{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:17:36Z","timestamp":1792628256569,"version":"4.5.0"},"reference-count":163,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provided clinicians with pragmatic treatment recommendations for bipolar disorder (BD). While these guidelines included commentary on how mixed features may direct treatment selection, specific recommendations were not provided\u2014a critical gap which the current update aims to address.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Overview of research regarding mixed presentations in BD, with treatment recommendations developed using a modified CANMAT\/ISBD rating methodology. Limitations are discussed, including the dearth of high\u2010quality data and reliance on expert opinion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No agents met threshold for first\u2010line treatment of DSM\u20105\u00a0manic or depressive episodes with mixed features. For mania + mixed features second\u2010line treatment options include asenapine, cariprazine, divalproex, and aripiprazole. In depression + mixed features, cariprazine and lurasidone are recommended as second\u2010line options. For DSM\u2010IV defined mixed episodes, with a longer history of research, asenapine and aripiprazole are first\u2010line, and olanzapine (monotherapy or combination), carbamazepine, and divalproex are second\u2010line. Research on maintenance treatments following a DSM\u20105\u00a0mixed presentation is extremely limited, with third\u2010line recommendations based on expert opinion. For maintenance treatment following a DSM\u2010IV mixed episode, quetiapine (monotherapy or combination) is first\u2010line, and lithium and olanzapine identified as second\u2010line options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CANMAT and ISBD groups hope these guidelines provide valuable support for clinicians providing care to patients experiencing mixed presentations, as well as further influence investment in research to improve diagnosis and treatment of this common and complex clinical state.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bdi.13135","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T06:53:01Z","timestamp":1633330381000},"page":"767-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":111,"title":["Canadian Network for Mood and 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