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Samalin L, Boudieu L, Llorca PM. Evaluating the efficacy and safety of the currently available once-every-two months long-acting injectable formulations of aripiprazole for the treatment of schizophrenia or as a maintenance monotherapy for bipolar I disorder in adults. Expert Rev Neurother 2024; 24:291-298. [PMID: 38299536 DOI: 10.1080/14737175.2024.2313550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION An aripiprazole long-acting injectable (LAI) antipsychotic is now available for gluteal administration every 2 months via two different formulations: aripiprazole lauroxil (AL) and aripiprazole monohydrate (Ari 2MRTU). These longer dosing regimens of aripiprazole LAI offer new potential benefits for patients. AREAS COVERED The authors review the evidence supporting the efficacy and safety of aripiprazole LAIs given every 2 months for the treatment of schizophrenia or bipolar disorder (BD) in adults. The article culminates with the authors' expert perspectives on the subject. EXPERT OPINION AL 1064 mg every 2 months has established efficacy for the treatment of schizophrenia based on pharmacokinetic bridging studies and prospective data for treatment of an acute exacerbation of schizophrenia. In an open-label trial, Ari 2MRTU showed efficacy for the treatment of schizophrenia and BD type I based on pharmacokinetic parameters (comparable to aripiprazole once-monthly 400 mg); it also showed efficacy regarding the secondary endpoints. Multiple doses of AL 1064 mg or Ari 2MRTU 960 mg are generally well tolerated, in line with the safety profile of oral aripiprazole, with the exception of the injection-site reactions. While AL may require a 1-day initiation regimen, Ari 2MRTU 960 covers all the recommended doses of oral aripiprazole (10-20 mg).
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Petrova N. On the treatment of bipolar affective disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:80-86. [DOI: 10.17116/jnevro202212201280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Verdolini N, Hidalgo-Mazzei D, Del Matto L, Muscas M, Pacchiarotti I, Murru A, Samalin L, Aedo A, Tohen M, Grunze H, Young AH, Carvalho AF, Vieta E. Long-term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms. Bipolar Disord 2021; 23:324-340. [PMID: 33354842 DOI: 10.1111/bdi.13040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/17/2020] [Accepted: 12/20/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This systematic review aimed at providing a critical, comprehensive synthesis of international guidelines' recommendations on the long-term treatment of bipolar disorder type I (BD-I). METHODS MEDLINE/PubMed and EMBASE databases were searched from inception to January 15th, 2019 following PRISMA and PICAR rules. International guidelines providing recommendations for the long-term treatment of BD-I were included. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation-AGREE II. RESULTS The final selection yielded five international guidelines, with overall good quality. The evaluation of applicability was the weakest aspect across the guidelines. Differences in their updating strategies and the rating of the evidence, particularly for meta-analyses, randomized clinical trials (RCTs) and observational studies, could be responsible of some level of heterogeneity among recommendations. Nonetheless, the guidelines recommended lithium as the 'gold standard' in the long-term treatment of BD-I. Quetiapine was another possible first-line option as well as aripiprazole (for the prevention of mania). Long-term treatment should contemplate monotherapy, at least initially. Clinicians should check regularly for efficacy and side effects and if necessary, switch to first-line alternatives (i.e. Valproate), combine first-line compounds with different mechanisms of action or switch to second-line options or combinations. CONCLUSIONS The possibility to monitor improvements in long-term outcomes, namely relapse prevention and inter-episode subthreshold depressive symptoms, based on the application of their recommendations is an unmet need of clinical guidelines. In terms of evidence of clinical guidelines, there is a need for more efficacious treatment strategies for the prevention of bipolar depression.
