HOW TO TREAT DEMENTIA IN VASCULAR DISEASE 2025

HOW TO TREAT DEMENTIA IN VASCULAR DISEASE 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 2

DEMENTIA IN VASCULAR DISEASE

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 2

DEMENTIA IN VASCULAR DISEASE

1. DEFINITION

Vascular dementia includes dementia due to multiple infarctions. Typically, there is a history of transient ischemic episodes characterized by brief episodes of altered consciousness, transient mild paresis, or temporary vision loss. Dementia may also follow acute cerebrovascular accidents or, less commonly, a single severe stroke.

It is characterized by impairments in higher cortical functions, including memory, reasoning, orientation, comprehension, calculation, learning capacity, language, and judgment. Vascular dementia results from the impact of cerebrovascular disease on cognitive function. The condition often has a sudden onset and progresses in a stepwise manner, with the severity of cognitive deficits depending on the location of the brain lesions.

1. ETIOLOGY

– Large Vessel Disease: Multi-infarct dementia due to multiple cortical or subcortical infarcts.

+ Atherosclerosis of coronary, extracranial, and intracranial arteries.

+ Cortical infarcts or large subcortical infarctions.

+ Risk factors: hypertension, diabetes mellitus, hypercholesterolemia, smoking, coronary artery disease, atrial fibrillation, cardiomyopathy, valvular heart disease.

– Small Vessel Disease: Subcortical vascular dementia.

+ Binswanger’s disease and lacunar infarcts.

+ Risk factors: hypertension, diabetes, hypercholesterolemia, smoking.

– Strategic Infarct Dementia: Infarcts in critical areas (e.g., thalamus, temporal lobe, internal capsule).

– Hemorrhagic Dementia: Cerebral hemorrhage (subarachnoid, subdural, intraparenchymal).

– Cerebral Amyloid Angiopathy: Associated with hemorrhage and ischemic events.

III. DIAGNOSIS

1. Definitive Diagnosis

1.1. Clinical Features

1.1.1. Dementia Manifestations

– Memory decline and impairment in at least two other cognitive domains (e.g., orientation, language, visuospatial function, attention, executive function, motor control, praxis), interfering with daily functioning.

– Fluctuating cognitive deficits, amnesia, intellectual decline, and focal neurologic signs. Insight and judgment are relatively preserved.

– Abrupt onset or stepwise deterioration. Emotional lability with transient depressive mood, unexplained crying or laughter, and episodes of clouded consciousness or delirium.

– Personality relatively preserved, though some cases show apathy, disinhibition, or exaggeration of premorbid traits (e.g., selfishness, paranoia, irritability).

1.1.2. Cerebrovascular Disease

Focal neurologic signs of stroke, with or without a stroke history, confirmed by imaging (CT/MRI):

– Multiple infarcts;

– Single strategic infarct (e.g., hippocampus, angular gyrus, anteromedial thalamus, caudate);

– Lacunar infarcts (multiple lacunes, basal ganglia, white matter);

– Diffuse periventricular white matter lesions.

1.1.3. Relationship Between Dementia and Cerebrovascular Disease

– Dementia onset within 3 months of a stroke.

– Exclusion of pre-stroke dementia.

– Sudden cognitive decline with fluctuating or stepwise progression.

1.2. Ancillary Testing

Tests tailored to individual cases:

1.2.1. Neuropsychological Testing

– Cognitive assessment (e.g., MMSE, GPCOG, Mini-Cog, ADAS-Cog, Wechsler scales);

– Depression scales (e.g., HAM-D, Beck, GDS);

– Anxiety scales (e.g., HAM-A, Zung);

– Sleep disturbance assessment (e.g., PSQI);

– Personality assessment (e.g., EPI, MMPI).

1.2.2. Laboratory Studies

– Complete blood count (CBC);

– Erythrocyte sedimentation rate (ESR);

– Biochemical panel: liver/kidney function, electrolytes, glucose, HbA1c, calcium, phosphate, vitamin B12, folate, thyroid function, lipid profile.

