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Stephan Y, Sutin AR, Terracciano A. Personality traits and polypharmacy: meta-analysis of five samples. Psychol Health 2024:1-15. [PMID: 38764247 DOI: 10.1080/08870446.2024.2352182] [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: 05/25/2023] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE The present study examined the prospective relationship between personality traits and the risk of polypharmacy. METHODS AND MEASURES Participants (age range: 16-101 years; N > 15,000) were from the English Longitudinal Study of Ageing (ELSA), the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the Wisconsin Longitudinal Study of Aging (WLS), and the Longitudinal Internet Studies for the Social Sciences (LISS). In each sample, personality traits and demographic factors were assessed at baseline. Number of medications was obtained from 2 to 20 years later. RESULTS Random-effect meta-analyses revealed that higher neuroticism was related to a higher risk of polypharmacy (Odd Ratio = 1.30; 95% CI 1.17-1.46) and excessive polypharmacy (Odd Ratio = 1.44; 95% CI 1.18-1.77) whereas higher conscientiousness (Odd Ratio = 0.84; 95% CI 0.74-0.95) and extraversion (Odd Ratio = 0.85; 95% CI 0.73-0.98) were associated with a lower risk of polypharmacy. Openness and agreeableness were unrelated to polypharmacy. Body mass index, number of chronic conditions, and depressive symptoms partially mediated the association between personality and the number of medications. CONCLUSION The present study provides replicable and robust evidence that neuroticism is a risk factor for simultaneous use of multiple medications, whereas conscientiousness and extraversion may play a protective role.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, USA
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2
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Bortolasci CC, Kidnapillai S, Spolding B, Truong TTT, Connor T, Swinton C, Panizzutti B, Liu ZSJ, Sanigorski A, Dean OM, Crowley T, Richardson M, Bozaoglu K, Vlahos K, Cowdery S, Watmuff B, Steyn SF, Wolmarans DW, Engelbrecht BJ, Perry C, Drummond K, Pang T, Jamain S, Gray L, McGee SL, Harvey BH, Kim JH, Leboyer M, Berk M, Walder K. Use of a gene expression signature to identify trimetazidine for repurposing to treat bipolar depression. Bipolar Disord 2023; 25:661-670. [PMID: 36890661 PMCID: PMC10946906 DOI: 10.1111/bdi.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVES The aim of this study was to repurpose a drug for the treatment of bipolar depression. METHODS A gene expression signature representing the overall transcriptomic effects of a cocktail of drugs widely prescribed to treat bipolar disorder was generated using human neuronal-like (NT2-N) cells. A compound library of 960 approved, off-patent drugs were then screened to identify those drugs that affect transcription most similar to the effects of the bipolar depression drug cocktail. For mechanistic studies, peripheral blood mononuclear cells were obtained from a healthy subject and reprogrammed into induced pluripotent stem cells, which were then differentiated into co-cultured neurons and astrocytes. Efficacy studies were conducted in two animal models of depressive-like behaviours (Flinders Sensitive Line rats and social isolation with chronic restraint stress rats). RESULTS The screen identified trimetazidine as a potential drug for repurposing. Trimetazidine alters metabolic processes to increase ATP production, which is thought to be deficient in bipolar depression. We showed that trimetazidine increased mitochondrial respiration in cultured human neuronal-like cells. Transcriptomic analysis in induced pluripotent stem cell-derived neuron/astrocyte co-cultures suggested additional mechanisms of action via the focal adhesion and MAPK signalling pathways. In two different rodent models of depressive-like behaviours, trimetazidine exhibited antidepressant-like activity with reduced anhedonia and reduced immobility in the forced swim test. CONCLUSION Collectively our data support the repurposing of trimetazidine for the treatment of bipolar depression.
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Affiliation(s)
- Chiara C. Bortolasci
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Srisaiyini Kidnapillai
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Briana Spolding
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Trang T. T. Truong
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Timothy Connor
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Courtney Swinton
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Bruna Panizzutti
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Zoe S. J. Liu
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Andrew Sanigorski
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Olivia M. Dean
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Tamsyn Crowley
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
- Bioinformatics Core Research Facility (BCRF)Deakin UniversityGeelongAustralia
| | - Mark Richardson
- Bioinformatics Core Research Facility (BCRF)Deakin UniversityGeelongAustralia
| | - Kiymet Bozaoglu
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Katerina Vlahos
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Stephanie Cowdery
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Brad Watmuff
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Stephan F. Steyn
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health SciencesNorth‐West UniversityPotchefstroomSouth Africa
| | - De Wet Wolmarans
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health SciencesNorth‐West UniversityPotchefstroomSouth Africa
| | - Barend J. Engelbrecht
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health SciencesNorth‐West UniversityPotchefstroomSouth Africa
| | - Christina Perry
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Katherine Drummond
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Terence Pang
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Stéphane Jamain
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, AP‐HP, DMU IMPACT, FHU ADAPTFondation FondaMentalCréteilFrance
| | - Laura Gray
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Sean L. McGee
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
| | - Brian H. Harvey
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health SciencesNorth‐West UniversityPotchefstroomSouth Africa
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health and Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Jee Hyun Kim
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
| | - Marion Leboyer
- Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, AP‐HP, DMU IMPACT, FHU ADAPTFondation FondaMentalCréteilFrance
| | - Michael Berk
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
- The Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
| | - Ken Walder
- IMPACTThe Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityGeelongAustralia
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3
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Yoshida Y, Ishizaki T, Masui Y, Arai Y, Inagaki H, Ogawa M, Yasumoto S, Iwasa H, Kamide K, Rakugi H, Ikebe K, Gondo Y. Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study. BMC Geriatr 2022; 22:372. [PMID: 35484487 PMCID: PMC9047377 DOI: 10.1186/s12877-022-03069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults. Methods This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI. Results The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy. Conclusions Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan.
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yasumichi Arai
- Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Madoka Ogawa
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | | | - Hajime Iwasa
- Fukushima Medical University, 1 Hikariga-oka, Fukushima, Japan
| | - Kei Kamide
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiromi Rakugi
- Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
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4
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Abstract
Many patients under treatment for mood disorders, in particular patients with bipolar mood disorders, experience episodes of mood switching from one state to another. Various hypotheses have been proposed to explain the mechanism of mood switching, spontaneously or induced by drug treatment. Animal models have also been used to test the role of psychotropic drugs in the switching of mood states. We examine the possible relationship between the pharmacology of psychotropic drugs and their reported incidents of induced mood switching, with reference to the various hypotheses of mechanisms of mood switching.