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Affiliation(s)
- Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena, School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Michele Muscas
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne, Clermont-Ferrand, France
- Fondation FondaMental, Hôpital Albert Chenevier, Créteil, France
| | - Alberto Aedo
- Bipolar Disorders Unit, Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Heinz Grunze
- Nuremberg & Psychiatrie, Paracelsus Medical University, Schwäbisch Hall, Germany
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre of Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Samalin L, Godin O, Olié E, Etain B, Henry C, Pelletier A, Poinso F, Encely L, Mazer N, Roux P, Loftus J, Gard S, Bennabi D, Polosan M, Schwitzer T, Aubin V, Schwan R, Passerieux C, Bougerol T, Dubertret C, Aouizerate B, Haffen E, Courtet P, Bellivier F, Leboyer M, Llorca PM, Belzeaux R. Evolution and characteristics of the use of valproate in women of childbearing age with bipolar disorder: Results from the FACE-BD cohort. J Affect Disord 2020; 276:963-969. [PMID: 32745833 DOI: 10.1016/j.jad.2020.07.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/19/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Valproate is associated with teratogenic and neurodevelopmental effects. Several agencies have restricted the conditions of its prescription in bipolar disorders (BD). We aimed to assess the evolution of valproate prescription and the clinical profile of BD women of childbearing age receiving valproate. METHODS Based on a large national cohort, we included all BD women 16-50 years old. Sociodemographic, clinical and pharmacological data were recorded. Logistic regression analyses were used to describe variables associated with valproate prescription. RESULTS Of the 1018 included women 16-50 years old, 26.9% were treated with valproate with a mean daily dosage of 968 mg. The prevalence of BD women using valproate was 32.6% before May 2015 and 17.3% after May 2015 (p<0.001), the date of French regulatory publication of restriction of valproate prescription. The multivariate analysis revealed that the inclusion period after May 2015 (OR=0.54, CI 95% 0.37-0.78, p=0.001), the age lower than 40 years (OR=0.65, CI 95% 0.43-0.98, p=0.040) and the number of lifetime mood episodes (OR=0.98, CI 95% 0.95-0.99, p=0.040) were the variables negatively associated with the use of valproate. LIMITATIONS Study could be underpowered to determine a clinical profile associated with valproate prescription. CONCLUSIONS The regulatory change in BD women of childbearing age had a significant impact on valproate prescription, even if the prescription rate remains high. Important efforts are needed to help clinicians and patients to improve quality of care in BD women of childbearing age.
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Affiliation(s)
- L Samalin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France.
| | - O Godin
- Fondation Fondamental, Créteil, France; INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - E Olié
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - B Etain
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - C Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, Université Descartes, Paris, France
| | - A Pelletier
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | - F Poinso
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - L Encely
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - N Mazer
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - P Roux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - J Loftus
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - S Gard
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - D Bennabi
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - M Polosan
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - T Schwitzer
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - V Aubin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - R Schwan
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - C Passerieux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - T Bougerol
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - C Dubertret
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - B Aouizerate
- Fondation Fondamental, Créteil, France; Department of Clinical and Academic Psychiatry, Charles-Perrens Hospital, Bordeaux, France; NutriNeuro, UMR INRA 1286, University of Bordeaux, Bordeaux, France
| | - E Haffen
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - P Courtet
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | | | - P M Llorca
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - R Belzeaux
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
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Murru A, Manchia M, Hajek T, Nielsen RE, Rybakowski JK, Sani G, Schulze TG, Tondo L, Bauer M. Lithium's antiviral effects: a potential drug for CoViD-19 disease? Int J Bipolar Disord 2020; 8:21. [PMID: 32435920 PMCID: PMC7239605 DOI: 10.1186/s40345-020-00191-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its introduction in modern medicine, naturalistic observations emerged about possible uses of lithium treatment for conditions different from recurring affective disorders, for which it is still a first-line treatment option. Some evidence about the antiviral properties of lithium began in the early 1970s, when some reports found a reduction of labial-herpetic recurrences. The present review aims to present most of the pre-clinical and clinical evidence about lithium's ability to inhibit DNA and RNA viruses, including Coronaviridae, as well as the possible pathways and mechanisms involved in such antiviral activity. MAIN BODY Despite a broad number of in vitro studies, the rationale for the antiviral activity of lithium failed to translate into methodologically sound clinical studies demonstrating its antiviral efficacy. In addition, the tolerability of lithium as an antiviral agent should be addressed. In fact, treatment with lithium requires continuous monitoring of its serum levels in order to prevent acute toxicity and long-term side effects, most notably affecting the kidney and thyroid. Yet lithium reaches heterogeneous but bioequivalent concentrations in different tissues, and the anatomical compartment of the viral infection might underpin a different, lower need for tolerability concerns which need to be addressed. CONCLUSIONS Lithium presents a clear antiviral activity demonstrated at preclinical level, but that remains to be confirmed in clinical settings. In addition, the pleiotropic mechanisms of action of lithium may provide an insight for its possible use as antiviral agent targeting specific pathways.