1.2.3. Urinalysis

1.2.4. Imaging

Brain CT, MRI, SPECT, PET, fMRI for confirmation; abdominal ultrasound, chest X-ray for comorbidities/complications.

1.2.5. Functional Testing

EEG, cerebral blood flow studies, ECG, transcranial Doppler ultrasound.

1.2.6. Specialized Testing

Syphilis serology, autoantibodies (e.g., antiphospholipid, lupus anticoagulant, ANA), HIV, genetic testing, amyloid-PET.

2. Differential Diagnosis

– Depressive disorder;

Delirium;

– Organic amnesia (e.g., hypothyroidism, B12 deficiency, chronic subdural hematoma, normal pressure hydrocephalus);

– Other primary dementias (e.g., Pick’s disease, Lewy body dementia, Creutzfeldt-Jakob disease, Huntington’s disease, Parkinson’s dementia, Alzheimer’s);

– Toxic states.

IV. TREATMENT

1. General Principles

– Treat cerebrovascular events, especially infarcts.

– Manage vascular risk factors.

– Address mild cognitive impairment stages.

– Employ non-pharmacologic and pharmacologic strategies.

2. Treatment Framework

– Pharmacotherapy;

– Psychotherapy;

– Supportive care.

3. Specific Treatments

3.1. Dementia Management

3.1.1. Pharmacotherapy

Cognitive Symptoms:

– Donepezil: 5-23 mg/day;

– Rivastigmine: 1.5-12 mg/day (oral or transdermal);

– Galantamine: 8-24 mg/day.

Adjunctive agents:

– Cerebrolysin: 10-20 mL/day;

– Ginkgo biloba: 80-120 mg/day;

– Piracetam: 400-1200 mg/day;

– Citicoline: 100-1000 mg/day;

– Choline alfoscerate: 200-800 mg/day;

– Vinpocetine: 5-100 mg/day.

For psychosis, hallucinations, depression, agitation: antipsychotics, antidepressants, anxiolytics.

3.1.2. Antipsychotics

Select one or more:

– Risperidone: 1-10 mg/day;

– Quetiapine: 50-800 mg/day;

– Olanzapine: 5-30 mg/day;

– Clozapine: 25-300 mg/day;

– Aripiprazole: 10-30 mg/day;

– Haloperidol: 0.5-20 mg/day.

3.1.3. Antidepressants

Select one or more:

– Sertraline: 50-200 mg/day;

– Citalopram: 10-40 mg/day;

– Escitalopram: 10-20 mg/day;

– Fluvoxamine: 100-200 mg/day;

– Paroxetine: 20-50 mg/day;

– Fluoxetine: 10-60 mg/day;

– Venlafaxine: 75-375 mg/day;

– Mirtazapine: 15-60 mg/day.

3.1.4. Mood Stabilizers

Options include:

– Valproate: 200-2500 mg/day;

– Divalproex: 750 mg/day to 60 mg/kg/day;

– Carbamazepine: 100-1600 mg/day;

– Oxcarbazepine: 300-2400 mg/day;

– Lamotrigine: 100-300 mg/day;

– Levetiracetam: 500-1500 mg/day.

Hepatic support: Aminoleban, silymarin, boganic, branched-chain amino acids.

Nutritional supplements, vitamins, minerals, dietary adjustments, IV nutrition as needed.

3.2. Psychotherapy

– Direct: Family therapy, individual psychotherapy;

– Indirect:

+ Ensure a safe environment;

+ Minimize external stimuli;

+ Promote sleep hygiene;

+ Educate families on care.

3.3. Physical and Occupational Therapy

Coordinate with rehabilitation specialists for:

– Motor recovery;

– Speech therapy.

3.4. Management of Comorbid Conditions

– Vascular Disease: Antiplatelet agents; carotid stenosis (stenting/surgery); hypertension (antihypertensives); dyslipidemia (statins, fibrates, nicotinic acid, cholesterol absorption inhibitors); diabetes (glucose-lowering agents).

– Support daily activities (e.g., bathing, hygiene) to prevent complications and enhance quality of life.

3.5. Social Management

– Refer to local dementia associations;

– Assess driving ability;

– Discuss care options (e.g., in-home support, skilled nursing).

