药 H. Lundbeck   ]   [  康哲药业 Kangzhe Pharma  ]  氟哌噻吨+美利曲辛 Flupentixol + Melitracen
适应症: 轻、中度抑郁和焦虑。神经衰弱、心因性抑郁,抑郁性神经官能症,隐匿性抑郁,心身疾病伴焦虑和情感淡漠,更年期抑郁,嗜酒及药瘾者的焦躁不安及抑郁。
MIMS药理分类 抗抑郁药 Antidepressants   /   抗焦虑药 Anxiolytics  
Deanxit tab 0.5 mg_10 mg5bc44ef6-3540-46c3-8965-9fcb0188c8e5.GIF
安律凡 Abilify  [  浙江大冢 Otsuka   ]  阿立哌唑 Aripiprazole
适应症: 治疗精神分裂症。
MIMS药理分类 抗精神病药 Antipsychotics  
Abilify tab 5 mg78d3652f-0c54-4734-82f2-9fcb01893006.GIF
欣百达 Cymbalta  [  礼来 Eli Lilly   ]  度洛西汀 Duloxetine
适应症: 抑郁症;广泛性焦虑障碍。
MIMS药理分类 抗抑郁药 Antidepressants  
Cymbalta cap 30 mg8cccfd0b-c445-41bc-9c43-9fcb01892e90.GIF
再普乐 ZYPREXA  [  礼来 Eli Lilly   ]  奥氮平 Olanzapine
适应症: 治疗精神分裂症,中、重度躁狂发作。预防双相情感障碍的复发。
MIMS药理分类 抗精神病药 Antipsychotics  
Zyprexa orodispersible tab 10 mgc04da33c-59fe-4db4-8aa0-a1cc01297214.GIF
阿米替林 - 常州四药 Amitriptyline - Changzhou Siyao  [ 常州四药 Changzhou Siyao Pharm 阿米替林 Amitriptyline
适应症: 各种抑郁症,主要用于焦虑性或激动性抑郁症。
MIMS药理分类 抗抑郁药 Antidepressants   /   神经病理性疼痛用药 Drugs for Neuropathic Pain  
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参考文献
  1. DSM-IV诊断标准 - 中华精神卫生网 (http://www.cma-mh.org)
  2. 中国1型糖尿病诊治指南 - 人民卫生出版社,2012年(中华医学会糖尿病学分会)
  3. 双相障碍防治指南- 中华医学会,2007年6月(主编:沈其杰)
  4. 神经内科疾病临床诊断与治疗方案-科学技术文献出版社,2010年2月(主编:曾进胜)
  5. 神经内科疾病临床诊疗规范教程-北京大学医学出版社,2010年7月(主编:贾建平)
  6. 精神科疾病临床诊疗规范教程-北京大学医学出版社,2009年4月(主编:郝伟)
  7. 糖尿病,临床诊疗指南内分泌及代谢性疾病分册-人民卫生出版社,2005年(中华医学会编著)
  8. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder [revision]. Am J Psychiatry. 2002 Apr;159(4)(Suppl):001-50. PMID: 11958165
  9. Bridle C, Palmer S, Bagnall AM, et al. A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder [executive summary]. Health Technol Assess. 2004 May;8(19):iii-iv, 1-187. PMID: 15147609
  10. Goodwin, GM; Consensus Group of the British Association for Pharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition-recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009 Jun;23(4):346-388. PMID: 19329543
  11. Grunze H, Vieta E, Goodwin GM, et al; WFSBP Task Force on Treatment Guidelines for Bipolar Disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry. 2009;10(2):85-116. http://www.wfsbp.org/fileadmin/user_upload/Treatment_Guidelines/Guidelines_Bipolar_Disorders_2009.pdf. Accessed 21 Jan 2011. PMID: 19347775
  12. Grunze H, Vieta E, Goodwin GM, et al; WFSBP Task Force on Treatment Guidelines for Bipolar Disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry. 2010 Mar;11(2):81-109. http://psychiatryonline.org/data/Journals/FOCUS/4393/foc00411000500.pdf. Accessed 21 Jan 2011. PMID: 20148751
  13. Hirschfeld RM. Guideline watch: practice guideline for the treatment of patients w/ bipolar disorder, 2nd ed. Psychiatryonline. http://psychiatryonline.org. 2004. Accessed 24 Jan 2011.
  14. Mitchell PB, Malhi GS, Ball JR. Major advances in bipolar disorder. Med J Aust. 2004 Aug;181(4):207-210. PMID: 15310256
  15. National Collaborating Centre for Mental Health. National Institute of Health and Clinical Excellence. The management of bipolar disorder in adults, children & adolescents, in primary and secondary care. http://www.nice.org.uk. Jul 2006.
  16. National Institute of Mental Health. Bipolar disorder. NIMH. http://nimh.nih.gov. 2009. Accessed 21 Jan 2011.
  17. Stovall J. Bipolar disorder: maintenance and treatment. UpToDate. http://www.uptodate.com. 23 Aug 2010. Accessed 25 Jan 2011.
  18. Stovall J. Bipolar disorder: pharmacotherapy for acute depression. UpToDate. http://www.uptodate.com. 27 Sep 2010. Accessed 25 Jan 2011.
  19. Stovall J. Bipolar disorder: pharmacotherapy for acute mania, mixed states, and hypomania in adults. UpToDate. http://www.uptodate.com. 05 Oct 2010. Accessed 25 Jan 2011.
  20. Thambu M, Jambunathan S, George P, et al. Malaysian consensus statement for the treatment of bipolar disorder. Malaysian Psychiatry Association. http://www.psychiatry-malaysia.org. 2007. Accessed 24 Jan 2011.
  21. The Royal Australian and New Zealand College of Psychiatrists (RANZCP). Bipolar disorder: Australian treatment guide for consumers and carers. https://www.ranzcp.org. Aug 2009. Accessed 24 Jan 2011.
  22. Yatham LN, Kennedy SH, O'Donovan C, et al; Guidelines Group, CANMAT. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007. Bipolar Disord. 2006 Dec;8(6):721-739. PMID: 17156158
  23. Yatham LN, Kennedy SH, O'Donovan, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord. 2005;7(Suppl 3):005-69. PMID: 15952957
  24. Yatham LN, Kennedy SH, Schaffer A, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord. 2009 May;11(3):225-255. doi: 10.1111/j.1399-5618.2009.00672.x. Accessed 24 Jan 2011. PMID: 19419382
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