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5
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Ortelbach N, Rote J, Dingelstadt AML, Stolzenburg A, Koenig C, O'Malley G, Quinlivan E, Fiebig J, Pfeiffer S, König B, Simhandl C, Bauer M, Pfennig A, Stamm TJ. The big five model in bipolar disorder: a latent profile analysis and its impact on longterm illness severity. Int J Bipolar Disord 2022; 10:1. [PMID: 35041119 PMCID: PMC8766615 DOI: 10.1186/s40345-021-00248-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Using a personality typing approach, we investigated the relationship between personality profiles and the prediction of longterm illness severity in patients with bipolar disorder (BD). While previous research suggests associations between BD and traits from the NEO-FFI profiles, the current study firstly aimed to identify latent classes of NEO-FFI profiles, and, secondly, to examine their impact on the longterm prognosis of BD. Methods Based on the NEO-FFI profiles of 134 euthymic patients diagnosed with BD (64.2% female, mean age = 44.3 years), successive latent profile analyses were conducted. Subsequently, a subsample (n = 80) was examined prospectively by performing multiple regression analysis of the latent classes to evaluate the longitudinal course of the disease (mean: 54.7 weeks) measured using a modified Morbidity Index. Results The latent profile analyses suggested a 3-class model typifying in a resilient (n = 68, 51%), vulnerable (n = 55, 41%) and highly vulnerable (n = 11, 8%) class. In the regression analysis, higher vulnerability predicted a higher longterm Morbidity Index (R2 = 0.28). Conclusions Subgroups of patients with BD share a number of discrete personality features and their illness is characterized by a similar clinical course. This knowledge is valuable in a variety of clinical contexts including early detection, intervention planning and treatment process.
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Affiliation(s)
- Niklas Ortelbach
- Department of Educational Science and Psychology, Free University of Berlin, Berlin, Germany
| | - Jonas Rote
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Alice Mai Ly Dingelstadt
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Stolzenburg
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Cornelia Koenig
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Grace O'Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.,Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | | | - Christian Simhandl
- Bipolar Center, Wiener Neustadt, Austria.,Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Thomas J Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Fehrbelliner Straße 38, 16816, Neuruppin, Germany. .,Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Mecklenburg-Western Pomerania, Germany.
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6
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Adachi N, Azekawa T, Edagawa K, Goto E, Hongo S, Kato M, Katsumoto E, Kikuchi T, Kubota Y, Miki K, Nakagawa A, Tsuboi T, Ueda H, Watanabe K, Watanabe Y, Yasui-Furukori N, Yoshimura R. Estimated model of psychotropic polypharmacy for bipolar disorder: Analysis using patients' and practitioners' parameters in the MUSUBI study. Hum Psychopharmacol 2021; 36:e2764. [PMID: 33089907 DOI: 10.1002/hup.2764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aims to clarify the relevant factors influencing practitioners' methods of prescribing medications for bipolar disorder, in a nation-wide survey in Japan. METHODS The clinical records of 3130 outpatients with bipolar disorder were consecutively reviewed from 176 psychiatric outpatient clinics. Fifteen parameters, that is, five patients' including five general characteristics (sex, age, education, occupation, and social adjustment), five patients' aspects of mental functioning (onset age, comorbid mental illness, rapid-cycling, psychopathologic severity, and followed-up years), and five practitioners' characteristics (sex, age, specialist experience, clinic standing years, and location), were evaluated. The number of psychotropic drugs (mood stabilizers, antidepressants, antipsychotic drugs, anxiolytics, and hypnotics) was used as an index of pharmacotherapy. Converted data from each practitioner-unit were analyzed. RESULTS Seven factors (patient's social adjustment, patient's psychopathology, patient's comorbid mental disorders, patient's followed-up years, doctor's age, clinic running years, and patient's education years) were correlated to the number of psychotropic drugs. Multiple regression analysis showed that the severity of illness (poor social adjustment, and comorbid mental illness) and an intractable disease course (long followed-up years), were significantly associated with the number of psychotropic drugs. CONCLUSION Our findings indicated that patient-related conditions affected psychotropic polypharmacy more strongly than did practitioner-related conditions.
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Affiliation(s)
| | | | | | | | | | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | | | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, School of Medicine, Kyorin University, Mitaka, Japan
| | | | - Koichiro Watanabe
- Department of Neuropsychiatry, School of Medicine, Kyorin University, Mitaka, Japan
| | | | | | - Reiji Yoshimura
- University of Occupational and Environment Health, Kitakyushu, Japan
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7
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Kidnapillai S, Bortolasci CC, Udawela M, Panizzutti B, Spolding B, Connor T, Sanigorski A, Dean OM, Crowley T, Jamain S, Gray L, Scarr E, Leboyer M, Dean B, Berk M, Walder K. The use of a gene expression signature and connectivity map to repurpose drugs for bipolar disorder. World J Biol Psychiatry 2020; 21:775-783. [PMID: 29956574 DOI: 10.1080/15622975.2018.1492734] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To create a gene expression signature (GES) to represent the biological effects of a combination of known drugs for bipolar disorder (BD) on cultured human neuronal cells (NT2-N) and rat brains, which also has evidence of differential expression in individuals with BD. To use the GES to identify new drugs for BD using Connectivity Map (CMap).Methods: NT2-N (n = 20) cells and rats (n = 8) were treated with a BD drug combination (lithium, valproate, quetiapine and lamotrigine) or vehicle for 24 and 6 h, respectively. Following next-generation sequencing, the differential expression of genes was assessed using edgeR in R. The derived GES was compared to differentially expressed genes in post-mortem brains of individuals with BD. The GES was then used in CMap analysis to identify similarly acting drugs.Results: A total of 88 genes showed evidence of differential expression in response to the drug combination in both models, and therefore comprised the GES. Six of these genes showed evidence of differential expression in post-mortem brains of individuals with BD. CMap analysis identified 10 compounds (camptothecin, chlorambucil, flupenthixol, valdecoxib, rescinnamine, GW-8510, cinnarizine, lomustine, mifepristone and nimesulide) acting similarly to the BD drug combination.Conclusions: This study shows that GES and CMap can be used as tools to repurpose drugs for BD.
