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Gottlieb S, van der Vaart A, Hassan A, Bledsoe D, Morgan A, O'Rourke B, Rogers WD, Wolstenholme JT, Miles MF. A selective GSK3β inhibitor, tideglusib, decreases intermittent access and binge ethanol self-administration in C57BL/6J mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.13.593949. [PMID: 38798478 PMCID: PMC11118361 DOI: 10.1101/2024.05.13.593949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Over 10% of the US population over 12 years old meets criteria for Alcohol Use Disorder (AUD), yet few effective, long-term treatments are currently available. Glycogen synthase kinase 3 beta (GSK3β) has been implicated in ethanol behaviors and poses as a potential therapeutic target in the treatment of AUD. Here we investigate the role of tideglusib, a selective GSK3β inhibitor, in ethanol consumption and other behaviors. We have shown tideglusib decreases ethanol consumption in both a model of daily, progressive ethanol intake (two-bottle choice, intermittent ethanol access) and binge-like drinking behavior (drinking-in-the-dark) without effecting water intake. Further, we have shown tideglusib to have no effect on ethanol pharmacokinetics, taste preference, or anxiety-like behavior, though there was a transient increase in total locomotion following treatment. Additionally, we assessed liver health following treatment via serum levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase and showed no effect on aminotransferase levels though there was a decrease in alkaline phosphatase. RNA sequencing studies revealed a role of GSK3β inhibition via tideglusib on the canonical Wnt signaling pathway, suggesting tideglusib may carry out its effects on ethanol consumption through effects on β-catenin binding to the transcription factors TCF3 and LEF1. The data presented here further implicate GSK3β in alcohol consumption and support the use of tideglusib as a potential therapeutic in the treatment of AUD.
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Madsen HØ, Hageman I, Martiny K, Faurholt-Jepsen M, Kolko M, Henriksen TEG, Kessing LV. BLUES - stabilizing mood and sleep with blue blocking eyewear in bipolar disorder - a randomized controlled trial study protocol. Ann Med 2023; 55:2292250. [PMID: 38109922 PMCID: PMC10732202 DOI: 10.1080/07853890.2023.2292250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Chronotherapeutic interventions for bipolar depression and mania are promising interventions associated with rapid response and benign side effect profiles. Filtering of biologically active short wavelength (blue) light by orange tinted eyewear has been shown to induce antimanic and sleep promoting effects in inpatient mania. We here describe a study protocol assessing acute and long-term stabilizing effects of blue blocking (BB) glasses in outpatient treatment of bipolar disorder. PATIENTS AND METHODS A total of 150 outpatients with bipolar disorder and current symptoms of (hypo)-mania will be randomized 1:1 to wear glasses with either high (99%) (intervention group) or low (15%) (control group) filtration of short wavelength light (<500 nm). Following a baseline assessment including ratings of manic and depressive symptoms, sleep questionnaires, pupillometric evaluation and 48-h actigraphy, participants will wear the glasses from 6 PM to 8 AM for 7 consecutive days. The primary outcome is the between group difference in change in Young Mania Rating Scale scores after 7 days of intervention (day 9). Following the initial treatment period, the long-term stabilizing effects on mood and sleep will be explored in a 3-month treatment paradigm, where the period of BB treatment is tailored to the current symptomatology using a 14-h antimanic schedule during (hypo-) manic episodes (BB glasses or dark bedroom from 6 PM to 8 AM) and a 2-h maintenance schedule (BB glasses on two hours prior to bedtime/dark bedroom) during euthymic and depressive states.The assessments will be repeated at follow-up visits after 1 and 3 months. Throughout the 3-month study period, participants will perform continuous daily self-monitoring of mood, sleep and activity in a smartphone-based app. Secondary outcomes include between-group differences in actigraphic sleep parameters on day 9 and in day-to-day instability in mood, sleep and activity, general functioning and objective sleep markers (actigraphy) at weeks 5 and 15. TRIAL REGISTRATION The trial will be registered at www.clinicaltrials.gov prior to initiation and has not yet received a trial reference. ADMINISTRATIVE INFORMATION The current paper is based on protocol version 1.0_31.07.23. Trial sponsor: Lars Vedel Kessing.
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Affiliation(s)
- Helle Østergaard Madsen
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Klaus Martiny
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Tone E. G. Henriksen
- Department of Research and Innovation, Division of Mental Health Care, Valen Hospital, Fonna Health Authority, Kvinnherad, Norway
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Almeida OP, Etherton-Beer C, Kelty E, Sanfilippo F, Preen DB, Page A. Lithium Dispensed for Adults Aged ≥ 50 Years Between 2012 and 2021: Analyses of a 10% Sample of the Australian Pharmaceutical Benefits Scheme. Am J Geriatr Psychiatry 2023; 31:716-725. [PMID: 37080815 DOI: 10.1016/j.jagp.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Lithium use seems to be declining in clinical practice. We examined the proportion of adults aged ≥ 50 years dispensed lithium between 2012 and 2021, and investigated the proportion of lithium users dispensed other medications. METHODS We used a 10% random sample data of the Australian Pharmaceutical Benefits Scheme from 2012 to 2021, and limited our analyses to adults aged ≥ 50 years. We retrieved data on lithium, other mood stabilisers, antipsychotics, antidepressants, anxiolytics and hypnotics, and medications for the treatment of other health systems. RESULTS We received 7081939 person-years records (53.2% women). The proportion of participants dispensed lithium decreased with age: 0.4% for those aged 50-59 years to < 0.1% for people aged ≥ 90 years. The dispensing of lithium increased over 10 years for those aged 50-69 and decreased in those older than 80 years. Among people dispensed lithium, nearly 1 in 5 were dispensed another mood stabiliser. Antipsychotics and antidepressants were dispensed to about 60% of participants dispensed lithium, with antidepressants dispensed more frequently to women than men. About 20% of people dispensed lithium were dispensed anxiolytics/hypnotics, more frequently for women than men. Medications to treat diseases of the alimentary, cardiovascular, endocrine and nervous systems were commonly dispensed to those dispensed lithium, as were antibiotics. CONCLUSIONS While the dispensing of lithium increased among young older adults since 2015 when guidelines for the management of mood disorders were published, our findings suggest that lithium may be under-utilised for the management of bipolar disorder in later life.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School (OPA, CE-B), University of Western Australia, Perth, Australia..
