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New Developments in the Use of Atypical Antipsychotics in the Treatment of Bipolar Disorder: a Systematic Review of Recent Randomized Controlled Trials. Curr Psychiatry Rep 2021; 23:39. [PMID: 33963957 DOI: 10.1007/s11920-021-01252-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Atypical antipsychotics are increasingly used in the treatment of bipolar disorder (BD). This systematic review provides an overview of recently published randomized controlled trials (RCTs) on the efficacy and safety of atypical antipsychotics in BD. RECENT FINDINGS Several studies supported efficacy of quetiapine monotherapy in acute bipolar I (BDI) and bipolar II (BDII) depression. Moreover, quetiapine adjunctive therapy showed superior efficacy to placebo in treatment-resistant bipolar depression. Cariprazine 1.5 mg was effective in treating bipolar I depression. Aripiprazole 400 mg IM once monthly was effective in preventing manic episodes with minimal metabolic effects. In youth with BD, lurasidone was effective and well-tolerated for acute depression while asenapine showed efficacy in treating acute manic and mixed episodes. Recently published RCTs generally support the efficacy of atypical antipsychotics in different phases of BD. Future studies should focus on understudied populations including pediatric BD and geriatric BD and BDII, as well as a focus on cognitive functioning and quality of life measures.
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Averill IRE, Beaglehole B, Douglas KM, Jordan J, Crowe MT, Inder M, Lacey CJ, Frampton CM, Bowie CR, Porter RJ. Activation therapy for the treatment of inpatients with depression - protocol for a randomised control trial compared to treatment as usual. BMC Psychiatry 2019; 19:52. [PMID: 30709391 PMCID: PMC6359820 DOI: 10.1186/s12888-019-2038-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inpatients with depression have a poor long term outcome with high rates of suicide, high levels of morbidity and frequent re-admission. Current treatment often relies on pharmacological intervention and focuses on observation to maintain safety. There is significant neurocognitive deficit which is linked to poor functional outcomes. As a consequence, there is a need for novel psychotherapeutic interventions that seek to address these concerns. METHODS We combined cognitive activation and behavioural activation to create activation therapy (AT) for the treatment of inpatient depression and conducted a small open label study which demonstrated acceptability and feasibility. We propose a randomised controlled trial which will compare treatment as usual (TAU) with TAU plus activation therapy for adult inpatients with a major depressive episode. The behavioural activation component involves therapist guided re-engagement with previously or potentially rewarding activities. The cognitive activation aspect utilises computer based exercises which have been shown to improve cognitive function. DISCUSSION The proposed randomised controlled trial will examine whether or not the addition of this therapy to TAU will result in a reduced re-hospitalisation rate at 12 weeks post discharge. Subjective change in activation and objectively measured change in activity levels will be rated, and the extent of change to neurocognition will be assessed. TRIAL REGISTRATION Unique trial number: U1111-1190-9517. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12617000024347p .
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Affiliation(s)
- Ian R. E. Averill
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Ben Beaglehole
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M. Douglas
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jennifer Jordan
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Marie T. Crowe
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Maree Inder
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Cameron J. Lacey
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher M. Frampton
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher R. Bowie
- 0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, Canada
| | - Richard J. Porter
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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