The International College of Neuropsychopharmacology (CINP) treatment guidelines for Bipolar disorder in adults (CINP-BD-2017), Part 3: The clinical guidelines

Abstract

Background: The current paper introduces the actual CINP clinical guidelines for the treatment of Bipolar disorder (BD). Concept and structure of the guidelines: The current clinical guidelines are based on evidence based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritised over combination therapy. There are separate recommendations for each of the major phases of BD expressed as a five-step algorithm. Discussion: The current CINP clinical guidelines for the treatment of BD are the most up-to-date guidance, and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features and rapid cycling is also a novel approach.Many issues need further studies, data are sparse and insufficient and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines which concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach.