The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research.
The current fourth paper on the International College of Neuropsychopharmacology guidelines for the treatment of bipolar disorder reports on the unmet needs that became apparent after an extensive review of the literature and also serves as a conclusion to the project of the International College of Neuropsychopharmacology workgroup.



The systematic review of the literature that was performed to develop the International College of Neuropsychopharmacology guidelines for bipolar disorder identified and classified a number of potential shortcomings.



Problems identified concerned the reliability and validity of the diagnosis of bipolar disorder and especially of bipolar depression. This, in turn, has profound consequences for early detection and correct treatment of the disorder. Another area that needs improvement is the unsatisfactory efficacy and effectiveness of therapeutic options, especially in special populations such as those with mixed features and rapid cycling course. Gender issues and adherence problems constitute an additional challenge. The literature suggests that while treatment providers are concerned more with treatment-related issues, patients and their caregivers worry more about issues pertaining to the availability of services and care, quality of life, and various types of burden. The workgroup identified additional unmet needs related to the current standard of research in bipolar disorder. These include the fragmentation of bipolar disorder into phases that are handled as being almost absolutely independent from each other, and thus the development of an overall therapeutic strategy on the basis of the existing evidence is very difficult. Trials are not always designed in a way that outcomes cover the most important aspects of bipolar disorder, and often the reporting of the results is biased and unsatisfactory. The data on combination treatments and high dosages are sparse, whereas they are common in real world practice.



The workgroup endorses the full release of raw study data to the scientific community, and the development of uniform clinical trial standards (also including more realistic outcomes) and the reporting of results. The 2 large appendices summarize the results of this systematic review with regard to the areas of lack of knowledge where further focused research is necessary.
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Konstantinos N
KN
Fountoulakis
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Eduard
E
Vieta
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Allan
A
Young
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Lakshmi
L
Yatham
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Heinz
H
Grunze
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Pierre
P
Blier
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Hans Jurgen
HJ
Moeller
3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Greece; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
Siegfried
S
Kasper
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D035843:Biomedical Research / Q000379:methods / Q000592:standards / Q000639:trends; D001714:Bipolar Disorder / Q000188:drug therapy*; D006801:Humans; D011600:Psychopharmacology / Q000379:methods* / Q000706:statistics & numerical data*
D014150:Antipsychotic Agents
BD; anticonvulsants; antidepressants; antipsychotics; bipolar depression; evidence-based guidelines; lithium; mania; mood stabilizers; treatment
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