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Affiliation(s)
- Srisaiyini Kidnapillai
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Chiara C Bortolasci
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Madhara Udawela
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Bruna Panizzutti
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA) and Programa de Pós-graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Briana Spolding
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Timothy Connor
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Andrew Sanigorski
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Olivia M Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, the University of Melbourne, Parkville, Australia
| | - Tamsyn Crowley
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,Bioinformatics Core Research Facility (BCRF), Deakin University, Geelong, Australia
| | - Stéphane Jamain
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Laura Gray
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Elizabeth Scarr
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, The University of Melbourne, Victoria, Australia
| | - Marion Leboyer
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Brian Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Faculty of Health Arts and Design, Centre for Mental Health, Swinburne University, Victoria, Australia
| | - Michael Berk
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Department of Psychiatry, the University of Melbourne, Parkville, Australia.,Orygen, the National, Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
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8
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Kidnapillai S, Wade B, Bortolasci CC, Panizzutti B, Spolding B, Connor T, Crowley T, Jamain S, Gray L, Leboyer M, Berk M, Walder K. Drugs used to treat bipolar disorder act via microRNAs to regulate expression of genes involved in neurite outgrowth. J Psychopharmacol 2020; 34:370-379. [PMID: 31913086 DOI: 10.1177/0269881119895534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The drugs commonly used to treat bipolar disorder have limited efficacy and drug discovery is hampered by the paucity of knowledge of the pathophysiology of this disease. This study aims to explore the role of microRNAs in bipolar disorder and understand the molecular mechanisms of action of commonly used bipolar disorder drugs. METHODS The transcriptional effects of bipolar disorder drug combination (lithium, valproate, lamotrigine and quetiapine) in cultured human neuronal cells were studied using next generation sequencing. Differential expression of genes (n=20) and microRNAs (n=6) was assessed and the differentially expressed microRNAs were confirmed with TaqMan MicroRNA Assays. The expression of the differentially expressed microRNAs were inhibited to determine bipolar disorder drug effects on their target genes (n=8). Independent samples t-test was used for normally distributed data and Kruskal-Wallis/Mann-Whitney U test was used for data not distributed normally. Significance levels were set at p<0.05. RESULTS We found that bipolar disorder drugs tended to increase the expression of miR-128 and miR-378 (p<0.05). Putative target genes of these microRNAs targeted pathways including those identified as "neuron projection development" and "axonogenesis". Many of the target genes are inhibitors of neurite outgrowth and neurogenesis and were downregulated following bipolar disorder drug combination treatment (all p<0.05). The bipolar disorder drug combination tended to decrease the expression of the target genes (NOVA1, GRIN3A, and VIM), however this effect could be reversed by the application of microRNA inhibitors. CONCLUSIONS We conclude that at a transcriptional level, bipolar disorder drugs affect several genes in concert that would increase neurite outgrowth and neurogenesis and hence neural plasticity, and that this effect is mediated (at least in part) by modulation of the expression of these two key microRNAs.
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Affiliation(s)
| | - Ben Wade
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia
| | - Chiara C Bortolasci
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia
| | - Bruna Panizzutti
- Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Briana Spolding
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia
| | - Timothy Connor
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia
| | - Tamsyn Crowley
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia.,Bioinformatics Core Research Facility (BCRF), Deakin University, Geelong, VIC, Australia
| | | | - Laura Gray
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | | | - Michael Berk
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, Deakin University, Geelong, VIC, Australia
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9
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Perugi G, Medda P, Barbuti M, Novi M, Tripodi B. The Role of Electroconvulsive Therapy in the Treatment of Severe Bipolar Mixed State. Psychiatr Clin North Am 2020; 43:187-197. [PMID: 32008684 DOI: 10.1016/j.psc.2019.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Electroconvulsive therapy (ECT) results effective in two-thirds of the patients with severe and drug-resistant mixed states. The episode duration is the main predictor of nonresponse. This practice may increase the risk of mood destabilization and chronic complications and may decrease the chance of recovery in many patients. Compared with the burden of neurologic and metabolic side effects associated with long-term use of complex pharmacologic regimens, ECT should be considered a safe option with a very low incidence of severe adverse events and a long-term nondestabilizing effect.
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy; Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Margherita Barbuti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Martina Novi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Beniamino Tripodi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy
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10
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Kidnapillai S, Bortolasci CC, Panizzutti B, Spolding B, Connor T, Bonifacio K, Sanigorski A, Dean OM, Crowley T, Jamain S, Gray L, Leboyer M, Berk M, Walder K. Drugs used in the treatment of bipolar disorder and their effects on cholesterol biosynthesis - A possible therapeutic mechanism. World J Biol Psychiatry 2019; 20:766-777. [PMID: 31535581 DOI: 10.1080/15622975.2019.1669823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To understand the therapeutic mechanisms of bipolar disorder (BD) drugs at molecular and cellular levels.Methods: Next generation sequencing was used to determine the transcriptional effects of a combination of four commonly prescribed BD drugs (lithium, valproate, lamotrigine and quetiapine) or vehicle (0.2% DMSO) in NT2-N (human neuronal) cells and rats. Differential expression of genes and pathway analysis were performed using edgeR in R and Gene Set Enrichment Analysis software respectively. Free cholesterol levels and neurite outgrowth were quantified in NT2-N cells following combination and individual BD drug treatments.Results: Pathway analysis showed up-regulation of many elements of the cholesterol biosynthesis pathway in NT2-N cells and oxidative phosphorylation in rat brains. Intracellular cholesterol transport genes were upregulated (NPC1, NPC2 and APOE), while the cholesterol efflux gene (ABCA1) was downregulated. BD drug combination tended to increase intracellular cholesterol levels and neurite outgrowth, but these effects were not seen for the drugs when used individually.Conclusions: These data suggest that BD drug combination is increasing cholesterol biosynthesis and the newly synthesised cholesterol is being utilised within the cells, possibly for synthesis of new membranes to facilitate neurite outgrowth. This mechanism possibly underpins clinical efficacy in individuals with BD treated with polypharmacy.
