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Kato T, Ogasawara K, Motomura K, Kato M, Tanaka T, Takaesu Y, Nio S, Kishi T, So M, Nemoto K, Suzuki E, Watanabe K, Matsuo K. Practice Guidelines for Bipolar Disorder by the JSMD (Japanese Society of Mood Disorders). Psychiatry Clin Neurosci 2024. [PMID: 39194164 DOI: 10.1111/pcn.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024]
Abstract
The Japanese Society of Mood Disorders (JSMD) published treatment guidelines of bipolar disorder in 2011. The present guidelines incorporating new findings were developed to comply to the guidelines of the National Academy of Medicine (NAM) by utilizing systematic reviews and meta-analysis and taking patient and family opinions as well as insights from multiple professional fields into account. They support combination therapy using mood stabilizers and second-generation antipsychotics in many aspects. They also have limitations, including the grouping of mood stabilizers and second-generation antipsychotics when meta-analysis was performed despite their distinct properties, due to the scarcity of drug-specific evidence. Despite the limitations, these guidelines provide clinical decision support for psychiatrists in Japan.
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Affiliation(s)
- Tadafumi Kato
- Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | - Keisuke Motomura
- Clinical Research Division, NHO Hizen Psychiatric Medical Center, Yoshinogari, Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Hirakata, Japan
| | - Teruaki Tanaka
- Deparment of Psychiatry, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate school of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Shintaro Nio
- Department of Psychiatry, Saiseikai Central Hospital, Tokyo, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mirai So
- Department of Psychiatry, Tokyo Dental College, Tokyo, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiji Suzuki
- Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Koji Matsuo
- Department of Psychiatry, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
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2
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Vinkers CH, Kupka RW, Penninx BW, Ruhé HG, van Gaalen JM, van Haaren PCF, Schellekens AFA, Jauhar S, Ramos-Quiroga JA, Vieta E, Tiihonen J, Veldman SE, Veling W, Vis R, de Wit LE, Luykx JJ. Discontinuation of psychotropic medication: a synthesis of evidence across medication classes. Mol Psychiatry 2024; 29:2575-2586. [PMID: 38503923 DOI: 10.1038/s41380-024-02445-4] [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] [Received: 08/25/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024]
Abstract
Pharmacotherapy is an effective treatment modality across psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies is vital to enable the best, personalized treatment for any given patient. Nonetheless, there is a scarcity of guidelines on discontinuation strategies. In this perspective, we therefore summarize and critically appraise the evidence on discontinuation of six major psychotropic medication classes: antidepressants, antipsychotics, benzodiazepines, mood stabilizers, opioids, and stimulants. For each medication class, a wide range of topics pertaining to each of the following questions are discussed: (1) Who can discontinue (e.g., what are risk factors for relapse?); (2) When to discontinue (e.g., after 1 year or several years of antidepressant use?); and (3) How to discontinue (e.g., what's the efficacy of dose reduction compared to full cessation and interventions to mitigate relapse risk?). We thus highlight how comparing the evidence across medication classes can identify knowledge gaps, which may pave the way for more integrated research on discontinuation.
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Affiliation(s)
- Christiaan H Vinkers
- Department of Psychiatry and Anatomy & Neurosciences, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental Health Program and Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brenda W Penninx
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Jakob M van Gaalen
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul C F van Haaren
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Sameer Jauhar
- Centre for Affective Disorders, Psychological Medicine, IoPPN, King's College, London, UK
| | - Josep A Ramos-Quiroga
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, 11364, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Stijn E Veldman
- Department of Psychiatry, Radboudumc, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
- Novadic-Kentron Addiction Care, Vught, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Roeland Vis
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Laura E de Wit
- Department of Psychiatry, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Jurjen J Luykx
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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Dols A, Kupka RW, Mathijssen H, Regeer EJ. The time has come to question the infinite maintenance treatment for bipolar disorders. Bipolar Disord 2024; 26:415-417. [PMID: 38736270 DOI: 10.1111/bdi.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph W Kupka
- Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Outpatient Clinic for Bipolar Disorders, Altrecht GGZ Mental Health Care Institute, Utrecht, The Netherlands
| | - Henk Mathijssen
- Plusminus (Dutch Patient Association for Bipolar Disorder), MIND (Dutch Online Platform for Mental Health), Utrecht, The Netherlands
| | - Eline J Regeer
- Outpatient Clinic for Bipolar Disorders, Altrecht GGZ Mental Health Care Institute, Utrecht, The Netherlands
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Hu Y, Xue H, Ni X, Guo Z, Fan L, Du W. Association between duration of antidepressant treatment for major depressive disorder and relapse rate after discontinuation: A meta-analysis. Psychiatry Res 2024; 337:115926. [PMID: 38733930 DOI: 10.1016/j.psychres.2024.115926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
The optimal duration of antidepressant treatment for patients with major depressive disorder to reduce the risk of relapse after discontinuation remains uncertain. Medline, Cochrane Central Register of Controlled Trials, and Embase were systematically searched for randomized controlled trials (RCTs) with a discontinuation design. A single-group summary meta-analysis was performed to calculate 6-month relapse rates after discontinuation. Meta-regression with restricted cubic splines was performed to model the non-linear relationship between treatment duration and relapse rate after discontinuation. Thirty-five RCTs were included. The relapse rate after discontinuation was approximately 34.81 % at 6 months and 45.12 % at 12 months. After controlling for covariates, the meta-analysis shows that the duration of treatment is associated with the risk of relapse after discontinuation in a non-linear curve, with a relatively higher risk of relapse observed for a duration of less than three months. There appears to be no further reduction in the risk of relapse when treatment is continued for over six months. Our results indicate the importance of at least three months of treatment to avoid the relatively high risk of relapse after discontinuation. The additional benefit of longer treatment remains to be proven.