| | | | - Erin Kelty
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - Frank Sanfilippo
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - David B Preen
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - Amy Page
- School of Allied Health (AP), University of Western Australia, Perth, Australia
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Okazaki T, Nakatsu K, Asaoka S, Okamura H. Factors Associated with Long-term Medication Adherence in Patients Who Participated in a Short-term Group Psychoeducation Program for Bipolar Disorder. Psychiatr Q 2023:10.1007/s11126-023-10031-0. [PMID: 37221417 DOI: 10.1007/s11126-023-10031-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Improving adherence to medication and quality of life is a challenge in treating bipolar disorder. Therefore, psychoeducation plays an important role. This study examined factors associated with long-term medication adherence in patients with bipolar disorder who participated in a short-term psychoeducation program. Additionally, the relationships between medication adherence and medication attitudes and quality of life (QOL) were assessed. Multiple regression analysis was conducted on 67 inpatients and outpatients using medication adherence (Brief Evaluation for Medication Influences and Beliefs [BEMIB] score) as the dependent variable and clinical and demographic variables before and after the program as explanatory variables, one year after completion of the program. Pearson's correlation coefficients were calculated for associations between patients' BEMIB score and medication attitudes (Drug Attitude Inventory-10 [DAI-10]) and QOL (World Health Organization QOL-26 [WHOQOL-26] score) before and after the program and one year after program completion. The results showed that the CSQ-8 J (Client Satisfaction Questionnaire-8 Japanese) and DAI-10 scores immediately after the program were significantly related to the BEMIB score one year after program completion. Both the BEMIB and DAI-10 showed significant positive correlations with several items of the WHOQOL-26, both after the program and one year after completion of the program. The results suggest that medication attitudes acquired through psychoeducation and program satisfaction impact long-term medication adherence. The study also indicates that medication attitudes and medication adherence after a psychoeducation program are associated with QOL. Thus, patients' subjective views after a psychoeducation program can play an important role in long-term medication adherence and QOL.
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Affiliation(s)
- Tomoyuki Okazaki
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Keigo Nakatsu
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Satoshi Asaoka
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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McVoy M, Levin JB. Updated strategies for the management of poor medication adherence in patients with bipolar disorder. Expert Rev Neurother 2023; 23:365-376. [PMID: 37036814 DOI: 10.1080/14737175.2023.2198704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Suboptimal adherence is a well-established, pervasive problem in individuals with bipolar disorder (BD) causing disability, suffering, and cost. AREAS COVERED This review covers new research since January 2016 regarding internal (patient-centered) and external (system level) barriers and facilitators to adherence. Measures of adherence, the efficacy of psychosocial adherence enhancement interventions in individuals with BD, and, finally, novel delivery systems for BD medication are also covered. Measures of adherence continue to fall broadly into objective measures (i.e. drug levels) and more subjective, self-report measures and a combination of these likely provides the most comprehensive picture. Efficacious components of psychosocial adherence enhancement interventions include psychoeducation, motivational interviewing, and cognitive behavioral strategies, yet methods for delivery vary. Long-acting injectable (LAI) medications for BD are the drug delivery system with the most promise for BD. Combining psychosocial components with novel drug delivery systems has the potential for establishing and maintaining medication adherence. EXPERT OPINION Psychosocial interventions improve adherence in individuals with BD. Psychoeducation is a necessary but not sufficient component in psychosocial interventions. LAIs should be considered earlier for adherence improvement than many treatment guidelines currently suggest. Comparative studies are lacking as is research into novel systems of medication delivery.
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Affiliation(s)
- Molly McVoy
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Neurological & Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Neurological & Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Kessing LV. Should long-acting injectable antipsychotics be used earlier and more frequent in bipolar disorder, type I? Nord J Psychiatry 2022; 76:487-488. [PMID: 34839767 DOI: 10.1080/08039488.2021.2008000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Holm M, Tanskanen A, Lähteenvuo M, Tiihonen J, Taipale H. Comparative effectiveness of mood stabilizers and antipsychotics in the prevention of hospitalization after lithium discontinuation in bipolar disorder. Eur Neuropsychopharmacol 2022; 61:36-42. [PMID: 35763976 DOI: 10.1016/j.euroneuro.2022.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
The aim of the study was to compare the real-world effectiveness of mood stabilizers and antipsychotics in the prevention of psychiatric hospitalizations and treatment failure after lithium discontinuation in a nationwide bipolar cohort. Using health-care registers, we identified everyone in Finland diagnosed with bipolar disorder during 1987-2018 who discontinued lithium after using it for at least one year (n = 4 052, median period of lithium use before discontinuation 2.7 years). The risk of psychiatric hospitalization and treatment failure (psychiatric hospitalization, death or change in medication) were investigated with within-individual Cox regression. Of mood stabilizer monotherapies, the periods of valproate use (HR = 0.83, 95% CI = 0.71 - 0.97) had lower risk of hospitalization than nonuse of mood stabilizers. Of antipsychotic monotherapies, the use of long-acting injectable (LAI) antipsychotics (HR = 0.48, 95% CI = 0.26 - 0.88) and chlorprothixene (HR = 0.62, 95% CI = 0.44 - 0.88) were associated with lower risk and the use of quetiapine (HR = 1.26, 95% CI = 1.07 - 1.48) and oral olanzapine (HR = 1.23, 95% CI = 1.01 - 1.49) with higher risk of psychiatric hospitalizations than nonuse of antipsychotics. Of mood stabilizer monotherapies, lithium use was associated with lower risk of treatment failure (HR = 0.82, 95% CI = 0.76 - 0.88) than valproate use. The results suggest that antipsychotic LAIs are especially effective in the prevention of psychiatric hospitalizations after lithium discontinuation. The need to alter used medications may be the lowest when lithium is restarted.
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Affiliation(s)
- M Holm
- Finnish Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
| | - A Tanskanen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - M Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - J Tiihonen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - H Taipale
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden; University of Eastern Finland, School of Pharmacy, Kuopio, Finland
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Chen Y, Zhang J, Hou F, Bai Y. Self-Reported Low Lithium Adherence Among Chinese Patients with Bipolar Disorder in Shenzhen: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2989-2999. [PMID: 36349196 PMCID: PMC9637360 DOI: 10.2147/ppa.s384683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lithium has been widely used to treat bipolar disorder (BD), although its adherence is rarely reported in China. This study aimed to explore the rate of lithium adherence and its associated factors in patients with BD, which has rarely been reported in China. METHODS We conducted a cross-sectional study among patients in Shenzhen Mental Health Center (Shenzhen Kangning Hospital), who were aged 12 years or above, were diagnosed with BD based on the International Classification of Diseases, tenth edition (ICD-10), and had been on lithium for at least 1 month. We collected information on sociodemographic and clinical characteristics and on knowledge about and attitudes toward lithium. We also investigated patients' concerns while taking lithium and where they can and wish to obtain information on lithium. RESULTS Of the 244 enrolled patients and 221 patients aged 18 years or older, 52% and 50% disclosed low adherence to lithium, respectively. Factors associated with poor lithium adherence were a younger age (odds ratio (OR): 0.962, 95% confidence interval (CI): 0.933-0.992), female sex (OR: 2.171, 95% CI: 1.146-4.112), and no hospitalization history (OR: 0.389, 95% CI: 0.217-0.689) for the full sample, and more years of education (OR: 4.086, 95% CI: 1.397-11.946) and fewer hospitalizations (OR: 0.615, 95% CI: 0.467-0.809) for patients aged 18 years or older. Less knowledge of periodic tests conducted during lithium treatment played a critical role in low lithium adherence (regression analysis of the full sample: OR: 0.642, 95% CI: 0.532-0.775, regression analysis of subgroups: OR: 0.609, 95% CI: 0.500-0.742). The treatment duration was a major concern among patients on lithium, and patients preferred obtaining lithium-associated information through health services and WeChat. CONCLUSION The rate of lithium adherence was low in this study. Psychoeducation to increase lithium compliance should mainly focus on patients who are young and provide thorough background information on lithium. Health services should actively provide lithium-associated information. A greater need for medication information based on WeChat was observed, implying its potential role in adherence-related psychoeducation.