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Affiliation(s)
- Srisaiyini Kidnapillai
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Chiara C Bortolasci
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Bruna Panizzutti
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA) and Programa de Pós-graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Briana Spolding
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Timothy Connor
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Kamila Bonifacio
- Laboratory of Graduation Research, State University of Londrina, Londrina, Brazil
| | - Andrew Sanigorski
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Olivia M Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Tamsyn Crowley
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,Bioinformatics Core Research Facility (BCRF), Deakin University, Geelong, Australia
| | - Stéphane Jamain
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Laura Gray
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Marion Leboyer
- INSERM U955, Psychiatrie Translationnelle, Université Paris Est, Créteil, France
| | - Michael Berk
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Australia Parkville.,Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
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11
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Cotton SM, Berk M, Jackson H, Murray G, Filia K, Hasty M, Chanen A, Davey C, Nelson B, Ratheesh A, MacNeil C. Improving functional outcomes in early-stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial. Early Interv Psychiatry 2019; 13:1470-1479. [PMID: 30740882 DOI: 10.1111/eip.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/29/2018] [Accepted: 01/13/2019] [Indexed: 01/26/2023]
Abstract
AIM Young people with bipolar disorder (BD) commonly experience reduced quality of life, persistent symptoms and impaired functional recovery despite often superior school performance. Compromised long-term functioning can ensue. There is evidence that psychological therapies alongside pharmacology may be more efficacious earlier in the course of the disorder. Intervention in the early stages may thus reduce the burden and risk associated with BD and mitigate the impact of the disorder on normal developmental trajectories. To date, however, the availability of evidence-based psychological therapies for young people with early BD is limited. Furthermore, there are no large-scale randomized controlled trials (RCTs) of such interventions. METHODS The study is a prospective, single-blind, RCT examining the effectiveness of an adjunctive individualized and manualized psychological intervention, compared with treatment as usual within youth-specific early intervention services. The REsearch into COgnitive and behavioural VERsatility (RECOVER) intervention is delivered over a 6-month period. About 122 young people in the early stages of BD-I (at least one manic episode in the previous 2 years, with no more than five lifetime treated/untreated manic or hypomanic episodes) will be recruited. The assessments will occur at baseline, 3, 6 (primary endpoint, end of treatment), 9, 12, 15 and 18 months. RESULTS Recruitment will commence in January 2019 and is anticipated to occur over a 3.5-year period. CONCLUSIONS To date, there are no evidence-based psychological therapies tailored to young people with early BD. We will test whether early psychological intervention in the course of BD can reduce the symptomatic, psychological, vocational and social impacts that are seen in entrenched disorder.
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Affiliation(s)
- Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,IMPACT Strategic Research Centre, Deakin University, School of Medicine, Geelong, Victoria, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health, Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Filia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Hasty
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Andrew Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Craig MacNeil
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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12
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Goldberg JF. Complex Combination Pharmacotherapy for Bipolar Disorder: Knowing When Less Is More or More Is Better. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:218-231. [PMID: 32047367 PMCID: PMC6999211 DOI: 10.1176/appi.focus.20190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Combination pharmacotherapy for bipolar disorder is commonplace and often reflects the severity and complexity of the illness and the comorbid conditions frequently associated with it. Across treatment settings, about one-fifth of patients with bipolar disorder appear to receive four or more psychotropic medications. Practice patterns often outpace the evidence-based literature, insofar as few systematic studies have examined the efficacy and safety of two or more medications for any given phase of illness. Most randomized trials of combination pharmacotherapy focus on the utility of pairing a mood stabilizer with a second-generation antipsychotic for prevention of either acute mania or relapse. In real-world practice, patients with bipolar disorder often take more elaborate combinations of mood stabilizers, antipsychotics, antidepressants, anxiolytics, stimulants, and other psychotropics for indefinite periods that do not necessarily arise purposefully and logically. In this article, I identify clinical factors associated with complex combination pharmacotherapy for patients with bipolar disorder; describe approaches to ensuring that each component of a treatment regimen has a defined role; discuss the elimination of unnecessary, ineffective, or redundant drugs in a regimen; and address complementary, safe, rationale-based drug combinations that target specific domains of psychopathology for which monotherapies often provide inadequate benefit.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City
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13
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Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC Geriatr 2018; 18:309. [PMID: 30541459 PMCID: PMC6292154 DOI: 10.1186/s12877-018-1001-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people. METHODS The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April 2013. Demographic and baseline clinical characteristics including sex, age, education, living alone or with others, access to health care privilege and monthly income were described. The number of medication, physical diseases and mental health problems (i.e. depression, anxiety, and personality trait of neuroticism) were analyzed using descriptive statistics, chi-square and proportional odds logistic regression. RESULTS The 803 participants consumed an average of 2.13 prescribed medicines daily (SD 1.46, median = 2). The largest group used 3 medications (18.6%). Predictors found to be associated with polypharmacy in the logistic regression model included hypertension (OR = 1.985, 95% CI = 1.420-2.775), anxiety disorder (OR = 4.402, 95% CI = 2.630-7.367), number of diseases (OR = 2.140, 95% CI = 1.874-2.445), depressive disorder (OR = 1.470, 95% CI = 1.080-2.001), diabetes mellitus (OR = 1.864, 95% CI = 1.122-3.098) and dyslipidemia (OR = 0.511, 95%CI = 0.325-0.803). CONCLUSIONS The prevalence of polypharmacy among Thai elderly was relatively high compared to other related studies. Several aspects should be taken into consideration before starting an additional medication in elderly patients. In addition to the number of physical disease that leads to polypharmacy, general practitioners should be aware of anxiety, depression, and personality trait of neuroticism that may be related to polypharmacy. Early detection for such condition as well as non-pharmacological intervention could be one way to help reduce polypharmacy in the elderly.
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Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Thanitha Sirirak
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90112, Thailand
| | - Rewadee Jenraumjit
- Department of Pharmaceutical care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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14
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Dehning J, Grunze H, Walpoth-Niederwanger M, Kemmler G, Hausmann A. The use of (newer) antipsychotics in bipolar inpatients over a 17-year observation period. Int Clin Psychopharmacol 2018; 33:297-303. [PMID: 30095482 DOI: 10.1097/yic.0000000000000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antipsychotics (AP) are commonly used in the treatment of bipolar disorder. They cover a broad spectrum of indications including acute psychotic, manic and depressive symptoms, and maintenance treatment. This study evaluates the changes in prescribing patterns of first-generation antipsychotics (FGA) and second-generation AP at Innsbruck University Hospital for the treatment of bipolar inpatients between 1999 and 2016. In this retrospective chart review, we included adult patients with a diagnosis of bipolar affective disorder (ICD 9: F296; ICD 10: F31) who were admitted as inpatients at the Department for Psychiatry and Psychotherapy between 1999 and 2016 for more than 7 days. The study was approved by the local ethics committee. The complete medical histories were searched retrospectively for the prescription of psychotropic medications at the time of discharge, with a special focus on APs. We found a significant increase in the use of atypical AP, mainly attributable to the prescription of quetiapine for all types of episodes, followed by aripiprazole for manic and as add-on therapy for depressive episodes. The prescription rate of clozapine decreased significantly. The prescription rate of FGA showed a small but not significant decrease for the treatment of manic and mixed episodes, and a significant decrease for depressive episodes. These trends apparently mirror in part the evidence base for the use of AP, but also illustrate that clinicians still appreciate the effectiveness of FGA despite their inferior tolerability profile.
