title: [Treatment of manic phases of bipolar disorder: critical synthesis of international guidelines].
abstract: BACKGROUND
  Bipolar disorder (BD) is the seventh leading cause of disability per year of life among all diseases in the population aged 15 to 44. It is a group of heterogeneous diseases, with frequent comorbid psychiatric or somatic disorders, variable treatment response and frequent residual symptoms between episodes. The major impairment associated with this disorder is related to the high relapse and recurrence rates, the functional impact of comorbidities and cognitive impairment between episodes. The prognosis of the disease relies on the efficacy of relapse and recurrence prevention interventions. Given the heterogeneity of the disorder, relapse and recurrence prevention needs to develop a personalized care plan from the start of the acute phase. In such a complex situation, guideline-driven algorithms of decision are known to improve overall care of patients with bipolar disorder, compared to standard treatment decisions. Although guidelines do not account for all the situations encountered with patients, this systematic approach contributes to the development of personalized medicine.
  
  
  METHODS
  We present a critical review of recent international recommendations for the management of manic phases. We summarize treatment options that reach consensus (monotherapy and combination therapy) and comment on options that differ across guidelines.
  
  
  RESULTS
  The synthesis of recent international guidelines shows a consensus for the initial treatment for manic phases. For acute and long-term management, the anti-manic drugs proposed are traditional mood stabilizers (lithium or valproate) and atypical antipsychotics (APA - olanzapine, risperidone, aripiprazole and quetiapine). All guidelines indicate stopping antidepressant drugs during manic phases. International guidelines also present with some differences. First, as monotherapy is often non sufficient in clinical practice, combination therapy with a traditional mood stabilizer and an APA are disputed either in first line treatment for severe cases or in second line. Second, mixed episodes treatment is not consensual either and some guidelines propose in first line valproate, carbamazepine and some APA, and advice not to use lithium. On the other hand, some guidelines do not propose specific treatment for mixed episodes and group them with manic episodes management. Duration of treatment is unclear.
  
  
  CONCLUSIONS
  Guidelines utilization has shown that the systemic use by clinicians of decision algorithms in comparison to "treatment as usual" modality improves the overall care of patients with BD. Future data from cohorts of patients seem necessary to complement the existing data from clinical trials. These cohort studies will help to take into account the different individual profiles of BD and thus may help to propose a more personalized medicine.
authors: Inserm, UMR-S1144, VariaPsy, équipe 1, Paris, France; Pôle neurosciences, AP-HP, groupe hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Université Paris-7 Paris-Diderot, UFR de médecine, Paris, France; Fondation FondaMental, 94000 Créteil, France. Electronic address: pierre.a.geoffroy@gmail.com.
authors: P A
authors: PA
authors: Geoffroy
authors: Inserm, UMR-S1144, VariaPsy, équipe 1, Paris, France; Pôle neurosciences, AP-HP, groupe hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Université Paris-7 Paris-Diderot, UFR de médecine, Paris, France; Fondation FondaMental, 94000 Créteil, France.
authors: F
authors: F
authors: Bellivier
authors: Université Paris-Est, UFR de médecine, Créteil, France; Pôle de psychiatrie, hôpital H. Mondor - A. Chenevier, AP-HP, 94000 Créteil, France; Inserm, U955, psychiatrie génétique, 94000 Créteil, France; Fondation FondaMental, 94000 Créteil, France.
authors: C
authors: C
authors: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D057285:Precision Medicine; D012008:Recurrence; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents
keywords: Bipolar disorder; Guidelines; Mania; Manic episode; Manie; Mood stabilizer; Recommandations; Thymorégulateur; Traitement; Treatment; Trouble bipolaire; Épisode maniaque