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Capuzzi E, Di Forti CL, Caldiroli A, Cova F, Surace T, Buoli M, Clerici M. Sociodemographic and clinical factors associated with prescription of first- versus second-generation long-acting antipsychotics in incarcerated adult males. Int Clin Psychopharmacol 2024; 39:276-283. [PMID: 37781763 DOI: 10.1097/yic.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Information on patterns of prescription of long-acting injection (LAI) antipsychotics among people who are incarcerated is lacking. Therefore, we aimed to evaluate prescribing rates for first-generation antipsychotic (FGA)-LAI versus second-generation antipsychotic (SGA)-LAI and to identify the factors associated with the prescription of one of the two classes of LAI. A cross-sectional study was conducted among incarcerated adult males hosted in Monza detention center between January 2013 and April 2023. Socio-demographic and clinical data were retrospectively collected. Descriptive and univariate statistics as well as logistic regression analyses were performed. Data were available for 135 consecutive incarcerated adult males with different mental disorders who received a LAI as part of their treatment. 75.6% of our sample was treated with FGA-LAIs, with haloperidol as the most commonly prescribed drug, followed by zuclopentixol and aripiprazole. Diagnosis of bipolar disorder and concomitant administration of antidepressants were statistically significant predictors of SGA-LAI prescription. Some patients' characteristics may influence prescription patterns in prison. Further longitudinal studies with larger samples should confirm these findings.
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Affiliation(s)
- Enrico Capuzzi
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori
| | | | - Alice Caldiroli
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori
| | - Francesca Cova
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori
| | - Teresa Surace
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimo Clerici
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori
- School of Medicine and Surgery, University of Milano Bicocca, Monza (MB)
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UYAR B, ATLI A, GÜL BİLEN D. Bipolar bozukluk tip I hastalarının tedavisinde uzun etkili antipsikotiklerin klinik kullanımı. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1089059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: This study aims to determine the usage frequency of long-acting injectable antipsychotics among bipolar disorder type 1 patients who presented to the Dicle University Faculty of Medicine Psychiatry and Mental Health outpatient clinic, the clinical characteristics of these patients, and the preferences of clinicians about these agents.
Materials and Methods: Our study included 111 patients older than 18 years old with bipolar disorder. The ’data of the patients were retrospectively obtained from electronic data records. The data were recorded in the data collection form prepared by the researchers with the support of the literature.
Results: The rate of the patients who used long-acting injectable antipsychotics was 21.6%. Among the patients who used long-acting injectable antipsychotics, the rate of those who used second-generation long-acting injectable antipsychotics was 58.3%, and the most frequently preferred agent was paliperidone palmitate. The patients who were using long-acting injectable antipsychotics had significantly higher rates of not working and numbers of hospitalizations.
Conclusion: Our results showed that long-acting injectable antipsychotics are preferred by clinicians in our outpatient clinic in the later stages of bipolar disorders and for patients with poor drug compliance, poor functionality, and more hospitalizations. Starting long-acting injectable antipsychotics in the early stages of bipolar disorders, even following the first attack, may increase treatment compliance, reduce the duration of hospitalization, and contribute to the functionality of patients.
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Existing and emerging pharmacological approaches to the treatment of mania: A critical overview. Transl Psychiatry 2022; 12:169. [PMID: 35461339 PMCID: PMC9035148 DOI: 10.1038/s41398-022-01928-8] [Citation(s) in RCA: 2] [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: 10/21/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Manic episodes are a defining, frequent and dramatically disabling occurrence in the course of Bipolar Disorder type I. Current pharmacotherapy of mania lists a good number of agents, but differences in efficacy and safety profiles among these agents must be considered in order to tailor personalized therapies, especially when the long-term course of the illness is considered. There is wide room and need to ameliorate current pharmacological approaches to mania, but ongoing pharmacological research on the topic is scant. In this work we try to critically assess clinical factors and patients' characteristics that may influence the treatment choice for manic episodes. In addition, we conduct a narrative review on experimental pharmacology of bipolar mania and psychotic disorders, presenting a critical overview on agents which could represent treatment alternatives for a manic episode in the next future. Results show limited novel or ongoing research on agents acting as mood stabilizers (Ebselen, Valnoctamide and Eslicarbazepine did not reach statistical significance in demonstrating antimanic efficacy). As for the emerging experimental antipsychotic, some of them (including KarXT, SEP-363856, RO6889450, ALKS3831) have demonstrated good antipsychotic efficacy and a favorable safety profile, but little is known about their use in patients with bipolar disorder and specifically designed trials are needed. Lastly, some benefits for the treatment of mania could be expected to come in the next future from non-mood stabilizers/non-antipsychotic agents (especially PKC inhibitors like Endoxifen): long-term trials are needed to confirm positive results in terms of long-term efficacy and safety.