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Affiliation(s)
- Yuhua Hu
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China
| | - Hui Xue
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China
| | - Xiaoyan Ni
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China
| | - Zhen Guo
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China
| | - Lijun Fan
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China
| | - Wei Du
- School of Public Health, Southeast University, 87 Ding Jiaqiao Rd., Nanjing, Jiangsu 210009, China.
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Kishi T, Citrome L, Sakuma K, Iwata N. A comparison of recurrence rates after discontinuation of second-generation antipsychotic long-acting injectable versus corresponding oral antipsychotic in the maintenance treatment of bipolar disorder: A systematic review. Psychiatry Res 2024; 333:115761. [PMID: 38301289 DOI: 10.1016/j.psychres.2024.115761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
It has been previously reported that among patients with schizophrenia that long-acting injectable (LAI) antipsychotic formulations can delay time to relapse longer when compared to their oral equivalents when patients discontinue therapy. Unanswered is whether this same pattern would be observed for patients with bipolar disorder receiving maintenance treatment. A systematic review was undertaken to identify relevant studies of LAI antipsychotics in maintenance treatment of bipolar disorder, employing a placebo-controlled randomized withdrawal design, and where equivalent studies using the corresponding oral formulation were also available. We found five studies [one aripiprazole monohydrate once monthly (AOM) study, one oral aripiprazole (OARI) study, two 2 weeks risperidone-LAI (RIS-LAI) studies, and one oral paliperidone (OPAL) study]. Numerically lower recurrence rates at 2, 4, 6, 8, 12, 16, 20, and 26 weeks were observed when AOM was discontinued when compared with discontinuation from OARI. Numerically lower recurrence rates at 2, 4, 6, 8, and 16 weeks were observed when RIS-LAI was discontinued when compared with discontinuation from OPAL. These results can be interpreted as a substantial delay in time to recurrence with a LAI antipsychotics formulation compared to the oral equivalent when medication is discontinued in patients with mania who had been stabilized on LAI antipsychotics or corresponding oral antipsychotics.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, United States
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
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Beunders AJM, Regeer EJ, van Eijkelen M, Mathijssen H, Nijboer C, Schouws SNTM, van Oppen P, Kok AAL, Kupka RW, Dols A. Bipolarity in Older individuals Living without Drugs (BOLD): Protocol and preliminary findings. J Affect Disord 2024; 348:160-166. [PMID: 38154581 DOI: 10.1016/j.jad.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/01/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Although clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment. METHODS The mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed. RESULTS BD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning. LIMITATIONS Our findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias. CONCLUSION A group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).
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Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Eline J Regeer
- Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Marieke van Eijkelen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | - Henk Mathijssen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | | | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
| | - Patricia van Oppen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Ralph W Kupka
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress, Amsterdam, the Netherlands.
