Revisión Sistemática del Tratamiento del Trastorno Bipolar con Características Mixtas

Introduction

The mixed states of bipolar disorder (BD) are typified as a subtype of mania or depression. Mixed episodes respond worse to monotherapy treatment, imply a higher risk of relapse, a chronicity of 15% at five years and an associated suicide risk similar to that of patients with depression.

Objective

To evaluate and compare the different therapeutic strategies for BD with mixed characteristics.

Methods

A systematic bibliographic review was carried out. Those studies carried out in patients with bipolar disorder with mixed characteristics and who were receiving treatment were selected.

Results

The initial search showed a total of 228 articles, of which 28 met the inclusion criteria. We included 19 randomised clinical trials (RCTs) comparing an antipsychotic with placebo.

Discussion

According to the data evaluated, antipsychotics —especially second-generation ones— represent a first-line tool for the treatment of manic symptoms with mixed characteristics. ECT should be considered as a secondary intervention strategy in the case of acute mania when an adequate response has not been obtained after the administration of first-line drugs.

Conclusions

The review found that the therapeutic recommendations for bipolar disorder with mixed characteristics are limited.