ASCP Corner: What Constitutes Evidence-Based Pharmacotherapy for Bipolar Disorder? Part 2: Complex Presentations and Clinical Context
J Clin Psychiatry 2008(3);69(3):495-496
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Because this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.
Part 1 of this ASCP CORNER examined
general principles of evidence-based medicine
(EBM) regarding first-line pharmacotherapies
across illness phases of bipolar
We shall now consider evidencebased
pharmacotherapy for clinical presentations
that fall outside the usual and
customary realm—for example, due to
atypical (e.g., “not otherwise specified”
[NOS]) or mixed affective features, course
specifiers (e.g., rapid cycling), true comorbidities,
or frank treatment resistance.
Since many patients with bipolar disorder
are neither usual nor customary, those with
“non-prototypical” features may well comprise
the majority of treatment-seeking
EBM discourages sweeping overgeneralizations
(e.g., “Aminoglycosides are
good antibiotics”), instead linking drug
utility with context (e.g., “Aminoglycosides
are good antibiotics for gram-negative infections
in renally intact patients”); hence,
distinct clinical contexts (e.g., “Quetiapine
treats depression in bipolar II patients with
rapid cycling”) may offer more useful ways
of thinking than unspecified clinical contexts
(e.g., “Is quetiapine useful for bipolar