Clinical practice guideline on pharmacological and psychological management of adult patients with bipolar disorder and comorbid substance use/Guia de practica clinica para el tratamiento farmacologico y psicologico de los pacientes adultos con trastorno bipolar y un diagnostico comorbido de trastorno por uso de sustancias

• Published in: Adicciones (Palma de Mallorca) 2022-06, Vol.34 (2), p.142
• Main Authors: Zorrilla, Inaki, Bernardo, Miquel, San, Luis, Fonseca, Francina, Arrojo, Manuel, Saiz, Pilar A, Goikolea, Jose Manuel, Garriga, Marina, Torrens, Marta, Arranz, Belen, Becona, Elisardo, Gonzalez-Pinto, Ana, Lopez, Ana, Tirado-Munoz, Judit, Cunill, Ruth, Florez, Gerardo
• Format: Article
• Language: English
• ISSN: 0214-4840

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. Key words: Bipolar disorder; substance use; alcohol; cocaine; methamphetamine; psychostimulant; nicotine. Esta revision resume las intervenciones farmacologicos y psicosociales que se han realizado en trastorno bipolar (TB) y un diagnostico comorbido de trastorno por uso de sustancias (TUS) y ademas proporciona recomendaciones clinicas respecto de cuales elementos de intervencion son utiles para hacer frente a los sintomas del uso de sustancias versus los sintomas de estado de animo en pacientes con estas afecciones concurrentes. Se utilizo la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describio mediante el enfoque GRADE. Muy pocos de los ensayos aleatorizados realizados hasta la fecha han proporcionado evidencia consistente para el manejo tanto de los sintomas de estado de animo como del uso de sustancias en pacientes con TB. No hay disponibilidad de ensayos clinicos para pacientes con TB que utilizan el cannabis. Algunos tratamientos han mostrado beneficios para los sintomas de estado de animo sin beneficios para el uso de a