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Affiliation(s)
- Yifeng Chen
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - Jian Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - Fengsu Hou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
| | - Yuanhan Bai
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China
- Correspondence: Yuanhan Bai, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, No. 77 Zhenbi Road, Pingshan District, Shenzhen City, 518118, People’s Republic of China, Email
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Kessing LV, Kyster NB, Bondo-Kozuch P, Christensen EM, Vejstrup B, Smidt B, Jørgensen AMB, Rosenberg R, Mardosas D, Rasmussen LB, Vinberg M, Hageman I, Faurholt-Jepsen M. Effect of specialised versus generalised outpatient treatment for bipolar disorder: the CAG Bipolar trial - study protocol for a randomised controlled trial. BMJ Open 2021; 11:e048821. [PMID: 34645661 PMCID: PMC8515461 DOI: 10.1136/bmjopen-2021-048821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite current available treatment patients with bipolar disorder often experience relapses and decreased overall functioning. Furthermore, patients with bipolar disorder are often not treated medically or psychologically according to guidelines and recommendations. A Clinical Academic Group is a new treatment initiative bringing together clinical services, research, education and training to offer care and treatment that is based on reliable evidence backed up by research. The present Clinical Academic Group for bipolar disorder (the CAG Bipolar) randomised controlled trial (RCT) aims for the first time to investigate whether specialised outpatient treatment in CAG Bipolar versus generalised community-based treatment improves patient outcomes and clinician's satisfaction with care in patients with bipolar disorder. METHODS AND ANALYSIS The CAG Bipolar trial is a pragmatic randomised controlled parallel-group trial undertaken in the Capital Region of Denmark covering a catchment area of 1.85 million people. Patients with bipolar disorder are invited to participate as part of their outpatient treatment in the Mental Health Services. The included patients will be randomised to (1) specialised outpatient treatment in the CAG Bipolar (intervention group) or (2) generalised community-based outpatient treatment (control group). The trial started 13 January 2020 and has currently included more than 600 patients. The outcomes are (1) psychiatric hospitalisations and cumulated number and duration of psychiatric hospitalisations (primary), and (2) self-rated depressive symptoms, self-rated manic symptoms, quality of life, perceived stress, satisfaction with care, use of medication and the clinicians' satisfaction with their care (secondary). A total of 1000 patients with bipolar disorder will be included. ETHICS AND DISSEMINATION The CAG Bipolar RCT is funded by the Capital Region of Denmark and ethical approval has been obtained from the Regional Ethical Committee in The Capital Region of Denmark (H-19067248). Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets. TRIAL REGISTRATION NUMBER NCT04229875.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Birte Smidt
- Psychiatric Center Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zealand, Hillerød, Denmark
| | - Ida Hageman
- Mental Health Services in the Capital Region of Denmark, Kobenhavn O, Denmark
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Relation of medication adherence to cognitive functions in egyptian patients with bipolar I disorder. Int Clin Psychopharmacol 2021; 36:193-200. [PMID: 33724253 DOI: 10.1097/yic.0000000000000355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonadherence to medication regimens is frequently reported in bipolar I disorder (BDI) patients. However, little is known about the relationship between cognitive functions and adherence in BDI. To establish possible associations between medication adherence and cognitive function in patients with BDI. A total of 110 inpatients with BDI were subjected to the Structured Clinical Interview for DSM-IV Axis I Disorder, Morisky 8-Item Medication Adherence Scale, Young Mania Rating Scale, Wechsler Adult Intelligence Scale-Revised, Wechsler memory scale (WMS) and Wisconsin card sorting test (WCST). Patients were assessed on admission and followed up 6 months after discharge. Six months after discharge, (58.2%) of patients were nonadherent to their medications. The nonadherent group were younger males with less years of education, with lower mean scores in information orientation and visual memory backward domains of WMS and lower mean scores in perseveration responses, perseveration errors and learning to learn domains of WCST. In logistic regression analysis, younger age and impaired information orientation domain of WMS were putative predictors of nonadherence. Episodic memory and younger age were the strongest patients' related factors associated with nonadherence to medication. These results suggest that rehabilitation of specific cognitive skills may improve adherence in BDI.
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Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials. EVIDENCE-BASED MENTAL HEALTH 2020; 23:2-7. [PMID: 32046986 PMCID: PMC10231585 DOI: 10.1136/ebmental-2019-300106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD). OBJECTIVES To (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones. METHODS Patients with BD (n=117) evaluated adherence to medication daily for 6-9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers' Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. FINDINGS During the study 90.50% of the days were evaluated as 'medication taken', 6.91% as 'medication taken with changes' and 2.59% as 'medication not taken'. Adherence to medication measured via smartphones was valid compared with the MARS (B: -0.049, 95% CI -0.095 to -0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. CONCLUSIONS Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. CLINICAL IMPLICATIONS Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. TRIAL REGISTRATION NUMBER NCT01446406 and NCT02221336.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
| | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
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Bauer M, Glenn T, Alda M, Bauer R, Grof P, Marsh W, Monteith S, Munoz R, Rasgon N, Sagduyu K, Whybrow PC. Trajectories of adherence to mood stabilizers in patients with bipolar disorder. Int J Bipolar Disord 2019; 7:19. [PMID: 31482209 PMCID: PMC6722168 DOI: 10.1186/s40345-019-0154-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/24/2019] [Indexed: 01/27/2023] Open
Abstract
Background Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes. Methods This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient. Results Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found. Conclusion In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - T Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - R Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - P Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - W Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - S Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - R Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - N Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - K Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - P 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
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13
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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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14
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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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15
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Chakrabarti S. Medication non-adherence in bipolar disorder: Review of rates, demographic and clinical predictors. World J Meta-Anal 2017; 5:103-123. [DOI: 10.13105/wjma.v5.i4.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To conduct a systematic search for all studies examining rates and demographic and illness-related determinants of medication non-adherence in bipolar disorder (BD).
METHODS A comprehensive literature search was undertaken of six English-language databases to identify published articles on medication non-adherence in BD from inception till December 2016. Any article, either a review or an original-research article was examined for its relevance to the subject. All such articles were manually searched to locate any further articles containing relevant information. Studies were included only if they had adequately described the patient sample, assessment methods and statistical procedures, presented their results systematically and their conclusions were congruent with the results.
