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Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics

Bipolar disorders (BDs) are a heterogeneous group of severe affective disorders generally described by the alternation of (hypo)manic, depressive, and mixed phases, with euthymic intervals of variable duration. BDs are burdened with high psychiatric and physical comorbidity, increased suicide risk a...

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Autores principales: Carli, Marco, Weiss, Francesco, Grenno, Giovanna, Ponzini, Sergio, Kolachalam, Shivakumar, Vaglini, Francesca, Viaggi, Cristina, Pardini, Carla, Tidona, Simone, Longoni, Biancamaria, Maggio, Roberto, Scarselli, Marco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bentham Science Publishers 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227916/
https://www.ncbi.nlm.nih.gov/pubmed/36825703
http://dx.doi.org/10.2174/1570159X21666230224102318
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author Carli, Marco
Weiss, Francesco
Grenno, Giovanna
Ponzini, Sergio
Kolachalam, Shivakumar
Vaglini, Francesca
Viaggi, Cristina
Pardini, Carla
Tidona, Simone
Longoni, Biancamaria
Maggio, Roberto
Scarselli, Marco
author_facet Carli, Marco
Weiss, Francesco
Grenno, Giovanna
Ponzini, Sergio
Kolachalam, Shivakumar
Vaglini, Francesca
Viaggi, Cristina
Pardini, Carla
Tidona, Simone
Longoni, Biancamaria
Maggio, Roberto
Scarselli, Marco
author_sort Carli, Marco
collection PubMed
description Bipolar disorders (BDs) are a heterogeneous group of severe affective disorders generally described by the alternation of (hypo)manic, depressive, and mixed phases, with euthymic intervals of variable duration. BDs are burdened with high psychiatric and physical comorbidity, increased suicide risk and reduced life expectancy. In addition, BDs can progress into complicated forms (e.g., mixed states, rapid/irregular cycling), which are more difficult to treat and often require personalized pharmacological combinations. Mood stabilizers, particularly Lithium and Valproic acid (VPA), still represent the cornerstones of both acute and chronic pharmacotherapies of BDs. Lithium is the gold standard in BD-I and BDII with typical features, while VPA seems more effective for atypical forms (e.g., mixed-prevalence and rapid-cycling). However, despite appropriate mood stabilization, many patients show residual symptoms, and more than a half recur within 1-2 years, highlighting the need of additional strategies. Among these, the association of atypical antipsychotics (AAPs) with mood stabilizers is recurrent in the treatment of acute phases, but it is also being growingly explored in the maintenance pharmacotherapy. These combinations are clinically more aggressive and often needed in the acute phases, whereas simplifying pharmacotherapies to mood stabilizers only is preferable in the long-term, whenever possible. When mood stabilizers are not enough for maintenance treatment, Quetiapine and, less consistently, Aripiprazole have been proposed as the most advisable adjunctive strategies, for their safety and tolerability profiles. However, in view of the increased risk of serious adverse effects, a careful patient-centered balance between costs and benefits is mandatory.
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spelling pubmed-102279162023-10-11 Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics Carli, Marco Weiss, Francesco Grenno, Giovanna Ponzini, Sergio Kolachalam, Shivakumar Vaglini, Francesca Viaggi, Cristina Pardini, Carla Tidona, Simone Longoni, Biancamaria Maggio, Roberto Scarselli, Marco Curr Neuropharmacol Medicine, Neurology, Pharmacology, Neuroscience Bipolar disorders (BDs) are a heterogeneous group of severe affective disorders generally described by the alternation of (hypo)manic, depressive, and mixed phases, with euthymic intervals of variable duration. BDs are burdened with high psychiatric and physical comorbidity, increased suicide risk and reduced life expectancy. In addition, BDs can progress into complicated forms (e.g., mixed states, rapid/irregular cycling), which are more difficult to treat and often require personalized pharmacological combinations. Mood stabilizers, particularly Lithium and Valproic acid (VPA), still represent the cornerstones of both acute and chronic pharmacotherapies of BDs. Lithium is the gold standard in BD-I and BDII with typical features, while VPA seems more effective for atypical forms (e.g., mixed-prevalence and rapid-cycling). However, despite appropriate mood stabilization, many patients show residual symptoms, and more than a half recur within 1-2 years, highlighting the need of additional strategies. Among these, the association of atypical antipsychotics (AAPs) with mood stabilizers is recurrent in the treatment of acute phases, but it is also being growingly explored in the maintenance pharmacotherapy. These combinations are clinically more aggressive and often needed in the acute phases, whereas simplifying pharmacotherapies to mood stabilizers only is preferable in the long-term, whenever possible. When mood stabilizers are not enough for maintenance treatment, Quetiapine and, less consistently, Aripiprazole have been proposed as the most advisable adjunctive strategies, for their safety and tolerability profiles. However, in view of the increased risk of serious adverse effects, a careful patient-centered balance between costs and benefits is mandatory. Bentham Science Publishers 2023-03-30 2023-03-30 /pmc/articles/PMC10227916/ /pubmed/36825703 http://dx.doi.org/10.2174/1570159X21666230224102318 Text en © 2023 Bentham Science Publishers https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
spellingShingle Medicine, Neurology, Pharmacology, Neuroscience
Carli, Marco
Weiss, Francesco
Grenno, Giovanna
Ponzini, Sergio
Kolachalam, Shivakumar
Vaglini, Francesca
Viaggi, Cristina
Pardini, Carla
Tidona, Simone
Longoni, Biancamaria
Maggio, Roberto
Scarselli, Marco
Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title_full Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title_fullStr Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title_full_unstemmed Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title_short Pharmacological Strategies for Bipolar Disorders in Acute Phases and Chronic Management with a Special Focus on Lithium, Valproic Acid, and Atypical Antipsychotics
title_sort pharmacological strategies for bipolar disorders in acute phases and chronic management with a special focus on lithium, valproic acid, and atypical antipsychotics
topic Medicine, Neurology, Pharmacology, Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227916/
https://www.ncbi.nlm.nih.gov/pubmed/36825703
http://dx.doi.org/10.2174/1570159X21666230224102318
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