3.6. Caregiver Support

– Caregivers face elevated stress;

– Care includes supporting both patient and caregiver;

– Provide tailored medical, psychological, and practical support.

V. PROGNOSIS AND COMPLICATIONS

Vascular dementia has a higher mortality rate than Alzheimer’s, likely due to coexisting vascular comorbidities. Common causes of death include circulatory disorders (e.g., myocardial ischemia) and respiratory conditions (e.g., pneumonia).

VI. PREVENTION

– Treat underlying conditions (e.g., hypertension, diabetes, hypercholesterolemia);

– Antiplatelet therapy (e.g., aspirin, clopidogrel, ticlopidine);

– Carotid endarterectomy;

– Nutrition: Omega-3, DHA supplementation.

REFERENCES

Vietnamese

1. Department of Psychiatry, Hanoi Medical University (2016), Lectures on Psychiatry. Medical Publishing House.  
2. Department of Psychiatry, Hanoi Medical University (2000), Organic Mental Disorders. Postgraduate Lecture Series.  
3. Department of Psychiatry & Medical Psychology, Military Medical Academy (2007), Psychiatry and Psychology. People’s Army Publishing House.  
4. Military Medical Academy (2016), Textbook of Psychiatric Disorders. People’s Army Publishing House, Hanoi.  
5. World Health Organization (1992), The International Classification of Diseases, 10th Revision (ICD-10): Mental and Behavioral Disorders. WHO, Geneva, 1992.  
6. World Health Organization (1992),ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research (translated by the Department of Psychiatry, Hanoi Medical University).  
7. David A., et al. (2010), Geriatric Psychiatry, Medical Publishing House, 2014. Translated by Nguyễn Kim Việt.  
8. Eduard V. (2009), Bipolar Disorder in Clinical Practice, Medical Publishing House, Hanoi.  
9. Kaplan & Sadock (2013), Pervasive Developmental Disorders, Synopsis of Child and Adolescent Psychiatry, Translated book, Medical Publishing House.  
10. Trần Hữu Bình (2016), Textbook of Psychiatric Disorders: Depressive Phase,Medical Publishing House, Hanoi.  
11. Lê Quang Cường (2005), Epilepsy, Medical Publishing House.  
12. Cao Tiến Đức (2017), Epilepsy: Mental Disorders in Epilepsy and Treatment, Medical Publishing House, pp. 9-15.  
13. Trần Viết Nghị (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University.  
14. Trần Viết Nghị, Nguyễn Minh Tuấn (1995), Treatment of Drug Addiction with Psychotropic Medications, Proceedings of the Scientific Conference on Drug Addiction Treatment Methods, Ministry of Health, Institute of Mental Health.  
15. Nguyễn Viết Thiêm (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University, pp. 103-111.  
16. Nguyễn Minh Tuấn (2016), Textbook of Psychiatric Disorders, Medical Publishing House.  
17. Nguyễn Minh Tuấn (2004), Heroin Addiction: Treatment Methods, Medical Publishing House.  
18. Nguyễn Minh Tuấn (2004), Diagnosis and Treatment of Dependence (Addiction), Medical Publishing House.  
19. Nguyễn Kim Việt (2016), Textbook of Psychiatric Disorders, Medical Publishing House, Hanoi.  
20. Nguyễn Kim Việt (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use,Department of Psychiatry, Hanoi Medical University.  
21. Nguyễn Kim Việt (2000), Organic Mental Disorders, Department of Psychiatry, Hanoi Medical University.  
22. Nguyễn Kim Việt, Nguyễn Văn Tuấn (2016), Textbook of Psychiatric Disorders, Department of Psychiatry, Hanoi Medical University, Medical Publishing House, pp. 74-79.