RESULTS The initial search yielded 249 articles on the subject; of these 198 articles were included. Of the 162 original-research studies, 132 had provided information on rates of medication non-adherence in BD. There was a wide variation in rates ranging from universal adherence (100%) to almost universal non-adherence (96%); this discrepancy was more due to methodological differences than true variations in rates. Notwithstanding the significant discrepancies in methodology, based on these 132 studies mean rates of 41.5%-43% and median rates of 40%-41% were obtained for medication non-adherence in BD. Rates of adherence with mood stabilizers were significantly lower than those for antipsychotics, or for medications of all classes. None of the demographic attributes were unequivocally linked to medication non-adherence in BD. Similarly, medication-related variables such as type of medications, doses, treatment regimens and side effects did not demonstrate consistent associations with non-adherence. Among clinical characteristics the presence of comorbid substance use disorder and absence of insight were the only two factors clearly linked to non-adherence in BD.
CONCLUSION Medication non-adherence is prevalent in about a third to half of patients with BD. Demographic, illness and treatment related factors do not predict non-adherence with certainty.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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16
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Levin JB, Krivenko A, Howland M, Schlachet R, Sajatovic M. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review. CNS Drugs 2016; 30:819-35. [PMID: 27435356 DOI: 10.1007/s40263-016-0368-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical.
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Affiliation(s)
- Jennifer B Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA. .,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.
| | - Anna Krivenko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Psychology, Cleveland State University, 2300 Chester Avenue, Cleveland, OH, 44115, USA
| | - Molly Howland
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rebecca Schlachet
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA.,Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106, USA
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17
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 457] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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18
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Faurholt-Jepsen M, Frost M, Ritz C, Christensen EM, Jacoby AS, Mikkelsen RL, Knorr U, Bardram JE, Vinberg M, Kessing LV. Daily electronic self-monitoring in bipolar disorder using smartphones - the MONARCA I trial: a randomized, placebo-controlled, single-blind, parallel group trial. Psychol Med 2015; 45:2691-2704. [PMID: 26220802 DOI: 10.1017/s0033291715000410] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of studies on electronic self-monitoring in affective disorder and other psychiatric disorders is increasing and indicates high patient acceptance and adherence. Nevertheless, the effect of electronic self-monitoring in patients with bipolar disorder has never been investigated in a randomized controlled trial (RCT). The objective of this trial was to investigate in a RCT whether the use of daily electronic self-monitoring using smartphones reduces depressive and manic symptoms in patients with bipolar disorder. METHOD A total of 78 patients with bipolar disorder according to ICD-10 criteria, aged 18-60 years, and with 17-item Hamilton Depression Rating Scale (HAMD-17) and Young Mania Rating Scale (YMRS) scores ≤17 were randomized to the use of a smartphone for daily self-monitoring including a clinical feedback loop (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for 6 months. The primary outcomes were differences in depressive and manic symptoms measured using HAMD-17 and YMRS, respectively, between the intervention and control groups. RESULTS Intention-to-treat analyses using linear mixed models showed no significant effects of daily self-monitoring using smartphones on depressive as well as manic symptoms. There was a tendency towards more sustained depressive symptoms in the intervention group (B = 2.02, 95% confidence interval -0.13 to 4.17, p = 0.066). Sub-group analysis among patients without mixed symptoms and patients with presence of depressive and manic symptoms showed significantly more depressive symptoms and fewer manic symptoms during the trial period in the intervention group. CONCLUSIONS These results highlight that electronic self-monitoring, although intuitive and appealing, needs critical consideration and further clarification before it is implemented as a clinical tool.
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Affiliation(s)
- M Faurholt-Jepsen
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - M Frost
- The Pervasive Interaction Laboratory (PIT Lab),IT University of Copenhagen,Copenhagen,Denmark
| | - C Ritz
- Department of Basic Sciences and Environment,Faculty of Life Sciences,University of Copenhagen,Copenhagen,Denmark
| | - E M Christensen
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - A S Jacoby
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - R L Mikkelsen
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - U Knorr
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - J E Bardram
- The Pervasive Interaction Laboratory (PIT Lab),IT University of Copenhagen,Copenhagen,Denmark
| | - M Vinberg
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
| | - L V Kessing
- The Copenhagen Clinic for Affective Disorder,Psychiatric Centre Copenhagen,Rigshospitalet,Copenhagen,Denmark
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19
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Kessing LV. Treatment Options in Bipolar Disorder: Lessons from Population-Based Registers with Focus on Lithium. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40501-015-0047-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Smith EG, Austin KL, Kim HM, Eisen SV, Kilbourne AM, Miller DR, Zivin K, Hannemann C, Sauer BC, Valenstein M. Mortality associated with lithium and valproate treatment of US Veterans Health Administration patients with mental disorders. Br J Psychiatry 2015; 207:55-63. [PMID: 25953891 DOI: 10.1192/bjp.bp.113.138685] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 09/26/2014] [Indexed: 11/23/2022]
Abstract
BackgroundThe mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators.AimsTo assess associations between lithium, valproate and non-suicide mortality.MethodIntention-to-treat, propensity score-matched cohort study.ResultsLithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37).ConclusionsPatients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research.
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Affiliation(s)
- Eric G Smith
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Karen L Austin
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Hyungjin Myra Kim
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Susan V Eisen
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Amy M Kilbourne
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Donald R Miller
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Kara Zivin
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Claire Hannemann
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Brian C Sauer
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
| | - Marcia Valenstein
- Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clin
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Scheen L, Brandt L, Bodén R, Tiihonen J, Andersen M, Kieler H, Reutfors J. Predictors for initiation of pharmacological prophylaxis in patients with newly diagnosed bipolar disorder--A nationwide cohort study. J Affect Disord 2015; 172:204-10. [PMID: 25451419 DOI: 10.1016/j.jad.2014.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment guidelines state that all patients with bipolar disorder should use pharmacological prophylaxis; however the actual use of prophylactic drugs after bipolar disorder diagnosis is unknown. Our aim was to assess the use of, and predictors for, pharmacoprophylaxis in newly diagnosed bipolar disorder patients. METHODS Data from three Swedish nationwide registers were obtained. We identified patients aged 18-75 with a first time diagnosis of bipolar disorder between 2006 and 2012 (n=31,770) and reviewed subsequent mood-stabilizer and antipsychotic prescription fills. In multivariable Cox regression models, we studied demographic and illness related factors as predictors of prescription fills after diagnosis. RESULTS In total, 72.2% (95% confidence interval [CI] 71.7-72.7%) of the patients filled a prescription of a prophylactic drug within 3 months after diagnosis. Pharmacological prophylaxis was mainly associated with a longer duration of hospitalization at bipolar disorder diagnosis (adjusted hazard ratio [AHR] 2.18; CI 2.02-2.35 for a hospitalization of ≥28 days compared to <7 days) and previous use of any mood-stabilizer or antipsychotic (inpatients: AHR 1.24; CI 1.17-1.31 and outpatients: AHR 1.78; CI 1.73-1.84). LIMITATIONS We had no information on drug prescriptions that were never filled. CONCLUSIONS The proportion of newly diagnosed bipolar disorder patients without pharmacological prophylaxis is substantial. Patients who are naïve to mood-stabilizers and antipsychotics and are hospitalized for a brief period at diagnosis are the ones least likely to initiate pharmacoprophylaxis, suggesting that this group deserves attention in order to improve the long term prognosis.
