Are guidelines in need of CPR? The development of clinical practice recommendations (CPR)

Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder

“…Their adoption, however, is limited due in part to the fact that they are not representative of patients encountered in real world practice and because they are often impenetrable (15). Their adoption, however, is limited due in part to the fact that they are not representative of patients encountered in real world practice and because they are often impenetrable (15).…”

“…Recently published reviews based on a substantial evidence-base (15,19,25) support the use of a number of monotherapy strategies for the treatment of acute mania. Recently published reviews based on a substantial evidence-base (15,19,25) support the use of a number of monotherapy strategies for the treatment of acute mania.…”

“…Recently published reviews based on a substantial evidence-base (15,19,25) support the use of a number of monotherapy strategies for the treatment of acute mania. Adjunctive use is recommended for coterminous psychotic or behavioural symptoms in mania (15,25), and benzodiazapines [e.g., lorazepam or clonazepam (44)] can be used short term to control behavioural disturbance but should be discontinued once symptoms start to allay (19). Adjunctive use is recommended for coterminous psychotic or behavioural symptoms in mania (15,25), and benzodiazapines [e.g., lorazepam or clonazepam (44)] can be used short term to control behavioural disturbance but should be discontinued once symptoms start to allay (19).…”

“…Second-line choices favour adjunctive therapies and medication combinations, such as adjunctive risperidone, lithium augmentation of antidepressants, olanzapine combined with fluoxetine, and lithium combined with valproate or lamotrigine (15,(54)(55)(56). Second-line choices favour adjunctive therapies and medication combinations, such as adjunctive risperidone, lithium augmentation of antidepressants, olanzapine combined with fluoxetine, and lithium combined with valproate or lamotrigine (15,(54)(55)(56).…”

“…Clinical practice guidelines attempt to synthesise the available pharmacotherapeutic evidence and make over-arching recommendations for the effective management of major psychiatric disorders. Their adoption, however, is limited due in part to the fact that they are not representative of patients encountered in real world practice and because they are often impenetrable (15). To this end, guidelines that incorporate clinical experience alongside evidence and provide recommendations in regards to assessment, care, and treatment have been developed (15), and the advice in this supplement builds on this foundation and provides further evidence-based guidance for the management of BD.…”