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Affiliation(s)
- Julia Dehning
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Heinz Grunze
- Zentrum für Psychiatrie Weinsberg, Klinikum am Weissenhof, Weinsberg
- Paracelsus Medical University, Nürnberg, Germany
| | | | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Armand Hausmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
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15
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Jaracz J, Rudnicka ET, Bierejszyk M, Witczyk K, Raczyńska A, Nowak W, Pisarczyk A, Woźniak K, Czernaś W, Moniakowski A, Jaracz K. The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland. Pharmacol Rep 2018; 70:694-698. [DOI: 10.1016/j.pharep.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/31/2017] [Accepted: 02/02/2018] [Indexed: 11/16/2022]
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16
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Pilhatsch M, Glenn T, Rasgon N, Alda M, Sagduyu K, Grof P, Munoz R, Marsh W, Monteith S, Severus E, Bauer R, Ritter P, Whybrow PC, Bauer M. Regularity of self-reported daily dosage of mood stabilizers and antipsychotics in patients with bipolar disorder. Int J Bipolar Disord 2018; 6:10. [PMID: 29713845 PMCID: PMC6161976 DOI: 10.1186/s40345-018-0118-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Polypharmacy is often prescribed for bipolar disorder, yet medication non-adherence remains a serious problem. This study investigated the regularity in the daily dosage taken of mood stabilizers and second generation antipsychotics. METHODS Daily self-reported data on medications taken and mood were available from 241 patients with a diagnosis of bipolar disorder who received treatment as usual. Patients who took the same mood stabilizer or second generation antipsychotic for ≥ 100 days were included. Approximate entropy was used to determine serial regularity in daily dosage taken. Generalized estimating equations were used to estimate if demographic or clinical variables were associated with regularity. RESULTS There were 422 analysis periods available from the 241 patients. Patients took drugs on 84.4% of days. Considerable irregularity was found, mostly due to single-day omissions and dosage changes. Drug holidays (missing 3 or more consecutive days) were found in 35.8% of the analysis periods. Irregularity was associated with an increasing total number of psychotropic drugs taken (p = 0.009), the pill burden (p = 0.026), and the percent of days depressed (p = 0.049). CONCLUSION Despite low missing percent of days, daily drug dosage may be irregular primarily due to single day omissions and dosage changes. Drug holidays are common. Physicians should expect to see partial adherence in clinical practice, especially with complex drug regimens. Daily dosage irregularity may impact the continuity of drug action, contribute to individual variation in treatment response, and needs further study.
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Affiliation(s)
- Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Kemal Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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17
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Bortolasci CC, Spolding B, Callaly E, Martin S, Panizzutti B, Kidnapillai S, Connor T, Hasebe K, Mohebbi M, Dean OM, McGee SL, Dodd S, Gray L, Berk M, Walder K. Mechanisms Underpinning the Polypharmacy Effects of Medications in Psychiatry. Int J Neuropsychopharmacol 2018; 21:582-591. [PMID: 29471411 PMCID: PMC6007392 DOI: 10.1093/ijnp/pyy014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/16/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Bipolar disorder is a mental health condition with progressive social and cognitive function disturbances. Most patients' treatments are based on polypharmacy, but with no biological basis and little is known of the drugs' interactions. The aim of this study was to analyze the effects of lithium, valproate, quetiapine, and lamotrigine, and the interactions between them, on markers of inflammation, bioenergetics, mitochondrial function, and oxidative stress in neuron-like cells and microglial cells. METHODS Neuron-like cells and lipopolysaccharide-stimulated C8-B4 cells were treated with lithium (2.5 mM), valproate (0.5 mM), quetiapine (0.05 mM), and lamotrigine (0.05 mM) individually and in all possible combinations for 24 h. Twenty cytokines were measured in the media from lipopolysaccharide-stimulated C8-B4 cells. Metabolic flux analysis was used to measure bioenergetics, and real-time PCR was used to measure the expression of mitochondrial function genes in neuron-like cells. The production of superoxide in treated cells was also assessed. RESULTS The results suggest major inhibitory effects on proinflammatory cytokine release as a therapeutic mechanism of these medications when used in combination. The various combinations of medications also caused overexpression of PGC1α and ATP5A1 in neuron-like cells. Quetiapine appears to have a proinflammatory effect in microglial cells, but this was reversed by the addition of lamotrigine independent of the drug combination. CONCLUSION Polypharmacy in bipolar disorder may have antiinflammatory effects on microglial cells as well as effects on mitochondrial biogenesis in neuronal cells.