English

1. The British Association for Psychopharmacology (2011). Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxf), 25(5), 567–620.
2. The National Institute for Health and Care Excellence (NICE) (2014). Psychosis and schizophrenia in adults: prevention and management. NICE guideline. CG178, 5-46.
3. The National Institute for Health and Care Excellence (2014). Bipolar disorder: the assessment and management of bipolar disorder in adults,children and young people in primary and secondary care. September 2014.
4. The National Institute for Health & Care Excellence – NICE (2010). The Treatmentand Management of Depression in Adults (updated edition). National Clinical Practice Guideline 90, 2010.
5. NICE(2012), “Epilepsies: diagnosis and management ”, NICE 
6. Abdul S. K., Manjula M, Paulomi M. S., et al (2013), “Cognitive Behavior Therapy for Patients with Schizotypal Disorder in an Indian Setting: A Retrospective Review of Clinical Data”, the German Journal of Psychiatry, pp 1-7.
7. Addington D., Abidi S., Garcia-Ortega I., et al. (2017). Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders. Can J Psychiatry, 62(9), 594–603.
8. American Psychiatric Association (1994), “Amphetamine-type stimulants” Diagnostic and Statistical Manual of Mental Disorders”, Fourth Edition, DSM-Washington, DC
9. American Psychiatric Association (2013). Alcohol-Related Disorders, Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric Publishing, 490-503.
10. AmericanPsychiatric Association (2013). Opioid  Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric.
11. AmericanPsychiatric Association (2013). Diagnostic and statistical manual of mental disorders DSM-IV.
12. Apurv K., Pinki D., Abdul K. (1997), “Treatment of acute and transient psychoticdisorders with low and high doses of oral haloperidol”, Indian Journal of Psychiatry, pp 2-8
13. American psychiatric association (2010). Practice guideline for the Treatment of Patients With Schizophrenia, Second Edition. 184.
14. Andreas M. (2012), “Schizoaffective Disorder”, Korean J Schizophr Res, pp 5-12.
15. American Psychiatric Association (1994). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
16. Babalonis S, Haney M, Malcolm R.J, et al (2017). Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers. DrugAlcohol Depend. 172, 9-13.
17. Benjamin J. S, Virginia A. S, Pedro R (2017). Substance-Related Disorders, Kapland & Sadock’s Comprehensive Textbook of Psychiatry, Lippincott Williams & Wilkins, Baltimore, Vol. 1.
18. Benjamin J. S., Virginia A. S. (2007), “Substance-Related Disorders- Amphetamine (or Amphetamine-like) Behavioral Sciences/Clinical Psychiatry ”, Kaplan & Sadock’s Synopsis of Psychiatry 10th Edition, Lippincott Williams & Wilkins (2007)
19. Bergamaschi M.M, Queiroz R.H.C, Zuardi A.W., et al (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 6(4), 237-249.
20. Benzoni O., Fàzzari G., Marangoni C., Placentino A., Rossi A. (2015), “Treatment of resistant mood and schizoaffective disorders with electroconvulsive therapy: a case series of 264 patients”, Journal of Psychopathology, pp 266-268.
21. Daniel R. R., Larry J. S., et al (2014), “Schizotypal personality disorders: a current review”, New York, pp 1-10.
22. Dervaux A.M. (2010). Influence de la consommation de substances sur l’émergence et l’évolution des troubles psychotiques: le cas du cannabis. La these doctotraie, Universit ´e Pierre et Marie Curie – Paris VI, Paris, France.
23. Dieter S., Steven C. S. (2014). “Drug treatment of epilepsy in adults ”, BMJ, p2-19.
24. Early Psychosis Guidelines Writing Group (2010). Australian clinical guidelines for earlypsychosis 2nd  Natl Cent Excell Youth Ment Health Melb, 2, 4–24.
25. Elisa C., Amir H. C., Peter B. (2009), “Treatment of Schizoaffective Disorder”, Psychiatry (Edgemont),p 15-17.
26. Felix-Martin W., Rafael C., (2016), “Current Treatment of Schizoaffective Disorder According to a Neural Network”, Neural Network. J Cytol Histol, pp 2-5
27. Gary R., Donald A., Wiliam H., et al (2017), “Guideline for the pharmacotherapy of schizophrenia in adul”, The canadian journal of schiatry,pp 605-612.
28. Galletly C., Castle D., Dark F., et al. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for themanagement of schizophrenia and related disorders. Aust N Z J Psychiatry, 50(5), 410–472.
29. Gautam S., Jain A., Gautam M., Vahia V. N., et al (2017). Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry;59, Suppl
30. Grunze H., et al. (2009). The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar
31. Hasan A., Falkai P., Wobrock T., et al. (2012). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry, 13(5), 318–
32. Hasan A., Falkai P., Wobrock T., et al. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia,Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side  World J Biol Psychiatry, 14(1), 2–44.
33. JakobsenD., Skyum E., Hashemi N., et al. (2017). Antipsychotic treatment of schizotypy and schizotypal personality disorder: a systematic review. J Psychopharmacol (Oxf), 31(4), 397–405.
34. Jinsoo C., Theo C. M. (2017), “Current Treatments for Delusional Disorder”, Psychiatry, pp 5-20
35. Jonathan K. B., Saeed F. (2012), “Acute and transient psychotic disorders: An overview of studies in Asia”, International Review of Psychiatry, pp 463-466
36. Jochim, J., Rifkin-Zybutz, R., Geddes, J., et al (2019).Valproate for acute mania. Cochrane Database of Systematic Reviews.
37. Kaplan& Sadock’s. Pocket Handbook of Psychiatric Drug Treatment
38. Kennedy S. H., Lam R. W., McIntyre R. S., et al (2016). Canadian Network forMood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. The Canadian Journal of Psychiatry, 61(9), 540–560.
39. Krishna R.P., Jessica C., et al(2014), “Schizophrenia: overview and treatment options”, New York, pp 638-643.
40. Lakshmi N. Y., Sidnay H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
41. Laskshmi N.Y., Sidney H. K. (2017). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry: Pharmacological treatment of depression and bipolar disorders, Wolters Kluwer.
42. Lakshmi N. Y., Sidney H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
43. Loya M., Dubey V., Diwan S., Singh H. (2017), “Acute and transient psychotic disorder and schizophrenia: On a continuum or distinct? A study of cognitive functions”, International Journal of Medicine Research, pp-4-7.
44. Manschrec, Nealia L. K. (2006), “Recent Advances in the Treatment of Delusional Disorder”, The Canadian Journal of Psychiatry, pp-114-118
45. Marcos E. M. B., Hermes M. T. B. (2016), “Schizoaffective Disorder and Depression. A case Study of a patient from ceará, Brazil”, iMedPub Journals, pp1-8
46. Mesut Cetin (2015), “Treatment of Schizophrenia: Past, Present and Future”, Bulletin of Clinical Psychopharmacology, pp 96-98.
47. Michael S., Christina Z., Gerd B., (2011), “Prevalence of delusional disorder among psychiatric inpatients: data from the German hospital register”, Neuropsychiatry, pp 319-322.