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Affiliation(s)
- Louise Scheen
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Robert Bodén
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Smith EG, Austin KL, Kim HM, Miller DR, Eisen SV, Christiansen CL, Kilbourne AM, Sauer BC, McCarthy JF, Valenstein M. Suicide risk in Veterans Health Administration patients with mental health diagnoses initiating lithium or valproate: a historical prospective cohort study. BMC Psychiatry 2014; 14:357. [PMID: 25515091 PMCID: PMC4343189 DOI: 10.1186/s12888-014-0357-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lithium has been reported in some, but not all, studies to be associated with reduced risks of suicide death or suicidal behavior. The objective of this nonrandomized cohort study was to examine whether lithium was associated with reduced risk of suicide death in comparison to the commonly-used alternative treatment, valproate. METHODS A propensity score-matched cohort study was conducted of Veterans Health Administration patients (n=21,194/treatment) initiating lithium or valproate from 1999-2008. RESULTS Matching produced lithium and valproate treatment groups that were highly similar in all 934 propensity score covariates, including indicators of recent suicidal behavior, but recent suicidal ideation was not able to be included. In the few individuals with recently diagnosed suicidal ideation, a significant imbalance existed with suicidal ideation more prevalent at baseline among individuals initiating lithium than valproate (odds ratio (OR) 1.30, 95% CI 1.09, 1.54; p=0.003). No significant differences in suicide death were observed over 0-365 days in A) the primary intent-to-treat analysis (lithium/valproate conditional odds ratio (cOR) 1.22, 95% CI 0.82, 1.81; p=0.32); B) during receipt of initial lithium or valproate treatment (cOR 0.86, 95% CI 0.46, 1.61; p=0.63); or C) after such treatment had been discontinued/modified (OR 1.51, 95% CI 0.91, 2.50; p=0.11). Significantly increased risks of suicide death were observed after the discontinuation/modification of lithium, compared to valproate, treatment over the first 180 days (OR 2.72, 95% CI 1.21, 6.11; p=0.015). CONCLUSIONS In this somewhat distinct sample (a predominantly male Veteran sample with a broad range of psychiatric diagnoses), no significant differences in associations with suicide death were observed between lithium and valproate treatment over 365 days. The only significant difference was observed over 0-180 days: an increased risk of suicide death, among individuals discontinuing or modifying lithium, compared to valproate, treatment. This difference could reflect risks either related to lithium discontinuation or higher baseline risks among lithium recipients (i.e., confounding) that became more evident when treatment stopped. Our findings therefore support educating patients and providers about possible suicide-related risks of discontinuing lithium even shortly after treatment initiation, and the close monitoring of patients after lithium discontinuation, if feasible. If our findings include residual confounding biasing against lithium, however, as suggested by the differences observed in diagnosed suicidal ideation, then the degree of beneficial reduction in suicide death risk associated with active lithium treatment would be underestimated. Further research is urgently needed, given the lack of interventions against suicide and the uncertainties concerning the degree to which lithium may reduce suicide risk during active treatment, increase risk upon discontinuation, or both.
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Affiliation(s)
- Eric G Smith
- />Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), MD-152, ENRM VAMC, 200 Springs Road, Bedford, MA 01730 USA
- />Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA USA
| | - Karen L Austin
- />Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI USA
- />Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI USA
| | - Hyungjin Myra Kim
- />Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI USA
- />Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI USA
- />Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI USA
| | - Donald R Miller
- />Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), MD-152, ENRM VAMC, 200 Springs Road, Bedford, MA 01730 USA
- />Department of Health Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Susan V Eisen
- />Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), MD-152, ENRM VAMC, 200 Springs Road, Bedford, MA 01730 USA
- />Department of Health Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Cindy L Christiansen
- />Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), MD-152, ENRM VAMC, 200 Springs Road, Bedford, MA 01730 USA
- />Department of Health Policy and Management, Boston University School of Public Health, Boston, MA USA
| | - Amy M Kilbourne
- />Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI USA
- />Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington, DC USA
- />Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Brian C Sauer
- />VA IDEAS2.0 Center, Department of Veterans Affairs, Salt Lake City, UT USA
- />Department of Internal Medicine, University of Utah, Salt Lake City, UT USA
| | - John F McCarthy
- />Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI USA
- />Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI USA
- />Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
| | - Marcia Valenstein
- />Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI USA
- />Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI USA
- />Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA
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Faurholt-Jepsen M, Vinberg M, Frost M, Christensen EM, Bardram J, Kessing LV. Daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones--the MONARCA II trial protocol: a randomized controlled single-blind parallel-group trial. BMC Psychiatry 2014; 14:309. [PMID: 25420431 PMCID: PMC4247697 DOI: 10.1186/s12888-014-0309-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/21/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with bipolar disorder often show decreased adherence with mood stabilizers and frequently interventions on prodromal depressive and manic symptoms are delayed. Recently, the MONARCA I randomized controlled trial investigated the effect of electronic self-monitoring using smartphones on depressive and manic symptoms. The findings suggested that patients using the MONARCA system had more sustained depressive symptoms than patients using a smartphone for normal communicative purposes, but had fewer manic symptoms during the trial. It is likely that the ability of these self-monitored measures to detect prodromal symptoms of depression and mania may be insufficient compared to automatically generated objective data on measures of illness activity such as phone usage, social activity, physical activity, and mobility. The Monsenso system, for smartphones integrating subjective and objective measures of illness activity was developed and will be tested in the present trial. METHODS The MONARCA II trial uses a randomized controlled single-blind parallel-group design. Patients with bipolar disorder according to ICD-10 who previously have been treated at the Copenhagen Clinic for Affective Disorder, Denmark are included and randomized to either daily use of the Monsenso system including an feedback loop between patients and clinicians (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for a 9-month trial period. The trial was started in September 2014 and recruitment is ongoing. The outcomes are: differences in depressive and manic symptoms; rate of depressive and manic episodes (primary); automatically generated objective data on measures of illness activity; number of days hospitalized; psychosocial functioning (secondary); perceived stress; quality of life; self-rated depressive symptoms; self-rated manic symptoms; recovery; empowerment and adherence to medication (tertiary) between the intervention group and the control group during the trial. Ethical permission has been obtained. Positive, neutral and negative findings will be published. DISCUSSION If the system is effective in reducing depressive and/or manic symptoms (and other symptoms of bipolar disorder) and the rate of episodes, there will be basis for extending the use to the treatment of bipolar disorder in general and in larger scale. TRIAL REGISTRATION ClinicalTrials.gov NCT02221336. Registered 26th of September 2014.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Maj Vinberg
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Mads Frost
- The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark ,Monsenso ApS, Rued Langgaards Vej 7, 2300 Copenhagen, Denmark
| | | | - Jakob Bardram
- The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark ,Monsenso ApS, Rued Langgaards Vej 7, 2300 Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Abstract
BACKGROUND No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder. AIMS To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late. METHOD Nationwide registers were used to identify all patients with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted to hospital. Early v. late intervention was defined in two ways: (a) start of lithium following first contact; and (b) start of lithium following a diagnosis of a single manic/mixed episode. RESULTS Regardless of the definition used, patients who started lithium early had significantly decreased rates of non-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: P<0.0001; hazard ratio (HR) = 0.87, 95% CI 0.76-0.91; single manic/mixed episode v. bipolar disorder: P<0.0001; HR = 0.75, 95% CI 0.67-0.84). CONCLUSIONS Starting lithium treatment early following first psychiatric contact or a single manic/mixed episode is associated with increased probability of lithium response.