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Affiliation(s)
- Andrea Murru
- Bipolar and Depressive Disorders Unit, IDIBAPS CIBERSAM, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry-Aalborg University Hospital, Aalborg, Denmark
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Genetic Epidemiology, Central Institute of Mental Health, Mannheim, Germany
| | - Leonardo Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Belzeaux R, Sanguinetti C, Murru A, Verdolini N, Pacchiarotti I, Hidalgo-Mazzei D, Cohen L, Anmella G, Barbuti M, Vieta E, Llorca PM, Samalin L. Pharmacotherapy for the peripartum management of bipolar disorder. Expert Opin Pharmacother 2019; 20:1731-1741. [PMID: 31159601 DOI: 10.1080/14656566.2019.1626826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The peripartum period in bipolar disorder (BD) patients is associated with high risk of relapse. Relapse during this period may affect fetal and child development. The consequences of psychotropic medication during pregnancy are also a major concern. The extent to which mood stabilizers may potentially affect the embryogenesis or the child development varies from high (e.g. valproate) to less clear and more debated (e.g. lithium). Areas covered: This review describes the current state of evidence with respect to the impact of recommended pharmacological interventions for BD during the peripartum period. It compares recent international treatment guidelines for the management of BD during the peripartum period. Last, this review presents a summary of key recommendations for BD women of childbearing age, for BD women during pregnancy and postpartum period from the international guidelines. Expert opinion: Management of the pharmacological treatment for BD patients during the perinatal period is challenging. Although treatment guidelines may be of significant help, high heterogeneity exists across them. Shared decision-making represents a useful patient-centered approach during the perinatal period. Large cohort studies are needed to better identify risk associated to treatment discontinuation or treatment exposure.
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Affiliation(s)
- Raoul Belzeaux
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France.,Fondation FondaMental , Créteil , France
| | - Catherine Sanguinetti
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France
| | - Andrea Murru
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Norma Verdolini
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain.,FIDMAG Germanes Hospitalaries Research Foundation , Barcelona , Catalonia , Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia , Perugia , Italy
| | - Isabella Pacchiarotti
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Lola Cohen
- APHM, Department of psychiatry and INT-UMR7289, CNRS Aix Marseille University , Marseille , France
| | - Gerard Anmella
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa , Pisa , Italy
| | - Eduard Vieta
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain
| | - Pierre-Michel Llorca
- Fondation FondaMental , Créteil , France.,Department of Psychiatry, CHU Clermont-Ferrand and University of Clermont Auvergne, EA 7280 , Clermont-Ferrand , France
| | - Ludovic Samalin
- Fondation FondaMental , Créteil , France.,Department of Psychiatry, CHU Clermont-Ferrand and University of Clermont Auvergne, EA 7280 , Clermont-Ferrand , France
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Murru A, Pacchiarotti I, Verdolini N, Reinares M, Torrent C, Geoffroy PA, Bellivier F, Llorca PM, Vieta E, Samalin L. Modifiable and non-modifiable factors associated with functional impairment during the inter-episodic periods of bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2018; 268:749-755. [PMID: 28534186 DOI: 10.1007/s00406-017-0811-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/17/2017] [Indexed: 12/13/2022]
Abstract