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Alcantarilla L, López-Castro M, Betriu M, Torres A, Garcia C, Solé E, Gelabert E, Roca-Lecumberri A. Risk factors for relapse or recurrence in women with bipolar disorder and recurrent major depressive disorder in the perinatal period: a systematic review. Arch Womens Ment Health 2023; 26:737-754. [PMID: 37718376 DOI: 10.1007/s00737-023-01370-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
It is well known that the perinatal period supposes a considerable risk of relapse for women with bipolar disorder (BD) and recurrent major depressive disorder (rMDD), with the consequences that this entails. Therefore, the authors sought to provide a critical appraisal of the evidence related to specific risk factors for this population with the aim of improving the prevention of relapses during pregnancy and postpartum. The authors conducted a systematic review assessing 18 original studies that provided data on risk factors for relapse or recurrence of BD and/or rMDD in the perinatal period (pregnancy and postpartum). Recurrences of BD and rMDD are more frequent in the postpartum period than in pregnancy, with the first 4-6 weeks postpartum being especially complicated. In addition, women with BD type I are at higher risk than those with BD type II and rMDD, and the most frequent presentation of perinatal episodes of both disorders is a major depressive episode. Other risk factors consistently repeated were early age of onset of illnesses, severity criteria, primiparity, abrupt discontinuation of treatment, and personal or family history of perinatal affective episodes. This review shows that there are common and different risk factors according to the type of disorder and to perinatal timing (pregnancy or postpartum) that should be known for an adequate prevention of relapses.
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Affiliation(s)
- Laura Alcantarilla
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
- Psychiatry Service, Hospital de Sagunto, Valencia, Spain
| | - María López-Castro
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
- Psychiatry Service, Sant Pau's Biomedical Research Institute (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Betriu
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Torres
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Cristina Garcia
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eva Solé
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical Psychology and Health, Autonomous University of Barcelona, Barcelona, Spain
| | - Alba Roca-Lecumberri
- Perinatal Mental Health Unit CLINIC_BCN, Hospital Clínic de Barcelona, Barcelona, Spain.
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Bartoli F, Callovini T, Cavaleri D, Crocamo C, Riboldi I, Aguglia A, De Fazio P, Martinotti G, D'Agostino A, Ostuzzi G, Barbui C, Carrà G. Effect of long-acting injectable antipsychotics on 1-year hospitalization in bipolar disorder: a mirror-image study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1579-1586. [PMID: 36436121 DOI: 10.1007/s00406-022-01522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
Long-acting injectable (LAI) antipsychotics are often used for the long-term management also of bipolar disorder (BD). Nonetheless, evidence on their effect on pragmatic outcomes such as hospitalization risk in BD is inconsistent. We carried out a mirror-image study comparing rates and number of days of hospitalization, one year before and after the initiation of LAI treatment, in a sample of subjects with BD. Participants were selected from the STAR Network Depot Study, a pragmatic, observational, multicenter research involving a cohort of inpatients and outpatients consecutively started on LAI treatment. Variations in rates and in total number of days of hospitalization between the 12 months before and those after treatment initiation were analyzed. Among 461 individuals screened for eligibility, we included 71 adults with BD, initiated either on first- (FGA) or second-generation (SGA) LAIs. We found a significant decrease in terms of 12-month hospitalization rates (p < 0.001) and number of days (p < 0.001) after LAI initiation, without any effect by age, gender, alcohol/substance use disorders, and symptom severity. Subgroup analyses based on antipsychotic class, history of LAI treatment, and concomitant oral medications, confirmed the decreasing trend on both hospitalization rates and number of days. However, these reductions were not significant among participants who continued this treatment for less than 6 months. Comprehensively, this study supports the role of LAIs as effective maintenance treatment options for BD. Further research is needed to identify clinical characteristics of people with BD who would most benefit from long-acting formulations of antipsychotics.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, University 'Gabriele d'Annunzio' of Chieti, Pescara, Chieti, Italy
| | | | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, London, UK
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Rajkumar RP. Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990-2019. Diseases 2023; 11:116. [PMID: 37754312 PMCID: PMC10528187 DOI: 10.3390/diseases11030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of 30 years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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10
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Bartoli F, Bachi B, Calabrese A, Cioni RM, Guzzi P, Nasti C, Palpella D, Barbieri FF, Limonta S, Crocamo C, Carrà G. Effect of long-acting injectable antipsychotics on emergency department visits and hospital admissions in people with bipolar disorder: A retrospective mirror-image analysis from the Northern Milan Area Cohort (NOMIAC) study. J Affect Disord 2022; 318:88-93. [PMID: 36058358 DOI: 10.1016/j.jad.2022.08.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/24/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mood recurrences in bipolar disorder (BD) are often associated with poor treatment adherence. Despite long-acting injectable antipsychotics (LAIs) may favor treatment compliance, their use in BD is still poorly explored. METHODS This mirror-image study investigated the effect of LAIs initiation on the number of emergency department (ED) visits and days of hospitalization, among individuals with BD from the mental health services of a large area of the Metropolitan City of Milan. The mirror periods were 365 days either side of the LAI initiation. Individual medical records were retrospectively reviewed. RESULTS Sixty-eight individuals with BD initiating a LAI over the index period were included. We estimated that LAI initiation overall reduced both ED visits (p = 0.002) and days of hospitalization (p < 0.001). This remained true only for those participants who i) continued LAI for the entire 12-month period of observation and ii) were treated with a second-generation antipsychotic LAI. In addition, LAI initiation reduced number of hospitalization days during hypo/manic (p = 0.013), but not depressive (p = 0.641) episodes, as well as compulsory admission days (p = 0.002). LIMITATIONS Due to the retrospective design, we could not collect systematic information on symptom severity and reasons of LAI discontinuation. Moreover, the limited sample size did not allow us to estimate effectiveness of single LAI agents. CONCLUSIONS Our study provides additional insight on the effectiveness of LAIs in BD, supporting their clinical utility for pragmatic outcomes such as ED visits and hospitalizations. Further longitudinal research is needed to clarify the real-world effectiveness of LAIs for BD clinical management.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy.