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Affiliation(s)
- Lars Vedel Kessing
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
| | - Eleni Vradi
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
| | - Per Kragh Andersen
- Lars Vedel Kessing, MD, DMSc, Psychiatric Center Copenhagen, Department O, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Eleni Vradi, MSc, Per Kragh Andersen, MSc, PhD, DMSc, Department of Biostatistics, University of Copenhagen, Denmark
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Abstract
BACKGROUND It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex hormones, e.g. estrogen, are fluctuating and particularly postpartum there is a steep fall in the levels of serum estrogen. The role of estrogen in women with bipolar disorder is, however, not fully understood. AIM The main objective of this review is to evaluate the possible relation between serum estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen. METHOD A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen. RESULTS Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four tamoxifen studies found that tamoxifen was effective in producing antimanic effects. CONCLUSION These results indicate that estrogen fluctuations may be an important factor in the etiology of bipolar disorder and it is obvious that more research on this topic is needed to clarify the role of estrogen in women with bipolar disorder.
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Affiliation(s)
- Ninja Meinhard
- Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen , Blegdamsvej 9, DK-2100 Copenhagen , Denmark
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Friedman ES, Calabrese JR, Ketter TA, Leon AC, Thase ME, Bowden CL, Sylvia LG, Ostracher MJ, Severe J, Iosifescu DV, Nierenberg AA, Reilly-Harrington NA. Using comparative effectiveness design to improve the generalizability of bipolar treatment trials data: contrasting LiTMUS baseline data with pre-existing placebo controlled trials. J Affect Disord 2014; 152-154:97-104. [PMID: 23845385 DOI: 10.1016/j.jad.2013.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/11/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Efficacy-based double-blind placebo controlled trials were conducted to establish efficacy and safety for FDA approval. Such designs allowed and encouraged the use of exclusion criteria to improve assay sensitivity and internal validity. The LiTMUS trial increased the representation of real-world individuals with bipolar disorder despite the acknowledgment that this compromises assay sensitivity. METHOD To maximize generalizability, LiTMUS used broad inclusion and narrow exclusion criteria: participants experiencing mood symptoms of sufficient intensity (at least with a CGI-BP ≥ 3) that would warrant a change in treatment, and that lithium treatment would be a reasonable therapeutic option if they were randomized to it. At baseline demographic, illness, clinical, and treatment characteristics were collected. The LiTMUS study design and baseline sociodemographic data were compared to previous efficacy studies. RESULTS As compared to the previous bipolar disorder efficacy studies, LiTMUS participants were of similar age, gender, weight and illness severity; however LiTMUS participants were more racially and ethnically representative of the general population, had a greater number of mood episodes in the past 12 months, more Axis I/II comorbidity, a greater number of prior suicide attempts, and higher functional capacity. CONCLUSIONS LiTMUS was a comparative effectiveness trial that had broad inclusion and minimal exclusion criteria that produced a more representative sample comprised of real-world participants. This design enables the results of the LiTMUS study to be a more representative of real world pharmacotherapuetic outcomes. LIMITATIONS Limitations include possible selection bias, paucity of sociodemographic data in efficacy trials, and lack of a placebo.
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Affiliation(s)
- E S Friedman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Kraemer S, Minarzyk A, Eppendorfer S, Henneges C, Hundemer HP, Wilhelm S, Grunze H. Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study. BMC Psychiatry 2013; 13:193. [PMID: 23866017 PMCID: PMC3724595 DOI: 10.1186/1471-244x-13-193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/07/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational study assessed time on mood stabilizing medication and retention rates in patients with bipolar disorder (BD). METHODS In an 18-month, prospective, multicenter, non-interventional study conducted in Germany 761 outpatients (≥18 years) with BD and on maintenance therapy were documented. For analysis, patients were stratified by baseline medication: monotherapy olanzapine (OM, N = 186), lithium (LM, N = 152), anticonvulsants (N = 216), other mood stabilizing medication (OMS, N = 44); combination therapy olanzapine/lithium (N = 47), olanzapine/anticonvulsant (N = 68), other combinations (OC, N = 48). Continuation on medication was assessed as retention rates with 95% confidence intervals. Time to discontinuation and relapse-free time were calculated by Kaplan-Meier analysis. A relapse was defined as increase to CGI-BP >3, worsening of CGI-BP by ≥2 points, hospitalization or death related to BD. A Cox regression was calculated for the discontinuation of mood stabilizing therapy (reference: OM). Logistic regression models with stepwise forward selection were used to explore possible predictors of maintenance of treatment and relapse. RESULTS After 540 days (18 months), the overall retention rate of baseline medication was 87.7%, without notable differences between the cohorts. The overall mean time on mood stabilizing treatment was 444.7 days, with a range of 377.5 (OMS) to 481 (LM) by cohort. 74.0% of all patients were without relapse, with rates between the cohorts ranging from 58.4% (OC) to 80.2% (LM). CONCLUSIONS Retention rates exceeded controlled trial results in all treatment cohorts, in addition to other explanations possibly reflecting that the physicians were expertly adapting treatment regimens to the individual patient's disease characteristics and special needs.
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Affiliation(s)
- Susanne Kraemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Anette Minarzyk
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Steffen Eppendorfer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Carsten Henneges
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Hans-Peter Hundemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Stefan Wilhelm
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Heinz Grunze
- Newcastle University; Institute of Neuroscience, Newcastle, UK
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Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, Wetterslev J. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry 2013; 202:212-9. [PMID: 23349295 DOI: 10.1192/bjp.bp.112.113548] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS To assess the effect of treatment in a specialised out-patient mood disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS A total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37-0.97, P = 0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care. CONCLUSIONS Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK 2100 Copenhagen Ø, Denmark.
