Table 2.

Unmet Needs in the Treatment of BD Patients As Identified During the Process of Guideline Development

Fragmentation of BD as a disorder char="12"

• Research does not consider BD as a single disorder but as a sequence of largely independent phases

• Almost impossible to reliably transform the available data into a longitudinal treatment strategy

Unsatisfactory design of RCTs

• Scales do not cover the full symptomatology of BD

• Recognition and reporting of diagnostic criteria and specifiers is problematic

• Duration too short for acute mania and acute bipolar depression studies

• Duration of the continuation phase too short before entering the maintenance phase

• Use of enriched samples almost in all maintenance studies

• Research on substance and alcohol abuse and medical comorbidities is insufficient

Focus on more realistic outcomes

• General impairment and disability

• Neurocognitive function

• Social and occupational functioning

• Quality of life

Limited data concerning combination treatment and high dosages

Incomplete results reporting

• Core symptoms of mania or depression

• Mixed features

• Data exist mostly on the manic but not the depressive component of mixed episodes

• Psychotic symptoms

• Rapid cycling

• Incomplete descriptive statistics

Reporting of the results

• Inconsistent way of reporting

• Often different study samples sizes are reported in different documents concerning the same study

• Last Observation Carried Forward vs Mixed-Effect Model Repeated Measure