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Riccardo Matteo Cioni
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Pierluca Guzzi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Christian Nasti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Dario Palpella
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Filippo Fabio Barbieri
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Serena Limonta
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy; Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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11
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Differences in the prophylactic effect of serum lithium levels on depression and mania in bipolar disorder: A dose-response meta-analysis. Eur Neuropsychopharmacol 2022; 58:20-29. [PMID: 35158229 DOI: 10.1016/j.euroneuro.2022.01.112] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 01/04/2023]
Abstract
The optimal serum lithium levels for preventing the recurrence of mood episodes in bipolar disorder are controversial, especially when polarity is considered. The present study aimed to comprehensively examine the dose-response relationship between lithium concentration and risk of recurrence of mood episodes. We conducted a systematic search of major databases before January 2021 (PROSPERO: CRD42021235812). A one-stage, random-effects, restricted cubic splines model was used to estimate the dose-response relationship between lithium concentration and risk of recurrence of any or specific mood episodes (depression or mania). The effect size is shown as odds ratio (OR). Our meta-analysis included six randomised controlled trials with a total of 975 participants. The dose-response curve showed that increased serum concentrations were associated with a gradual decrease in the risk of any mood episodes (OR 0.50 at 0.60 mmol/l, OR 0.15 at 1.20 mmol/l). The risk of depression decreased slightly with a concentration of 0.60 mmol/l (OR 0.83) but dropped rapidly as the concentration increased to 1.20 mmol/l (OR 0.39). By contrast, the risk for mania initially decreased steadily (OR 0.44), but decreased only marginally (OR 0.30) as the concentration increased. To reduce the recurrence risk to 56%, prevention of depression required a higher concentration than that required for mania (1.13 mmol/l vs. 0.60 mmol/l). Our results suggest a negative dose-response relationship between serum lithium levels and risk of recurrence. In particular, the different preventive effects of serum concentration on depression and mania will be an important clinical reference.
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12
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Nestsiarovich A, Gaudiot CES, Baldessarini RJ, Vieta E, Zhu Y, Tohen M. Preventing new episodes of bipolar disorder in adults: Systematic review and meta-analysis of randomized controlled trials. Eur Neuropsychopharmacol 2022; 54:75-89. [PMID: 34489127 DOI: 10.1016/j.euroneuro.2021.08.264] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Uncertainty remains regarding the relative efficacy of maintenance pharmacotherapy for bipolar disorder (BD), and available data require updating. The present systematic review and meta-analysis aims to consolidate the evidence from the highest quality randomized controlled trials (RCTs) published up to July 2021, overcoming the limitations of earlier reviews. The PubMed and the Cochrane Central Register of Controlled Trials were searched for double-blind RCTs involving lithium, mood stabilizing anticonvulsants (MSAs), antipsychotics, antidepressants, and other treatments. Rates of new mood episodes with test vs. reference treatments (placebo or alternative active agent) were compared by random-effects meta-analysis. Polarity index was calculated for each treatment type. Eligible trials involved ≥6 months of maintenance follow up. Of 2,158 identified reports, 22 met study eligibility criteria, and involved 7,773 subjects stabilized for 1-12 weeks and followed-up for 24-104 weeks. Psychotropic monotherapy overall (including lithium, MSAs, and second generation antipsychotics (SGA) was more effective in preventing new BD episodes than placebo (odds ratio, OR=0.42; 95% confidence interval, CI 0.34-0.51, p<0.00001). Significantly lower risk of new BD episodes was observed with the following individual drugs: aripiprazole, asenapine, lithium, olanzapine, quetiapine, and risperidone long-acting (ORs varied 0.19-0.46). Adding aripiprazole, divalproex, quetiapine, or olanzapine/risperidone to lithium or an MSA was more effective compared with lithium or MSA monotherapy (OR=0.37; 95%CI 0.25-0.55, p<0.00001). Active treatment favored prevention of mania over depression. The key limitations were "responder-enriched" design in most trials and high outcomes heterogeneity. PROSPERO registration number is CRD42020162663.
