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Casarez RL, Johnson CM, Soares JC, Meyer TD. Use of a virtual environment to promote self-management and lifestyle changes in persons with bipolar disorder. Arch Psychiatr Nurs 2024; 49:73-82. [PMID: 38734458 DOI: 10.1016/j.apnu.2024.02.003] [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: 06/12/2023] [Revised: 08/08/2023] [Accepted: 02/09/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE Self-management and lifestyle interventions are a key factor in treatment outcomes for persons with bipolar disorder (BD). A virtual environment (VE), due to it's ability to provide flexibility of involvement in its platform, may be an alternative to face-to-face treatment to provide support for self-management. The purpose of this study is to explore how a VE, developed for chronic illness self-management, may be modified to promote self-management and lifestyle changes in those with BD. METHOD This study used a qualitative description design with focus groups. Data were collected via minimally structured interviews and analyzed using thematic content analysis. A total of seven focus groups were conducted, and the sample consisted of 30 adults with BD. Age range was 21-77 years with 21 females, seven males, and two non-binary individuals. RESULTS Five themes emerged from the findings: Self-management and lifestyle interventions with regards to (1) mental health; (2) holistic health; (3) role of peers; (4) involvement of the family; (5) technological aspects of the VE. CONCLUSIONS Focus group participants suggested that the VE may be an efficacious way to enhance self-management and promote lifestyle interventions in those with BD. Research is needed to adapt such platforms to the need of the patients and examine its' effect on health outcomes.
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Affiliation(s)
- Rebecca L Casarez
- The University of Texas Health Science Center, Cizik School of Nursing, USA; Department of Graduate Studies, 6901 Bertner Ave., Houston, TX 77030, USA.
| | - Constance M Johnson
- The University of Texas Health Science Center, Cizik School of Nursing, USA; Department of Research, 6901 Bertner Ave., Houston, TX 77030, USA.
| | - Jair C Soares
- McGovern Medical School, The University of Texas Health Science Center at Houston, USA; Faillace Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, USA.
| | - Thomas D Meyer
- McGovern Medical School, The University of Texas Health Science Center at Houston, USA; Faillace Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, USA.
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2
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Doane MJ, Thompson J, Jauregui A, Gasper S, Csoboth C. Clinical, Economic, and Humanistic Outcomes Associated with Obesity Among People with Bipolar I Disorder in the United States: Analysis of National Health and Wellness Survey Data. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:681-689. [PMID: 37743958 PMCID: PMC10516196 DOI: 10.2147/ceor.s411928] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction People living with bipolar I disorder (BD-I) have an increased risk for obesity compared with the general population that may be related to genetic, lifestyle, and treatment factors. Few studies have examined possible effects of obesity on those living with BD-I. This study examined relationships between obesity and clinical, humanistic, and economic outcomes among adults with BD-I. Methods This retrospective, cross-sectional study analyzed survey responses from a nationally representative sample of US adults participating in the 2016 or 2020 National Health and Wellness Survey. Respondents (18-64 years) with a self-reported physician diagnosis of BD-I were included and categorized by body mass index: underweight/normal weight (<25 kg/m2), overweight (25 to <30 kg/m2), or obese (≥30 kg/m2). Adjusted analyses assessed comorbidities, health-related quality of life (HRQoL), work productivity, health care resource utilization (HCRU), and economic outcomes. Results In total, responses from 1,853 participants were analyzed; most were female (65%) and white (62%). Respondents with obesity had the highest prevalence of medical comorbidities, including high blood pressure (52%), sleep apnea (37%), hypercholesterolemia (34%), and type 2 diabetes (12%). Obesity was generally associated with the lowest scores of physical health and HRQoL. Activity impairment scores were highest among respondents with obesity, as were numbers of hospitalizations and emergency department visits in the previous 6 months. Respondents with obesity incurred higher annual indirect and direct medical costs ($28,178 and $37,771, respectively) when compared with the underweight/normal weight ($23,823 and $32,227, respectively) and overweight ($24,312 and $35,231, respectively) groups. Conclusion In this nationally representative sample, obesity was associated with several outcomes that may negatively affect people living with BD-I, including medical comorbidities, higher HCRU, HRQoL impairments, and greater indirect and direct medical costs. These findings highlight the importance of considering the presence of or risk for obesity and associated medical comorbidities when treating BD-I.