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Faurholt-Jepsen M, Vinberg M, Christensen EM, Frost M, Bardram J, Kessing LV. Daily electronic self-monitoring of subjective and objective symptoms in bipolar disorder--the MONARCA trial protocol (MONitoring, treAtment and pRediCtion of bipolAr disorder episodes): a randomised controlled single-blind trial. BMJ Open 2013; 3:bmjopen-2013-003353. [PMID: 23883891 PMCID: PMC3731717 DOI: 10.1136/bmjopen-2013-003353] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Electronic self-monitoring of affective symptoms using cell phones is suggested as a practical and inexpensive way to monitor illness activity and identify early signs of affective symptoms. It has never been tested in a randomised clinical trial whether electronic self-monitoring improves outcomes in bipolar disorder. We are conducting a trial testing the effect of using a Smartphone for self-monitoring in bipolar disorder. METHODS We developed the MONARCA application for Android-based Smartphones, allowing patients suffering from bipolar disorder to do daily self-monitoring-including an interactive feedback loop between patients and clinicians through a web-based interface. The effect of the application was tested in a parallel-group, single-blind randomised controlled trial so far including 78 patients suffering from bipolar disorder in the age group 18-60 years who were given the use of a Smartphone with the MONARCA application (intervention group) or to the use of a cell phone without the application (placebo group) during a 6-month study period. The study was carried out from September 2011. The outcomes were changes in affective symptoms (primary), social functioning, perceived stress, self-rated depressive and manic symptoms, quality of life, adherence to medication, stress and cognitive functioning (secondary and tertiary). ANALYSIS Recruitment is ongoing. ETHICS Ethical permission has been obtained. DISSEMINATION Positive, neutral and negative findings of the study will be published. REGISTRATION DETAILS The trial is approved by the Regional Ethics Committee in The Capital Region of Denmark (H-2-2011-056) and The Danish Data Protection Agency (2013-41-1710). The trial is registered at ClinicalTrials.gov as NCT01446406.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Clinic for Affective Disorders, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Clinic for Affective Disorders, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Mads Frost
- PIT Lab, IT University of Copenhagen, Copenhagen, Denmark
| | - Jakob Bardram
- PIT Lab, IT University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Clinic for Affective Disorders, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Werneke U, Ott M, Renberg ES, Taylor D, Stegmayr B. A decision analysis of long-term lithium treatment and the risk of renal failure. Acta Psychiatr Scand 2012; 126:186-97. [PMID: 22404233 PMCID: PMC3440572 DOI: 10.1111/j.1600-0447.2012.01847.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD). METHOD Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD. RESULTS At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention. CONCLUSION At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.
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Affiliation(s)
- U Werneke
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Sweden.
| | - M Ott
- Division of Internal Medicine, Department of Nephrology, Sunderby HospitalLuleå, Sweden
| | - E Salander Renberg
- Division of Psychiatry, Department of Clinical Sciences, Umeå UniversityUmeå, Sweden
| | - D Taylor
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Institute of Pharmaceutical Sciences, King's CollegeLondon, UK
| | - B Stegmayr
- Institute of Public Health and Clinical Medicine, Umeå UniversityUmeå, Sweden
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van Melick EJM, Wilting I, Souverein PC, Egberts TCG. Differences in Lithium Use Patterns in the Netherlands: Comparing Middle-Aged and Older Patients in a Database Study. ACTA ACUST UNITED AC 2012; 10:193-200. [DOI: 10.1016/j.amjopharm.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/01/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Abstract
INTRODUCTION Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice. OBJECTIVE The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy. METHOD A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding. RESULTS Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application. CONCLUSION Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.
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Affiliation(s)
- Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia.
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Kessing LV, Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J. The effects of centralised and specialised combined pharmacological and psychological intervention compared with decentralised and non-specialised treatment in the early course of severe unipolar and bipolar affective disorders--design of two randomised clinical trials. Trials 2011; 12:32. [PMID: 21291564 PMCID: PMC3045900 DOI: 10.1186/1745-6215-12-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/03/2011] [Indexed: 12/26/2022] Open
Abstract
Background In unipolar, and bipolar affective disorders, there is a high risk of relapse that increases as the number of episodes increases. Naturalistic follow-up studies suggest that the progressive development of the diseases is not prevented with the present treatment modalities. It is not known whether centralised and specialised secondary care intervention initiated early after the onset of the diseases can prevent the progression and thereby improve the prognosis. Methods Two randomised clinical multi-centre trials comparing a centralised and specialised outpatient intervention program consisting of combined pharmacological and psychological intervention with standard decentralised psychiatric treatment. Patients discharged from their first, second, or third hospitalisation due to a manic episode or bipolar disorder (trial 1) or to a single depressive episode or recurrent depressive disorder (trial 2) were randomised. Central randomisations for both trials were stratified for the number of hospitalisations and treatment centre. The primary outcome measure for the two trials is time to re-hospitalisation with an affective episode. Discussion These trials are the first to evaluate the effect of a centralised and specialised intervention in patients with early severe affective disorders. The trials used a pragmatic design comparing a specialised mood disorder clinic intervention with decentralised, non-specialised standard psychiatric treatment. Trial Registration ClinicalTrials.gov: NCT00253071
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Affiliation(s)
- Lars Vedel Kessing
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Berk L, Hallam KT, Colom F, Vieta E, Hasty M, Macneil C, Berk M. Enhancing medication adherence in patients with bipolar disorder. Hum Psychopharmacol 2010; 25:1-16. [PMID: 20041478 DOI: 10.1002/hup.1081] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Medication adherence contributes to the efficacy-effectiveness gap of treatment in patients with bipolar disorder. This paper aims to examine the challenges involved in improving medication adherence in bipolar disorder, and to extract some suggestions for future directions from the core psychosocial studies that have targeted adherence as a primary or secondary outcome. METHODS A search was conducted for articles that focused on medication adherence in bipolar disorder, with emphasis on publications from 1996 to 2008 using Medline, Web of Science, CINAHL PLUS, and PsychINFO. The following key words were used: adherence, compliance, alliance, adherence assessment, adherence measurement, risk factors, psychosocial interventions, and psycho-education. RESULTS There are a number of challenges to understanding non-adherence including the difficulty in defining and measuring it and the various risk factors that need to be considered when aiming to enhance adherence. Nevertheless, the importance of addressing adherence is evidenced by the connection between adherence problems and poor outcome. Despite these challenges, a number of small psychosocial studies targeting adherence as a primary outcome point to the potential usefulness of psycho-education aimed at improving knowledge, attitudes, and adherence behavior, but more large scale randomized controlled trials are needed in this area. Evidence of improved outcomes from larger randomized controlled trials of psychosocial interventions that target medication adherence as a secondary outcome suggests that tackling other factors besides medication adherence may also be an advantage. While some of these larger studies demonstrate an improvement in medication adherence, the translation of these interventions into real life settings may not always be practical. A person centered approach that considers risk factors for non-adherence and barriers to other health behaviors may assist with the development of more targeted briefer interventions. Integral to improving medication adherence is the delivery of psycho-education, and attention needs to be paid to the implementation, and timing of psycho-education. Progress in the understanding of how medicines work may add to the credibility of psycho-education in the future. CONCLUSIONS Enhancement of treatment adherence in bipolar patients is a necessary and promising management component as an adjunct to pharmacotherapy. The current literature on psychosocial interventions that target medication adherence in bipolar disorder points to the possibility of refining the concept of non-adherence and adapting psycho-education to the needs of certain subgroups of people with bipolar disorder. Large scale randomized controlled trials of briefer or more condensed interventions are needed that can inform clinical practice.