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Affiliation(s)
- Chiara C Bortolasci
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia,Graduation Program in Health Sciences, State University of Londrina, Londrina, Brazil
| | - Briana Spolding
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Edward Callaly
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sheree Martin
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Bruna Panizzutti
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre and Programa de Pós-graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Srisaiyini Kidnapillai
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Timothy Connor
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Kyoko Hasebe
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | - Olivia M Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sean L McGee
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Laura Gray
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Michael Berk
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia,Correspondence: Ken Walder, PhD, Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia ()
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18
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Amare AT, Schubert KO, Hou L, Clark SR, Papiol S, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka JM, Birner A, Brichant-Petitjean C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski PM, Dalkner N, Dayer A, Del Zompo M, DePaulo JR, Étain B, Falkai P, Forstner AJ, Frisen L, Frye MA, Fullerton JM, Gard S, Garnham JS, Goes FS, Grigoroiu-Serbanescu M, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Hofmann A, Jamain S, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe J, Kittel-Schneider S, Kliwicki S, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy MJ, McElroy S, Colom F, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Nöthen MM, Novák T, O’Donovan C, Ozaki N, Ösby U, Pfennig A, Potash JB, Reif A, Reininghaus E, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Volkert J, Witt S, Wright A, Zandi PP, Mitchell PB, Bauer M, Alda M, Rietschel M, McMahon FJ, Schulze TG, Baune BT. Association of Polygenic Score for Schizophrenia and HLA Antigen and Inflammation Genes With Response to Lithium in Bipolar Affective Disorder: A Genome-Wide Association Study. JAMA Psychiatry 2018; 75:65-74. [PMID: 29121268 PMCID: PMC5833535 DOI: 10.1001/jamapsychiatry.2017.3433] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Lithium is a first-line mood stabilizer for the treatment of bipolar affective disorder (BPAD). However, the efficacy of lithium varies widely, with a nonresponse rate of up to 30%. Biological response markers are lacking. Genetic factors are thought to mediate treatment response to lithium, and there is a previously reported genetic overlap between BPAD and schizophrenia (SCZ). OBJECTIVES To test whether a polygenic score for SCZ is associated with treatment response to lithium in BPAD and to explore the potential molecular underpinnings of this association. DESIGN, SETTING, AND PARTICIPANTS A total of 2586 patients with BPAD who had undergone lithium treatment were genotyped and assessed for long-term response to treatment between 2008 and 2013. Weighted SCZ polygenic scores were computed at different P value thresholds using summary statistics from an international multicenter genome-wide association study (GWAS) of 36 989 individuals with SCZ and genotype data from patients with BPAD from the Consortium on Lithium Genetics. For functional exploration, a cross-trait meta-GWAS and pathway analysis was performed, combining GWAS summary statistics on SCZ and response to treatment with lithium. Data analysis was performed from September 2016 to February 2017. MAIN OUTCOMES AND MEASURES Treatment response to lithium was defined on both the categorical and continuous scales using the Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder score. The effect measures include odds ratios and the proportion of variance explained. RESULTS Of the 2586 patients in the study (mean [SD] age, 47.2 [13.9] years), 1478 were women and 1108 were men. The polygenic score for SCZ was inversely associated with lithium treatment response in the categorical outcome, at a threshold P < 5 × 10-2. Patients with BPAD who had a low polygenic load for SCZ responded better to lithium, with odds ratios for lithium response ranging from 3.46 (95% CI, 1.42-8.41) at the first decile to 2.03 (95% CI, 0.86-4.81) at the ninth decile, compared with the patients in the 10th decile of SCZ risk. In the cross-trait meta-GWAS, 15 genetic loci that may have overlapping effects on lithium treatment response and susceptibility to SCZ were identified. Functional pathway and network analysis of these loci point to the HLA antigen complex and inflammatory cytokines. CONCLUSIONS AND RELEVANCE This study provides evidence for a negative association between high genetic loading for SCZ and poor response to lithium in patients with BPAD. These results suggest the potential for translational research aimed at personalized prescribing of lithium.
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Affiliation(s)
| | - Azmeraw T. Amare
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Klaus Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia2Northern Adelaide Local Health Network, Mental Health Services, Adelaide, South Australia, Australia
| | - Liping Hou
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Scott R. Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilian University of Munich, Munich, Germany5Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilian University of Munich, Munich, Germany6Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Boston, Massachusetts10Program for Quantitative Genomics, Harvard School of Public Health, Boston, Massachusetts11Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | | | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Nirmala Akula
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Unitat de Zoologia i Antropologia Biològica (Dpt Biologia Evolutiva, Ecologia i Ciències Ambientals), Facultat de Biologia and Institut de Biomedicina, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Jean-Michel Aubry
- Department of Psychiatry, Mood Disorders Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Frank Bellivier
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche Scientifique 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-F. Widal, Paris, France
| | - Antonio Benabarre
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Salud Mental, Barcelona, Catalonia, Spain
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Joanna M. Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota23Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Clara Brichant-Petitjean
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche Scientifique 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-F. Widal, Paris, France
| | - Pablo Cervantes
- The Neuromodulation Unit, McGill University Health Centre, Montreal, Canada
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany26Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Piotr M. Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Alexandre Dayer
- Department of Psychiatry, Mood Disorders Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J. Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Bruno Étain
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche Scientifique 1144, Université Paris Diderot, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-F. Widal, Paris, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Andreas J. Forstner
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany26Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland31Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Louise Frisen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Janice M. Fullerton
- Neuroscience Research Australia, Sydney, New South Wales, Australia33School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Sébastien Gard
- Service de Psychiatrie, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S. Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fernando S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ontario, Canada
| | - Ryota Hashimoto
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan39Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Herms
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany26Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Per Hoffmann
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany26Human Genomics Research Group, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Andrea Hofmann
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stephane Jamain
- Institut National de la Santé et de la Recherche Médicale Unité 955, Psychiatrie Translationnelle, Créteil, France
| | - Esther Jiménez
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Salud Mental, Barcelona, Catalonia, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Po-Hsiu Kuo
- Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara König
- Department of Psychiatry and Psychotherapeutic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Gonzalo Laje
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden49Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- 50Inserm U955, Translational Psychiatry Laboratory, Université Paris-Est-Créteil, Department of Psychiatry and Addictology of Mondor University Hospital, Assistance Publique–Hôpitaux de Paris, Hôpital Albert Chenevier–Henri Mondor, Pôle de Psychiatrie, Créteil, France
| | - Susan G. Leckband
- Department of Pharmacy, Veterans Affairs San Diego Healthcare System, San Diego, California
| | | | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy54Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lina Martinsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael J. McCarthy
- Department of Psychiatry, University of California San Diego56Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Susan McElroy
- Department of Psychiatry, Lindner Center of Hope and University of Cincinnati, Mason, Ohio
| | - Francesc Colom
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Salud Mental, Barcelona, Catalonia, Spain58Mental Health Research Group, IMIM–Hospital del Mar, Barcelona, Catalonia, Spain
| | - Marina Mitjans
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain60Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Francis M. Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Palmiero Monteleone
- Neurosciences Section, Department of Medicine and Surgery, University of Salerno, Salerno, Italy62Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Markus M. Nöthen
- Institute of Human Genetics and Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Tomas Novák
- National Institute of Mental Health, Klecany, Czech Republic
| | - Claire O’Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Germany
| | - James B. Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Andreas Reif
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Guy A. Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Janusz K. Rybakowski
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter R. Schofield
- Neuroscience Research Australia, Sydney, New South Wales, Australia33School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara W. Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Paul D. Shilling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Katzutaka Shimoda
- Department of Psychiatry, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| | - Christian Simhandl
- Bipolar Center Wiener Neustadt, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Claire M. Slaney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Pavla Stopkova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mario Maj
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Eduard Vieta
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red Salud Mental, Barcelona, Catalonia, Spain
| | - Julia Volkert
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, New South Wales, Australia
| | - Peter P. Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, New South Wales, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Francis J. McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | - Thomas G. Schulze
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland4Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilian University of Munich, Munich, Germany6Department of Psychiatry and Psychotherapy, University Medical Center
- Georg-August University Göttingen, Göttingen, Germany30Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland70Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard T. Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Golden JC, Goethe JW, Woolley SB. Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients. J Affect Disord 2017. [PMID: 28628769 DOI: 10.1016/j.jad.2017.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is common for patients with bipolar disorder (BP) to receive multiple psychotropics, but few studies have assessed demographic and clinical features associated with risk for receiving complex psychotropic polypharmacy. METHODS This longitudinal cohort study examined 2712 inpatients with a DSM-IV clinical diagnosis of BP to assess associations between complex polypharmacy (defined as ≥4 psychotropics) and demographic and clinical features; associations with risk of rehospitalization were also examined. Logistic regressions were performed with the sample as a whole and with each of four DSM-IV BP subtypes individually. RESULTS Complex polypharmacy was present in 21.0%. BP-I depressed patients were more likely to receive complex regimens than BP-I manic, BP-I mixed or BP-II patients. In the sample as a whole, variables significantly associated with complex polypharmacy included female, white, psychotic features and a co-diagnosis of borderline personality, post-traumatic stress or another anxiety disorder. The only examined medication not significantly associated with complex polypharmacy was lithium, although only in BP-I depressed and BP-I mixed. Complex polypharmacy was associated with rehospitalization in BP-I mania within 15 and 30days post index hospitalization. LIMITATIONS All data were from one clinical facility; results may not generalize to other settings and patient populations. CONCLUSIONS BP-I depression may pose a greater treatment challenge than the other BP subtypes. Lithium may confer an overall advantage compared to other medications in BP-I depressed and BP-I mixed. Further research is needed to guide pharmacotherapy decisions in BP patients.
