Relapse prevention in bipolar disorder: a critical review of current guidelines
Bibliographic record
Abstract
Bipolar disorder is an important and serious mental illness associated with significant morbidity and mortality. However, unfortunately, the evidence base regarding treatment is less than satisfactory. In such circumstances clinicians often resort to reputable sets of guidelines. A number of these currently exist; in the United Kingdom the most prominent being that produced by the British Association of Psychopharmacology (BAP). This paper reviews the methodology of this guideline and its recommendations regarding the long-term treatment of bipolar disorder and compares this with guidelines produced by the American Psychiatric Association (APA), the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the Texas Implementation of Medication Algorithms (TIMA) for bipolar I disorder. It is concluded that the BAP guidelines continue to be a reasonable set of recommendations, though there are new data available since their publication. All the guidelines reviewed place lithium and valproate at the top of the list of options for long-term treatment. There is a trend to increasingly recognize atypical antipsychotics, particularly olanzapine, as an additional alternative and an increasing prominence of lamotrigine for prevention of depressive relapses. All other treatment options currently have an extremely limited evidence base and do not feature consistently in the published guidelines.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".