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Singh B, Yocum AK, Strawbridge R, Burdick KE, Millett CE, Peters AT, Sperry SH, Fico G, Vieta E, Verdolini N, Godin O, Leboyer M, Etain B, Tso IF, Coombes BJ, McInnis MG, Nierenberg AA, Young AH, Ashton MM, Berk M, Williams LJ, Keramatian K, Yatham LN, Overs BJ, Fullerton JM, Roberts G, Mitchell PB, Andreassen OA, Andreazza AC, Zandi PP, Pham D, Biernacka JM, Frye MA. Patterns of pharmacotherapy for bipolar disorder: A GBC survey. Bipolar Disord 2024; 26:22-32. [PMID: 37463846 PMCID: PMC10794603 DOI: 10.1111/bdi.13366] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To understand treatment practices for bipolar disorders (BD), this study leveraged the Global Bipolar Cohort collaborative network to investigate pharmacotherapeutic treatment patterns in multiple cohorts of well-characterized individuals with BD in North America, Europe, and Australia. METHODS Data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities were provided from each participating cohort. Individual site and regional pooled proportional meta-analyses with generalized linear mixed methods were conducted to identify prescription patterns. RESULTS This study included 10,351 individuals from North America (n = 3985), Europe (n = 3822), and Australia (n = 2544). Overall, participants were predominantly female (60%) with BD-I (60%; vs. BD-II = 33%). Cross-sectionally, mood-stabilizing anticonvulsants (44%), second-generation antipsychotics (42%), and antidepressants (38%) were the most prescribed medications. Lithium was prescribed in 29% of patients, primarily in the Australian (31%) and European (36%) cohorts. First-generation antipsychotics were prescribed in 24% of the European versus 1% in the North American cohort. Antidepressant prescription rates were higher in BD-II (47%) compared to BD-I (35%). Major limitations were significant differences among cohorts based on inclusion/exclusion criteria, data source, and time/year of enrollment into cohort. CONCLUSIONS Mood-stabilizing anticonvulsants, second-generation antipsychotics, and antidepressants were the most prescribed medications suggesting prescription patterns that are not necessarily guideline concordant. Significant differences exist in the prescription practices across different geographic regions, especially the underutilization of lithium in the North American cohorts and the higher utilization of first-generation antipsychotics in the European cohorts. There is a need to conduct future longitudinal studies to further explore these differences and their impact on outcomes, and to inform and implement evidence-based guidelines to help improve treatment practices in BD.
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Affiliation(s)
- Balwinder Singh
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine E Burdick
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amy T Peters
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Ophelia Godin
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Marion Leboyer
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Bruno Etain
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Melanie M Ashton
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lana J Williams
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Bronwyn J Overs
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gloria Roberts
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel Pham
- The Milken Institute, Washington, District of Columbia, USA
| | - Joanna M Biernacka
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Mark A Frye
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Gardea-Resendez M, Ortiz-Orendain J, Miola A, Fuentes Salgado M, Ercis M, Coombes BJ, Gruhlke PM, Bostwick JM, Michel I, Vande Voort JL, Ozerdem A, McKean A, Frye MA, Taylor-Desir M. Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study. Front Psychiatry 2023; 14:1241071. [PMID: 37732076 PMCID: PMC10507622 DOI: 10.3389/fpsyt.2023.1241071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
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Affiliation(s)
- Manuel Gardea-Resendez
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Javier Ortiz-Orendain
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Alessandro Miola
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Mete Ercis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Brandon J. Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peggy M. Gruhlke
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - J. Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ian Michel
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Monica Taylor-Desir
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Li K, Richards E, Goes FS. Racial differences in the major clinical symptom domains of bipolar disorder. Int J Bipolar Disord 2023; 11:17. [PMID: 37166695 PMCID: PMC10175527 DOI: 10.1186/s40345-023-00299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder. RESULTS In the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25). CONCLUSIONS In two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome.
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Affiliation(s)
- Kevin Li
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Erica Richards
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gardea-Resendez M, Taylor-Desir MJ, Romo-Nava F, Bond D, Vallender EJ, Cuellar-Barboza AB, Prieto ML, Nunez N, Veldic M, Ozerdem A, Singh B, Markota M, Colby CL, Coombes BJ, Biernacka JM, McElroy SL, Frye MA. Clinical Phenotype of Tardive Dyskinesia in Bipolar Disorder. J Clin Psychopharmacol 2022; 42:159-162. [PMID: 35230047 DOI: 10.1097/jcp.0000000000001532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Recognizing the negative impact that antipsychotic-induced movement disorders have on the quality of life and treatment outcomes in bipolar disorder (BD), this study aimed to assess clinical correlates and antipsychotic use patterns of tardive dyskinesia (TD+) in BD. MATERIALS AND METHODS Participants with and without TD were included. Clinical variables were compared using t-test and χ2 test. Antipsychotic use patterns in TD+, including number of trials, mean doses, and estimated cumulative exposure, were assessed in a case-only analysis. RESULTS The prevalence rate of TD was 5.1%. In comparison to the TD- group (n = 1074), TD+ participants (n = 58) were older, more likely to be female and have type I bipolar illness. There were 60.3% of the TD+ group that continued using antipsychotics at study entry and had a mean cumulative exposure to antipsychotics of 18.2 ± 15.6 years. Average dose, in haloperidol equivalents, was 5.9 ± 3.5 mg and 77.7% of the trials were second-generation antipsychotics. CONCLUSIONS This study confirms previously identified TD risk factors, such as age, sex, and bipolar subtype in a large BD cohort. Limitations included a cross-sectional design and the lack of tardive illness severity assessment. As atypical antipsychotics continue to be primary mood stabilization treatment, attempting to harmonize large data sets to identify additional biomarkers of tardive risk will optimize individualized care for patients with BD.
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Affiliation(s)
| | | | | | - David Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Eric J Vallender
- Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, Jackson, MS
| | | | | | - Nicolas Nunez
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Marin Veldic
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Aysegul Ozerdem
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Balwinder Singh
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Matej Markota
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Colin L Colby
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Susan L McElroy
- Lindner Center of HOPE/University of Cincinnati, Cincinnati, OH
| | - Mark A Frye
- From the Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
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