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Affiliation(s)
| | - John W Goethe
- The Institute of Living, Hartford, CT, USA; New York Medical College, USA.
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Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M. The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Curr Neuropharmacol 2017; 15:359-371. [PMID: 28503107 PMCID: PMC5405614 DOI: 10.2174/1570159x14666161017233642] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features. METHOD 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features. RESULTS Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse. CONCLUSION ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a "last resort".
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Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Behavioral Science
“G. De Lisio”, Carrara-Pisa, Pisa, Italy
| | - Pierpaolo Medda
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Toni
- Institute of Behavioral Science
“G. De Lisio”, Carrara-Pisa, Pisa, Italy
| | | | - Chiara Socci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Windfuhr K, While D, Kapur N, Ashcroft DM, Kontopantelis E, Carr MJ, Shaw J, Appleby L, Webb RT. Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients. Psychol Med 2016; 46:3407-3417. [PMID: 27650367 DOI: 10.1017/s0033291716001823] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses. METHOD Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899). RESULTS Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency. CONCLUSIONS A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.
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Affiliation(s)
- K Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - D While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety,Manchester Pharmacy School and NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre,University of Manchester,UK
| | - E Kontopantelis
- Centre for Health Informatics,Institute of Population Health,University of Manchester,UK
| | - M J Carr
- Centre for Mental Health and Safety,University of Manchester,UK
| | - J Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - L Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - R T Webb
- Centre for Mental Health and Safety,University of Manchester,UK
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Fabbri C, Serretti A. Genetics of long-term treatment outcome in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:17-24. [PMID: 26297903 DOI: 10.1016/j.pnpbp.2015.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/03/2015] [Accepted: 08/14/2015] [Indexed: 01/07/2023]
Abstract
Bipolar disorder (BD) shows one of the strongest genetic predispositions among psychiatric disorders and the identification of reliable genetic predictors of treatment response could significantly improve the prognosis of the disease. The present study investigated genetic predictors of long-term treatment-outcome in 723 patients with BD type I from the STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) genome-wide dataset. BD I patients with >6months of follow-up and without any treatment restriction (reflecting a natural setting scenario) were included. Phenotypes were the total and depressive episode rates and the occurrence of one or more (hypo)manic/mixed episodes during follow-up. Quality control of genome-wide data was performed according to standard criteria and linear/logistic regression models were used as appropriate under an additive hypothesis. Top genes were further analyzed through a pathway analysis. Genes previously involved in the susceptibility to BD (DFNB31, SORCS2, NRXN1, CNTNAP2, GRIN2A, GRM4, GRIN2B), antidepressant action (DEPTOR, CHRNA7, NRXN1), and mood stabilizer or antipsychotic action (NTRK2, CHRNA7, NRXN1) may affect long-term treatment outcome of BD. Promising findings without previous strong evidence were TRAF3IP2-AS1, NFYC, RNLS, KCNJ2, RASGRF1, NTF3 genes. Pathway analysis supported particularly the involvement of molecules mediating the positive regulation of MAPK cascade and learning/memory processes. Further studies focused on the outlined genes may be helpful to provide validated markers of BD treatment outcome.
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Affiliation(s)
- Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
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Fornaro M, De Berardis D, Koshy AS, Perna G, Valchera A, Vancampfort D, Stubbs B. Prevalence and clinical features associated with bipolar disorder polypharmacy: a systematic review. Neuropsychiatr Dis Treat 2016; 12:719-35. [PMID: 27099503 PMCID: PMC4820218 DOI: 10.2147/ndt.s100846] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Uncertainty exists regarding the prevalence and clinical features associated with the practice of polypharmacy in bipolar disorder (BD), warranting a systematic review on the matter. METHODS Three authors independently searched major electronic databases from inception till September 2015. Articles were included that reported either qualitative or quantitative data about the prevalence and clinical features associated with polypharmacy in adult cases of BD. RESULTS The operative definitions of polypharmacy adopted across varying studies varied, with concomitant use of two or more psychotropic medications or use of four or more psychotropic medications at once being the most common and the most reliable, respectively. Regardless of type or current mood episode polarity of BD, prevalence rates up to 85% and 36% were found using the most permissive (two or more medications at once) and the most conservative (four or more) operative definitions for polypharmacy, respectively. Point prevalence prescription rates of one or more antidepressant or antipsychotic as part of a polypharmacy regimen occurred in up to 45% or 80% of the cases, respectively, according to the most permissive definition of polypharmacy. In contrast, lithium prescription rates ranged from 13% to 33% in BD patients receiving polypharmacy according to conservative and permissive definitions, possibly suggesting a reduced need for augmentation of combination strategies for those cases of BD with a favorable lifetime lithium response and/or long-lasting treatment as well as less likelihood of lithium response over the time most severe cases possibly exposed to a more complex polypharmacy overall. LIMITATIONS "Apples and oranges" bias; publication bias for most recently introduced compounds. CONCLUSION Polypharmacy is common among people with BD across varying type and mood episode phases of illness. Special population, including BD patients at high risk of familial load for suicidal behavior, solicit further research as well as the plausible "protective" role of lithium toward polypharmacy in BD. The PROSPERO registration number is CRD42014015084.
