Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno bipolar y un diagnóstico comórbido de trastorno por uso de sustancias
- Ana González-Pinto
- José Manuel Goikolea
- Iñaki Zorrilla
- Miquel Bernardo
- Manuel Arrojo
- Ruth Cunill
- Xavi Castell
- Elisardo Becoña
- Ana López
- Marta Torrens
- Judit Tirado-Muñoz
- Francina Fonseca
- Belén Arranz
- Marina Garriga
- Pilar A. Sáiz
- Gerardo Flórez
- Luis San
ISSN: 0214-4840
Ano de publicación: 2022
Volume: 34
Número: 2
Páxinas: 142-156
Tipo: Artigo
Outras publicacións en: Adicciones: Revista de socidrogalcohol
Obxectivos de Desenvolvemento Sustentable
Resumo
This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.
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