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Kessing LV, Christensen EM, Krarup SK, Kyster N, Pedersen L, Legind C, Hansen L, Vejstrup B, Faurholt-Jepsen M, Baandrup L, Knorr U. An algorithm for pharmacological treatment of mania during hospitalisation. DANISH MEDICAL JOURNAL 2024; 71:A08230525. [PMID: 38704837 DOI: 10.61409/a08230525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Current evidence for pharmacological treatment of mania during hospitalisation is insufficient as there are no larger well-designed randomised trials of comparative medical treatments of mania during inpatient stays. Moreover, there is considerable variation in pharmacological medication in clinical practice during hospitalisation for mania. Based on a hospital data overview, a systematic search of the literature and a three-day consensus meeting, this narrative review proposed an algorithm for optimised pharmacological treatment of mania during hospitalisation and its subsequent scientific evaluation.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
- Department of Clinical Medicine, University of Copenhagen
| | | | - Sarah Krarup Krarup
- Psychiatric Center North Zealand, Mental Health Services, Capital Region of Denmark, Denmark
| | - Natacha Kyster
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
| | - Lykke Pedersen
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
| | - Christian Legind
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
- Department of Clinical Medicine, University of Copenhagen
| | - Line Hansen
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
| | - Birgitte Vejstrup
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
- Department of Clinical Medicine, University of Copenhagen
| | - Lone Baandrup
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
- Department of Clinical Medicine, University of Copenhagen
| | - Ulla Knorr
- Psychiatric Center Copenhagen, Mental Health Services, Capital Region of Denmark
- Department of Clinical Medicine, University of Copenhagen
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Kessing LV. Why is lithium [not] the drug of choice for bipolar disorder? a controversy between science and clinical practice. Int J Bipolar Disord 2024; 12:3. [PMID: 38228882 DOI: 10.1186/s40345-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND During over half a century, science has shown that lithium is the most efficacious treatment for bipolar disorder but despite this, its prescription has consistently declined internationally during recent decades to approximately 35% ever use or less of patients with bipolar disorder. CONTENT This narrative review provides an overview of the decreasing use of lithium in bipolar disorder internationally, shortly summarises the evidence for lithium's acute and prophylactic effects in bipolar disorder, discuss the challenges in relation to lithium including side effects, long-term risks and myths around lithium and provides two detailed examples on how specialised care models may result in successful increase of the use of lithium to 70% of patients with bipolar disorder largescale and improve care regionally and nationally. CONCLUSIONS Decades of scientific investigations and education and teaching of clinicians and the public has not increased the use of lithium on a population-based large scale. It is argued that lithium should be the drug of choice for maintenance therapy as the single first-line treatment and that organizational changes are needed with specialised care for bipolar disorder to systematically and long-term change the use of lithium on a large-scale population-level.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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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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Faurholt-Jepsen M, Kyster NB, Dyreholt MS, Christensen EM, Bondo-Kozuch P, Lerche AS, Smidt B, Knorr U, Brøndmark K, Cardoso AMB, Mathiesen A, Sjælland R, Nørbak-Emig H, Sponsor LL, Mardosas D, Sarauw-Nielsen IP, Bukh JD, Heller TV, Frost M, Iversen N, Bardram JE, Busk J, Vinberg M, Kessing LV. The effect of smartphone-based monitoring and treatment including clinical feedback versus smartphone-based monitoring without clinical feedback in bipolar disorder: the SmartBipolar trial-a study protocol for a randomized controlled parallel-group trial. Trials 2023; 24:583. [PMID: 37700334 PMCID: PMC10496351 DOI: 10.1186/s13063-023-07625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION A substantial proportion of patients with bipolar disorder experience daily subsyndromal mood swings, and the term "mood instability" reflecting the variability in mood seems associated with poor prognostic factors, including impaired functioning, and increased risk of hospitalization and relapse. During the last decade, we have developed and tested a smartphone-based system for monitoring bipolar disorder. The present SmartBipolar randomized controlled trial (RCT) aims to investigate whether (1) daily smartphone-based outpatient monitoring and treatment including clinical feedback versus (2) daily smartphone-based monitoring without clinical feedback or (3) daily smartphone-based mood monitoring only improves mood instability and other clinically relevant patient-related outcomes in patients with bipolar disorder. METHODS AND ANALYSIS The SmartBipolar trial is a pragmatic randomized controlled parallel-group trial. Patients with bipolar disorder are invited to participate as part of their specialized outpatient treatment for patients with bipolar disorder in Mental Health Services in the Capital Region of Denmark. The included patients will be randomized to (1) daily smartphone-based monitoring and treatment including a clinical feedback loop (intervention group) or (2) daily smartphone-based monitoring without a clinical feedback loop (control group) or (3) daily smartphone-based mood monitoring only (control group). All patients receive specialized outpatient treatment for bipolar disorder in the Mental Health Services in the Capital Region of Denmark. The trial started in March 2021 and has currently included 150 patients. The outcomes are (1) mood instability (primary), (2) quality of life, self-rated depressive symptoms, self-rated manic symptoms, perceived stress, satisfaction with care, cumulated number and duration of psychiatric hospitalizations, and medication (secondary), and (3) smartphone-based measures per month of stress, anxiety, irritability, activity, and sleep as well as the percentage of days with presence of mixed mood, days with adherence to medication and adherence to smartphone-based self-monitoring. A total of 201 patients with bipolar disorder will be included in the SmartBipolar trial. ETHICS AND DISSEMINATION The SmartBipolar trial is funded by the Capital Region of Denmark and the Independent Research Fund Denmark. Ethical approval has been obtained from the Regional Ethical Committee in The Capital Region of Denmark (H-19067248) as well as data permission (journal number: P-2019-809). The results will be published in peer-reviewed academic journals, presented at scientific meetings, and disseminated to patients' organizations and media outlets. TRIAL REGISTRATION Trial registration number: NCT04230421. Date March 1, 2021. Version 1.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Natacha Blauenfeldt Kyster
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Malene Schwarz Dyreholt
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Pernille Bondo-Kozuch
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Anna Skovgaard Lerche
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Birte Smidt
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Ulla Knorr
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Brøndmark
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Anne-Marie Bangsgaard Cardoso
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anja Mathiesen
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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