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Koh LYC, Chandwani N, Lim S, Chan CYW. The concurrent use of two long-acting injectables in the maintenance treatment of bipolar disorder. Bipolar Disord 2021; 23:312-314. [PMID: 33125821 DOI: 10.1111/bdi.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Shuli Lim
- Institute of Mental Health, Singapore, Singapore
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Caliskan AM, Calisir S, Caliskan S, Arslan M, Inanli I, Eren I. Impact of initiating long-acting injectable paliperidone palmitate on relapse and hospitalization in patients with bipolar I disorder: A mirror image retrospective study. Asian J Psychiatr 2020; 54:102457. [PMID: 33271736 DOI: 10.1016/j.ajp.2020.102457] [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] [Received: 08/23/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
Literature assessing the use of long-acting injectable paliperidone palmitate in patients with bipolar I disorder is limited. The aim of this retrospective study was to determine the effectiveness of long-acting injectable paliperidone palmitate treatment on relapse and hospitalization in a real-world setting. Patients with bipolar I disorder aged 18-65 years, who were treated with paliperidone palmitate once-monthly (PP1M) for at least one year, were included. The rate of relapse, hospitalization, and length of hospital stay were collected. Safety outcomes included levels of prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein. The data of 36 patients who met the study criteria were evaluated. Number and length of hospitalizations, number of manic and mixed episodes significantly decreased after PP1M addition. When we compared the prolactin, fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein levels as an indicator of the safety of treatment, there was no statistically significant change in these values before and after PP1M addition. Our findings suggested PP1M may be effective in reducing manic and mixed episodes. Limitations include a mirror image retrospective design and small sample size.
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Affiliation(s)
- Ali Metehan Caliskan
- Department of Psychiatry, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey.
| | - Saliha Calisir
- Department of Psychiatry, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Sila Caliskan
- Department of Psychiatry, Konya Beyhekim State Hospital, Konya, Turkey
| | - Mehmet Arslan
- Department of Psychiatry, Kırklareli Babaeski State Hospital, Kırklareli, Turkey
| | - Ikbal Inanli
- Department of Psychiatry, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Ibrahim Eren
- Department of Psychiatry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Li K, Liao Y, Yang Z, Yang C, Chen M, Wu X, Gan Z. Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance. Front Psychiatry 2020; 11:529672. [PMID: 33488408 PMCID: PMC7819884 DOI: 10.3389/fpsyt.2020.529672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI). Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression-Bipolar Disorder-Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up. Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected. Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.
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Affiliation(s)
- Kanglai Li
- Very Important Patients Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingtao Liao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhihua Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Caishuang Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhua Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiuhua Wu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Long-Acting Injectable Second-Generation/Atypical Antipsychotics for the Management of Bipolar Disorder: A Systematic Review. CNS Drugs 2019; 33:431-456. [PMID: 30963507 DOI: 10.1007/s40263-019-00629-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-adherence to medications is a major determinant of poor outcome in bipolar disorder. Second-generation long-acting injectable (LAI) antipsychotics help ensure medication adherence which in turn can lead to more favourable outcomes. However, the role of these medications in bipolar disorder is not well established. OBJECTIVE We sought to review available evidence relating to the efficacy and safety of using second-generation LAI antipsychotics in bipolar disorder. METHODS PRISMA guidelines were followed to systematically review all clinical studies that reported on the efficacy and safety of second-generation LAI antipsychotics in patients with bipolar disorder. We searched Ovid Medline, PsycINFO, and Cochrane Central Register of Controlled Trials from inception to November 2018. RESULTS Of 459 identified citations, 53 studies were fully evaluated and 37 met our inclusion criteria. Overall, second-generation LAI antipsychotics were found to be well tolerated and effective for treatment of manic symptoms and preventing mood recurrences in adults with bipolar disorder. However, we found disparity in the evidence available for individual agents. While several randomized controlled trials (RCTs) reported on the use of risperidone LAI in bipolar disorder, we found only one RCT on the use of aripiprazole LAI, and none for use of paliperidone palmitate or olanzapine pamoate (evidence for the former is limited to one observational study and one case series, and for the latter to a single case report). Studies in children and adolescents were restricted to case reports and small open-label studies. CONCLUSION Second-generation LAI antipsychotics, particularly risperidone and aripiprazole LAI, may be a safe and effective alternative to oral medications in the management of bipolar disorder.
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Jawad I, Watson S, Haddad PM, Talbot PS, McAllister-Williams RH. Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacol 2018; 8:349-363. [PMID: 30524703 PMCID: PMC6278745 DOI: 10.1177/2045125318804364] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.
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Affiliation(s)
- Ibrahim Jawad
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Stuart Watson
- Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter S Talbot
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic, Health Science Centre, Manchester, UK
| | - R Hamish McAllister-Williams
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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