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Affiliation(s)
- Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias - Villa San Benedetto Menni Hospital, FoRiPsi, Italy
| | - Alessandro Valchera
- Hermanas Hospitalarias, FoRiPsi Villa S. Giuseppe Hospital, Ascoli Piceno, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Pharmacotherapy of acute mania: monotherapy or combination therapy with mood stabilizers and antipsychotics? CNS Drugs 2015; 29:221-7. [PMID: 25711483 DOI: 10.1007/s40263-015-0235-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of combination therapy with mood stabilizers and antipsychotics in acute mania in bipolar disorder (BD) is widespread, although most treatment guidelines recommend monotherapy as the first option, and reserve combination therapy, which is associated with more frequent and more severe side effects, for when patients do not respond to the former treatment option. Reasons to prescribe combination therapy include the lack of efficacy of the current treatment (either real or due to undisclosed poor adherence), psychiatric comorbidities, severe previous course of illness, slow cross-tapering during treatment switching, and potential benefits from particular combinations. The decision to start with monotherapy or combination therapy may depend on the patient characteristics, and is still under debate. Clinical trials designed to ascertain whether combination therapy or monotherapy is more advantageous for patients in acute mania and beyond, according to illness severity, are urgently needed. Adding a third monotherapy arm to the conventional two-arm, adjunctive-design trials or initiating combination therapy from the beginning may help to shed some light on the issue.
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Weinstock LM, Gaudiano BA, Epstein-Lubow G, Tezanos K, Celis-deHoyos CE, Miller IW. Medication burden in bipolar disorder: a chart review of patients at psychiatric hospital admission. Psychiatry Res 2014; 216:24-30. [PMID: 24534121 PMCID: PMC3968952 DOI: 10.1016/j.psychres.2014.01.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/21/2013] [Accepted: 01/25/2014] [Indexed: 11/25/2022]
Abstract
Individuals with bipolar disorder (BD) often receive complex polypharmacy regimens as part of treatment, yet few studies have sought to evaluate patient characteristics associated with this high medication burden. This retrospective chart review study examined rates of complex polypharmacy (i.e., ≥4 psychotropic medications), patterns of psychotropic medication use, and their demographic and clinical correlates in a naturalistic sample of adults with bipolar I disorder (BDI; N=230) presenting for psychiatric hospital admission. Using a computer algorithm, a hospital administrator extracted relevant demographic, clinical, and community treatment information for analysis. Patients reported taking an average of 3.31 (S.D.=1.46) psychotropic medications, and 5.94 (S.D.=3.78) total medications at intake. Overall, 82 (36%) met criteria for complex polypharmacy. Those receiving complex polypharmacy were significantly more likely to be female, to be depressed, to have a comorbid anxiety disorder, and to have a history of suicide attempt. Women were significantly more likely than men to be prescribed antidepressants, benzodiazepines, and stimulants, even after controlling for mood episode polarity. Study data highlight the high medication burden experienced by patients with BD, especially those who are acutely symptomatic. Data also highlight the particularly high medication burden experienced by women with BD; a burden not fully accounted for by depression.
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Affiliation(s)
- Lauren M. Weinstock
- Corresponding Author: Lauren M. Weinstock, PhD. Psychosocial Research Program, Alpert Medical School of Brown University & Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. FAX: 401-455-6235,
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26
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Stoops WW, Rush CR. Combination pharmacotherapies for stimulant use disorder: a review of clinical findings and recommendations for future research. Expert Rev Clin Pharmacol 2014; 7:363-74. [PMID: 24716825 DOI: 10.1586/17512433.2014.909283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite concerted efforts to identify a pharmacotherapy for managing stimulant use disorders, no widely effective medications have been approved. Innovative strategies are necessary to develop successful pharmacotherapies for stimulant use disorders. This manuscript reviews human laboratory studies and clinical trials to determine whether one such strategy, use of combination pharmacotherapies, holds promise. The extant literature shows that combination pharmacotherapy produced results that were better than placebo treatment, especially with medications shown to have efficacy as monotherapies. However, many studies did not compare individual constituents to the combination treatment, making it impossible to determine whether combination treatment is more effective than monotherapy. Future research should systematically compare combined treatments with individual agents using medications showing some efficacy when tested alone.
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Affiliation(s)
- William W Stoops
- Department of Behavioral Science, University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536, USA
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Sachs BD, Ni JR, Caron M. Sex differences in response to chronic mild stress and congenital serotonin deficiency. Psychoneuroendocrinology 2014; 40:123-9. [PMID: 24485484 PMCID: PMC3918518 DOI: 10.1016/j.psyneuen.2013.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/25/2013] [Accepted: 11/08/2013] [Indexed: 12/29/2022]
Abstract
Women exhibit a nearly twofold increased risk of developing depression and anxiety disorders when compared to men, a fact that has been hypothesized to result in part from increased stress susceptibility. Here, we used the tryptophan hydroxylase-2 R439H knock-in mouse (Tph2KI) and the chronic unpredictable mild stress (CMS) model to examine sex differences in response to congenital 5-HT deficiency and chronic stress. Our results demonstrate that female mice, but not 5-HT-deficient animals, exhibit significantly increased susceptibility to CMS-induced despair-like behavior in the forced swim test. In addition, female 5-HT-deficient mice exhibit anhedonia-like behavior in the sucrose preference test, whereas male 5-HT-deficient animals do not, suggesting that females exhibit increased sensitivity to at least some of the effects of congenital 5-HT deficiency. Although CMS did not reduce cell proliferation in the hippocampus, low levels of brain 5-HT were associated with increased hippocampal cell proliferation, an effect that was predominantly observed in females. Overall, these results highlight the importance of interactions between psychiatric disease risk factors such as sex, chronic stress and congenital 5-HT deficiency in the development of aberrant emotional behavior.
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Affiliation(s)
| | - Jason R. Ni
- Department of Cell Biology, Duke University, Durham, NC 27710, USA
| | - Marc Caron
- Department of Cell Biology, Duke University, Durham, NC 27710, USA, Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
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