The chronic, long-term evolution of bipolar disorder (BD) requires a careful clinical characterization with prognostic implications in terms of symptom and functional control. The OPTHYMUM multicenter study was conducted in France with the objective of evaluating residual symptoms on overall functioning of BD patients during inter-episodic period. The aims of the present study were to identify the potentially modifiable (e.g., treatable) and non-modifiable variables associated with functional impairment during the inter-episodic periods of BD. Sample was divided into two groups according to level of functioning (adequate vs. impaired), based on the FAST scale total score. FAST cut-off for functional impairment is a score >11. The two subgroups were compared as per sociodemographic and clinical variables with standard univariate analyses, and a logistic regression model was created. The model as a whole contained independent non-modifiable factors (age, gender, BD type, illness duration) and modifiable factors (illness severity, predominant polarity, depressive and manic residual symptoms, comorbidities). The final model was statistically significant (χ 2 = 53.89, df = 5, p < 0.001). Modifiable factors most strongly associated with functional impairment were manic predominant polarity (OR = 1.79, CI 95% 1.09-2.96, p = 0.022), residual depressive symptoms (OR = 1.30, CI 95% 1.18-1.43, p < 0.001) and illness severity (OR = 1.24, CI 95% 1.01-1.52, p = 0.037), whilst non-modifiable factor was illness duration (OR = 1.03, CI 95% 1.01-1.05, p = 0.017). Despite intrinsic and non-modifiable illness characteristics, a clinical-wise choice of treatment may help to improve control of manic relapses. Potential improvement of residual depressive symptoms may alleviate the functional burden associated with bipolar disorder.
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Affiliation(s)
- Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maria Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Carla Torrent
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Pierre-Alexis Geoffroy
- Inserm U1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisiére-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Frank Bellivier
- Inserm U1144, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis-Lariboisiére-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.,Fondation FondaMental, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France. .,CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France.
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Verdolini N, Pacchiarotti I, Köhler CA, Reinares M, Samalin L, Colom F, Tortorella A, Stubbs B, Carvalho AF, Vieta E, Murru A. Violent criminal behavior in the context of bipolar disorder: Systematic review and meta-analysis. J Affect Disord 2018; 239:161-170. [PMID: 30014956 DOI: 10.1016/j.jad.2018.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the potential importance of understanding violent criminal behavior (VCB) in individuals suffering from bipolar disorder (BD), previous findings are conflicting. The aims of the present study are to clarify the association of VCB and BD in comparison to general population and other psychiatric conditions. METHODS A systematic review of literature from January 1st, 1980 through January 16th, 2017 from 3 electronic databases (MEDLINE/PubMed, EMBASE and PsycInfo), following the PRISMA and the MOOSE statements. Original peer-reviewed studies reporting data on VCB in BD were included. A random-effects meta-analysis was performed. Potential sources of heterogeneity were examined through subgroup and meta-regression analyses. The protocol was registered in PROSPERO, CRD42017054070. RESULTS Twelve studies providing data from 58,475 BD participants. The prevalence of VCB in BD was 7.1% (95%CI = 3.0‒16.5%; k = 4). The association of BD and VCB compared to general population was not significant (OR = 2.784; 95% CI, 0.687‒11.287, P = .152). The association was significant only in cross-sectional studies, in studies in which VCB was assessed through self-reported measures, and in studies conducted in the USA. BD was more likely to be associated with VCB when BD patients were compared to controls with depressive disorders, whilst it was found to be less associated with VCB when BD was compared to psychotic disorders. LIMITATIONS 1. the methodological heterogeneity across the included studies. 2. causal inferences were precluded by the inclusion of cross-sectional studies. CONCLUSIONS These findings might provide a more balance portrait of the association between BD and VCB to clinicians, law enforcement and general public.