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Affiliation(s)
- Anastasiya Nestsiarovich
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Christopher E S Gaudiot
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA; International Consortium for Bipolar & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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13
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Rotenberg LDS, Borges-Júnior RG, Lafer B, Salvini R, Dias RDS. Exploring machine learning to predict depressive relapses of bipolar disorder patients. J Affect Disord 2021; 295:681-687. [PMID: 34509784 DOI: 10.1016/j.jad.2021.08.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic mood disorder characterized by recurrent episodes of mania or hypomania and depression, expressed by changes in energy levels and behavior. However, most of relapse studies use evidence-based approaches with statistical methods. With the advance of the precision medicine this study aims to use machine learning (ML) approaches as a possible predictor in depressive relapses in BD. METHOD Four accepted and well used ML algorithms (Support Vector Machines, Random Forests, Naïve Bayes, and Multilayer Perceptron) were applied to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) dataset in a cohort of 800 patients (507 patients presented depressive relapse and 293 did not), who became euthymic during the study and were followed for one year. RESULTS The ML algorithms presented reasonable performance in the prediction task, ranging from 61 to 80% in the F-measure. The Random Forest algorithm obtained a higher average of performance (Relapse Group 68%; No Relapse Group 74%). The three most important mood symptoms observed in the relapse visit (Random Forest) were: interest; depression mood and energy. LIMITATIONS Social and psychological parameters such as marital status, social support system, personality traits, might be an important predictor in depressive relapses, although we did not compute this data in our study. CONCLUSIONS Our findings indicate that applying precision medicine models by means of machine learning in BD studies could be feasible as a sensible approach to better support medical decision-making in the BD treatment and prevention of future relapses.
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Affiliation(s)
- Luisa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Rogerio Salvini
- Instituto de Informática, Universidade Federal de Goiás, Goiás, Brazil
| | - Rodrigo da Silva Dias
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil.
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14
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Stevens AWMM, Draisma S, Goossens PJJ, Broekman BFP, Honig A, der Klein EAMKV, Nolen WA, Post RM, Kupka RW. The course of bipolar disorder in pregnant versus non-pregnant women. Int J Bipolar Disord 2021; 9:35. [PMID: 34734318 PMCID: PMC8566649 DOI: 10.1186/s40345-021-00239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background and rationale Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. Methods Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. Results No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). Conclusions Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.
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Affiliation(s)
- Anja W M M Stevens
- Center for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands. .,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Stasja Draisma
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Specialized Mental Health Care, Research and Innovation Amsterdam, Amsterdam, The Netherlands
| | - Peter J J Goossens
- Center for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Birit F P Broekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, The Netherlands
| | - Adriaan Honig
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Willem A Nolen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Bipolar Collaborative Network, Bethesda, MD, USA
| | - Robert M Post
- Bipolar Collaborative Network, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, District of Columbia, George Washington University, Washington, USA
| | - R W Kupka
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Specialized Mental Health Care, Research and Innovation Amsterdam, Amsterdam, The Netherlands.,Bipolar Collaborative Network, Bethesda, MD, USA
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15
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Kishi T, Matsuda Y, Sakuma K, Okuya M, Mishima K, Iwata N. Recurrence Rates in Stable Bipolar Disorder Patients after Drug Discontinuation versus Drug Maintenance: A Systematic Review and Meta-analysis - Corrigendum. Psychol Med 2021; 51:2730. [PMID: 33757608 DOI: 10.1017/s0033291721001033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Yuki Matsuda
- Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Makoto Okuya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
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16