48. MIMS neurology & psychiatry disease management guidelines

49. RajivTandon (2018), “Pharmacological Treatment of Schizophrenia 2017-2018 Update Summary”, org, pp 37-40.
50. Robert E., et al (2014). Substance-Related and Addictive Disorders. The AmericainPsychiatric Publishing Textbook of Psychiatry, 6 th, DSM-5 Edition, Bristish Library, USA, 735 – 814.
51. Rong C, Lee Y., Carmona N.E., et al (2017). Cannabidiol in medical marijuana: Research vistas and potential opportunities. Pharmacol Res. 121, 213-8.
52. Skelton M., Khokhar W.A., Thacker S.P. (2015). Treatments for delusional disorder. Cochrane Database Syst Rev.
53. Stahl S.M, Stein D.J, Lerer B (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based psychopharmacology
54. Stephen M.S., Dan J.S., Bernard L. (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based
55. Stahl S. (2009). Stahl’s essential psychopharmacology: neuroscientific basis and practical implications: Cambridge University Press.
56. Stahl, M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications, Cambridge University Press.
57. Vieta, Berk M., Schulze&nbspT. G., et al (2018). Bipolar disorders. Nature Reviews Disease Primers, 4, 18008
58. Update2009 on the Treatment of Acute  The World Journal of Biological Psychiatry. 10(2); 85-116.

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