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Affiliation(s)
- Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Ellisse Building, 8th Floor, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cristiano A Köhler
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Ludovic Samalin
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, 58, Rue Montalembert, 63000, Clermont-Ferrand, France; Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, 40 rue de Mesly, 94000, Créteil, France
| | - Francesc Colom
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Mental Health Group, IMIM Hospital del Mar, CIBERSAM, Plaza Charles Darwin, sn, 08003 Barcelona, Catalonia, Spain
| | - Alfonso Tortorella
- FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre of Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
| | - Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
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Samalin L, Honciuc M, Boyer L, de Chazeron I, Blanc O, Abbar M, Llorca PM. Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD). BMC Psychiatry 2018; 18:103. [PMID: 29653535 PMCID: PMC5899333 DOI: 10.1186/s12888-018-1686-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. SDM has raised great interest in mental healthcare over the last decade, as it is considered a fundamental part of patient-centered care. However, there is no research evaluating the efficacy of SDM compared to usual care (CAU), as it relates to quality of care and more specifically treatment adherence, in bipolar disorder (BD). METHODS/DESIGN This is a 12-month multi-centre, cluster-randomized controlled trial comparing the efficacy of SDM to CAU. Adult BD patients (n = 300) will be eligible after stabilization for at least 4 weeks following an acute mood episode. The intervention will consist of applying the standardized SDM process as developed by the Ottawa Hospital Research Institute in order to choose the maintenance treatment of BD. A multidisciplinary team developed a decision aid "choose my long-term treatment with my doctor" for BD patients to clarify possible therapeutic options. Primary outcome will assess the patient's level of adherence (based on hetero-evaluation) of ongoing treatment at 12 months. Secondary outcomes will assess the difference between the 2 groups of patients in terms of adherence to maintenance drug therapy based on other measures (self-assessment scale and plasma levels of mood stabilizers). Additionally, other dimensions will be assessed: decisional conflict, satisfaction with care and involvement in decision making, beliefs about treatment, therapeutic relationship, knowledge about information for medical decision and clinical outcomes (depression, mania, functioning and quality of life). The primary endpoint will be analysed without adjustment by comparison of adherence scores between the two groups using Student t-tests or Mann-Whitney tests according to the variable distribution. A set of secondary analyses will be adjusted for covariates of clinical interest using generalized linear mixed regression models. DISCUSSION This will be the first study evaluating the effect of an SDM intervention on patient adherence in BD. This is also an innovative protocol because it proposes the development of an evidence-based tool that should help patients and clinicians to initiate discussions regarding the use of BD treatment. TRIAL REGISTRATION The study has been registered with ClinicalTrials.gov as NCT03245593 .
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Affiliation(s)
- L. Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - M. Honciuc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - L. Boyer
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - I. de Chazeron
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - O. Blanc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | | | - P. M. Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
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Samalin L, Genty JB, Boyer L, Lopez-Castroman J, Abbar M, Llorca PM. Shared Decision-Making: a Systematic Review Focusing on Mood Disorders. Curr Psychiatry Rep 2018; 20:23. [PMID: 29589129 DOI: 10.1007/s11920-018-0892-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This study aims to provide a review of the randomized controlled studies evaluating the effects of shared decision-making (SDM) intervention in comparison to care as usual in patients with mood disorders. RECENT FINDINGS Of the 14 randomized controlled studies identified, only three 6-month studies evaluated the interest of SDM interventions using decision aids in depressed patients. All of them showed that the intervention effectively improved patient satisfaction and engagement in the decision-making process. Only one study in patients with bipolar disorder (BD) showed improvement of depressive symptoms, functioning, and quality of life. Other included studies were collaborative care interventions using a SDM approach in patients with depression in specific populations depending on age, gender, income, and physical comorbidities. All of them showed significant improvement in depression outcomes or medication adherence. SDM interventions using decision aids and collaborative care showed evidence of improvements in the management of depression. Stronger evidence of SDM interest in BD is needed.
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Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France. .,Service de Psychiatrie B, Centre Hospitalier Universitaire, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Jean-Baptiste Genty
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France
| | - Laurent Boyer
- Public Health, Chronic Diseases and Quality of Life Research Unit, Aix-Marseille University, EA3279, Marseille, France
| | - Jorge Lopez-Castroman
- CHU Nimes, Nimes, France.,INSERM Unit 1061, University of Montpellier, Montpellier, France
| | | | - Pierre-Michel Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, EA7280, Clermont-Ferrand, France
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