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Lambrichts S, Vansteelandt K, Crauwels B, Obbels J, Pilato E, Denduyver J, Ernes K, Maebe P, Migchels C, Roosen L, Buggenhout S, Bouckaert F, Schrijvers D, Sienaert P. Relapse after abrupt discontinuation of maintenance electroconvulsive therapy during the COVID-19 pandemic. Acta Psychiatr Scand 2021; 144:230-237. [PMID: 34086984 PMCID: PMC8212096 DOI: 10.1111/acps.13334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Maintenance electroconvulsive therapy (M-ECT) is considered an effective relapse prevention strategy in severe mood and psychotic disorders. How long M-ECT should be continued, and what the outcome is after its discontinuation has not been adequately studied. In our tertiary psychiatric hospital, M-ECT treatments were suspended at the start of the COVID-19 pandemic. We aimed to determine the 6-month relapse rate and time to relapse after abrupt discontinuation of M-ECT and to assess the impact of patient and treatment characteristics on the risk of relapse. METHODS Eighty-one patients whose M-ECT was discontinued abruptly were followed up prospectively for 6 months, or until relapse (i.e., hospital admission, restart of ECT, change of pharmacotherapy, or suicide (attempt)). We used multivariable Cox proportional hazards models to assess the impact of patient and treatment characteristics on the risk of relapse. RESULTS Thirty-six patients (44.44%) relapsed within 6 months following abrupt discontinuation of M-ECT. A greater number of previous acute ECT courses, a diagnosis of psychotic disorder (compared with major depressive disorder or bipolar disorder), and a shorter interval between M-ECT treatments at the time of discontinuation were significantly associated with increased risk of relapse. CONCLUSION Almost half of the patients relapsed, similar to the relapse rate after a successful acute course of ECT. Patients with a shorter interval between M-ECT treatments at the time of discontinuation seem to be at increased risk, as well as patients with a diagnosis of psychotic disorder, compared to patients with mood disorders.
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Affiliation(s)
- Simon Lambrichts
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Kristof Vansteelandt
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Bo Crauwels
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Jasmien Obbels
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Eva Pilato
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Jonas Denduyver
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Katrien Ernes
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Pieter‐Paul Maebe
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Charlotte Migchels
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Lore Roosen
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Satya Buggenhout
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Filip Bouckaert
- KU LeuvenUniversity Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI)UAntwerpAntwerpBelgium
| | - Pascal Sienaert
- KU LeuvenDepartment of NeurosciencesResearch Group PsychiatryNeuropsychiatryAcademic Center for ECT and Neuromodulation (AcCENT)University Psychiatric Center KU Leuven (UPC KU LeuvenKortenbergBelgium
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17
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Grunze A, Amann BL, Grunze H. Efficacy of Carbamazepine and Its Derivatives in the Treatment of Bipolar Disorder. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:433. [PMID: 33946323 PMCID: PMC8146840 DOI: 10.3390/medicina57050433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug-drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.
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Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany;
| | - Benedikt L. Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, 08019 Barcelona, Spain;
- Department of Psychiatry Autonomous, University of Barcelona, CIBERSAM, 28029 Madrid, Spain
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany
- Paracelsus Medical University, 90419 Nuremberg, Germany
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Sleem A, El-Mallakh RS. Advances in the psychopharmacotherapy of bipolar disorder type I. Expert Opin Pharmacother 2021; 22:1267-1290. [PMID: 33612040 DOI: 10.1080/14656566.2021.1893306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Research into the pharmacologic management of bipolar type I illness continues to progress. AREAS COVERED Randomized clinical trials performed with type I bipolar disorder in the years 2015 to August 2020 are reviewed. There are new indications for the use of cariprazine, for bipolar mania and depression, and a long-acting injectable formulation of aripiprazole has also been approved for relapse prevention in bipolar illness. Most of the randomized clinical trials are effectiveness studies. EXPERT OPINION Over the 20 years from 1997 through 2016, the use of lithium and other mood stabilizers has declined by 50%, while the use of both second-generation antipsychotics (SGAs) and antidepressants has increased considerably. Over the same time period (1990-2017), disability-adjusted life years (DALYs) increased by 54.4%, from 6.02 million in 1990 to 9.29 million in 2017 which is greater than the 47.74% increase in incidence of the disease, suggesting that the changes in prescribing patterns have not been helpful for our patients. Furthermore, recent effectiveness studies continue to confirm the superiority of lithium and other mood stabilizers in the management of bipolar illness for both psychiatric and medical outcomes, reaffirming their role as foundational treatments in the management of type I bipolar disorder. Clinicians need to reassess their prescribing habits.
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Affiliation(s)
- Ahmad Sleem
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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