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Treating mixed mania/hypomania: a review and synthesis of the evidence

机译：治疗混合躁狂症/ Hypomania：证据的审查和综合

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The DSM-5 incorporates a broad concept of mixed states and captured = 3 nonoverlapping symptoms of the opposite polarity using a " with mixed features" specifier to be applied to manic/hypomanic and major depressive episodes. Pharmacotherapy of mixed states is challenging because of the necessity to treat both manic/hypomanic and depressive symptoms concurrently. High-potency antipsychotics used to treat manic symptoms and antidepressants can potentially deteriorate symptoms of the opposite polarity. This review aimed to provide a synthesis of the current evidence for pharmacotherapy of mixed states with an emphasis on mixed mania/hypomania. A PubMed search was conducted for randomized controlled trials (RCTs) that were at least moderately sized, included a placebo arm, and contained information on acute-phase and maintenance treatments of adult patients with mixed episodes or mania/hypomania with significant depressive symptoms. Most studies were post-hoc subgroup and pooled analyses of the data from RCTs for acute manic and mixed episodes of bipolar I disorder; only two prospectively examined efficacy for mixed mania/hypomania specifically. Aripiprazole, asenapine, carbamazepine, olanzapine, and ziprasidone showed the strongest evidence of efficacy in acute-phase treatment. Quetiapine and divalproex/valproate were also efficacious. Combination therapies with these atypical antipsychotics and mood stabilizers can be considered in severe cases. Olanzapine and quetiapine (alone or in combination with lithium/divalproex) showed the strongest evidence of efficacy in maintenance treatment. Lithium and lamotrigine may be beneficial given their preventive effects on suicide and depressive relapse. Further prospective studies primarily focusing on mixed states are needed.
机译：DSM-5包括混合状态的广泛概念，并使用“具有混合特征”说明符来捕获的混合状态和相反极性的症状，以适用于躁狂/多重抑郁发作。混合状态的药物疗法是挑战的，因为必须同时治疗躁狂/卑鄙和抑郁症状。用于治疗躁狂症症状和抗抑郁药的高效力抗精神病药可能会使相反极性的症状恶化。该审查旨在为混合状态的药物疗法提供当前证据，重点是混合的躁狂症/软辣椒。对至少适度尺寸的随机对照试验（RCT）进行了PubMed搜索，包括安慰剂ARM，并包含有关成年患者的急性阶段和维持治疗的信息，其混合发作或躁狂症/丘脑病具有显着抑郁症状。大多数研究是hoc子群，并汇总来自急性躁狂和混合发作的RCT的数据的数据;仅对混合的躁狂症/卑鄙/卑鄙的疗效仅进行两次前瞻性检查的疗效。阿里普哌唑，茶碱，卡巴马嗪，奥氮翼和齐普拉西酮显示出急性期治疗中有效性的最强证据。喹诗和DivallProex /丙普罗特也有效。在严重的情况下，可以考虑具有这些非典型抗精神病药和情绪稳定剂的组合疗法。 Olanzapine和Quetiapine（单独或与锂/ DivalProex组合）显示了在维持治疗中有效的最强证据。锂和乳甲柠檬嗪可能是有益的，因为它们对自杀和抑郁复发的预防作用。需要进一步的预期研究主要关注混合状态。

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