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Affiliation(s)
- Lesley Berk
- University of Melbourne, Victoria, Australia
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Nierenberg AA, Sylvia LG, Leon AC, Reilly-Harrington NA, Ketter TA, Calabrese JR, Thase ME, Bowden CL, Friedman ES, Ostacher MJ, Novak L, Iosifescu DV. Lithium treatment -- moderate dose use study (LiTMUS) for bipolar disorder: rationale and design. Clin Trials 2009; 6:637-48. [PMID: 19933719 DOI: 10.1177/1740774509347399] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent data indicate that lithium use for bipolar disorder has declined over the last decade and that lithium largely has been replaced with alternate, commercially promoted medications that may or may not result in better outcomes. PURPOSE This article describes the rationale and study design of LiTMUS, a multi-site, prospective, randomized clinical trial of outpatients with bipolar disorder. LiTMUS seeks to address whether initiating therapy at lower doses of lithium as part of optimized treatment (OPT, guideline-informed, evidence-based, and personalized pharmacotherapy) improves outcomes and decreases the need for other medication changes across 6 months of therapy. METHODS LiTMUS will randomize 284 adults with bipolar disorder (Type I or II) across 6 study sites. The co-primary outcomes are overall illness severity on clinical global improvement scale for bipolar disorder and a novel measure, necessary clinical adjustments. This metric provides a composite that reflects both clinical response and tolerability. Other relevant outcomes include full symptomatic recovery, quality of life, suicidal behaviors, and moderators of suicidality. RESULTS As of August 28th, 2009, we have consented 338 patients and randomized 281 for this study. LIMITATIONS The potential limitations of the study include an arbitrary definition of 'low, but effective' doses of lithium, lack of a placebo-controlled group, open treatment, and use of a new outcome measure (i.e., necessary clinical adjustments). CONCLUSION We expect that this study will inform our understanding of the effectiveness of low to moderate doses of lithium therapy for individuals with bipolar disorder.
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Affiliation(s)
- Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Bramness JG, Weitoft GR, Hallas J. Use of lithium in the adult populations of Denmark, Norway and Sweden. J Affect Disord 2009; 118:224-8. [PMID: 19249102 DOI: 10.1016/j.jad.2009.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 01/20/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lithium is an important drug in the treatment of bipolar disorder. Earlier epidemiological studies of lithium use have depended on sales statistics, clinical surveys or population surveys. The national prescription databases in Denmark, Norway and Sweden may help provide more reliable information on the epidemiology of lithium use. METHODS Data were taken from the three national prescription databases in Denmark, Norway and Sweden from July 2005 until June 2006, encompassing 1 year of prescription data. Similar methods were used to identify a number of different pharmacoepidemiological measures and data were collected for adults aged 18-69 at the time of prescription. RESULTS Norway and Sweden had higher sales and more prevalent use than Denmark. In all three countries, more female than males were treated and the prevalence of use increased linearly with age. In all, 0.17, 0.21, and 0.25% of the populations in Denmark, Norway and Sweden respectively redeemed at least 1 prescription for lithium in the period studied. The amount prescribed per user per year varied with age, increasing to maximum doses at 40 years of age and then decreasing. CONCLUSION This study is the first attempt to use prescription databases in all three Scandinavian countries to describe in detail the epidemiology of a drug's use. The analysis revealed subtle differences in the clinical use of lithium that cannot be explained by differences in the epidemiology of bipolar disorder.
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Affiliation(s)
- Jørgen G Bramness
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [PMID: 18533281 PMCID: PMC7167700 DOI: 10.1002/pds.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
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Abstract
OBJECTIVE To investigate the prevalence of mixed episodes during the course of illness in bipolar disorder. METHOD A total of 1620 patients with an ICD-10 diagnosis of bipolar affective disorder at the first psychiatric contact were identified in a period from 1994 to 2003 in Denmark and the prevalence of mixed, depressive and hypomanic/manic episodes were calculated at each episode. RESULTS The prevalence of mixed episodes increased from the first episode to the tenth episode, however, only for women (6.7% of the first episodes leading to psychiatric care compared with 18.2% of the tenth episodes). For men, the prevalence of mixed episodes was constantly low. At all episodes, the presence of a current mixed episode increased the risk substantially of getting a future mixed episode. CONCLUSION Clinicians should pay more attention to mixed episodes, especially among women, as they may represent an increasing treatment challenge as the illness progress.
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Affiliation(s)
- L V Kessing
- Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark.
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Søndergård L, Lopez AG, Andersen PK, Kessing LV. Mood-stabilizing pharmacological treatment in bipolar disorders and risk of suicide. Bipolar Disord 2008; 10:87-94. [PMID: 18199245 DOI: 10.1111/j.1399-5618.2008.00464.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated the association between continued mood-stabilizing treatment (lithium and anticonvulsants) in bipolar disorder (BD) and the risk of suicide. METHODS Using linkage of national registers, the association between continued mood-stabilizing treatment and suicide was investigated among all patients discharged nationwide from hospital psychiatry as an in- or outpatient in a period from 1995 to 2000 in Denmark with a diagnosis of BD. RESULTS A total of 5,926 patients were included in the study and among these 51 patients committed suicide eventually during the study period. Although the rate of suicide was higher during periods when patients purchased anticonvulsants (293 suicides per 100,000 person-years) than during periods with lithium (136 suicides per 100,000 person-years), the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants: patients who continued treatment with mood-stabilizing drugs had a decreased rate of suicide compared to patients who purchased mood stabilizers once only [rate ratio for anticonvulsants = 0.28, 95% confidence interval (CI) = 0.19-0.41; rate ratio for lithium = 0.20, 95% CI = 0.10-0.38]. Further, the rate of suicide decreased consistently with the number of additional prescriptions. Switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide (rate ratio = 0.28, 95% CI = 0.20-0.40), whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate. CONCLUSIONS Although continued treatment with anticonvulsants and continued treatment with lithium was associated with a rather similar reduction in the rate of suicide, the results suggest that treatment with lithium may have some superiority in relation to prevention of suicide.
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Affiliation(s)
- Lars Søndergård
- Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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