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Gomes FA, Soleas EK, Kcomt A, Duffy A, Milev R, Post RM, Bauer M, Brietzke E. Practices, knowledge, and attitudes about lithium treatment: Results of online surveys completed by clinicians and lithium-treated patients. J Psychiatr Res 2023; 164:335-343. [PMID: 37393799 DOI: 10.1016/j.jpsychires.2023.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Lithium remains the gold-standard medication for acute and prophylactic treatment of bipolar disorder. Understanding clinicians' practices and patients' experiences, knowledge and attitudes about lithium may improve its clinical use. METHODS Online anonymous surveys collected information about clinician's practices and level of confidence in managing lithium and patients' experiences with lithium treatment and information received about benefits and side effects. Knowledge and attitudes regarding lithium were assessed with the Lithium Knowledge Test (LKT) and the Lithium Attitudes Questionnaire (LAQ). RESULTS Among 201 clinicians, 64.2% endorsed often treating patients with lithium and reported high levels of confidence in assessing and managing lithium. Practices concerning clinical indications, drug titration, and serum levels were guideline-concordant, but compliance with monitoring recommendations was less frequent. Practitioners were interested in receiving more education about lithium. The patients' survey recruited 219 participants with 70.3% being current lithium users. Most patients (68%) found lithium helpful and 71% reported experiencing any kind of side effect. Most responders did not receive information about side effects or other benefits of lithium. Patients with higher scores on the LKT were more likely to have positive attitudes about lithium. LIMITATIONS Cross-sectional design with predominantly English-speaking participants from Brazil and North America. CONCLUSIONS There is a discrepancy between guidelines, clinician confidence and knowledge of lithium use and practice. A deeper understanding of how to monitor, prevent and manage long-term side effects and which patients are most likely to benefit from lithium may narrow the gap between knowledge and use.
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Affiliation(s)
- Fabiano A Gomes
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Eleftherios K Soleas
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Andrew Kcomt
- Mood Disorders Association of Ontario, ON, Canada
| | - Anne Duffy
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Providence Care Hospital, Kingston, On, Canada
| | | | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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Lee J, Kim S, Lee B, Kim YB, Kim KH, Chung G, Lee SJ, Lee S, Sun W, Park HK, Choi SY. Major depression-related factor NEGR1 controls salivary secretion in mouse submandibular glands. iScience 2023; 26:106773. [PMID: 37216094 PMCID: PMC10196562 DOI: 10.1016/j.isci.2023.106773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/26/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Salivary gland cells, which secrete water in response to neuronal stimulation, are closely connected to other neurons. Transcriptomic studies show that salivary glands also express some proteins responsible for neuronal function. However, the physiological functions of these common neuro-exocrine factors in salivary glands are largely unknown. Here, we studied the function of Neuronal growth regulator 1 (NEGR1) in the salivary gland cells. NEGR1 was also expressed in mouse and human salivary glands. The structure of salivary glands of Negr1 knockout (KO) mice was normal. Negr1 KO mice showed tempered carbachol- or thapsigargin-induced intracellular Ca2+ increases and store-operated Ca2+ entry. Of interest, the activity of the large-conductance Ca2+-activated K+ channel (BK channel) was increased, whereas Ca2+-activated Cl- channel ANO1 channel activity was not altered in Negr1 KO mice. Pilocarpine- and carbachol-induced salivation was decreased in Negr1 KO mice. These results suggest that NEGR1 influence salivary secretion though the muscarinic Ca2+ signaling.
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Affiliation(s)
- Jisoo Lee
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Soohyun Kim
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Boram Lee
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Yoo-Bin Kim
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Kwang Hwan Kim
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Gehoon Chung
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Sung Joong Lee
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Soojin Lee
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Woong Sun
- Department of Anatomy, Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Hee-Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
| | - Se-Young Choi
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
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Doane MJ, Raymond K, Saucier C, Bessonova L, O'Sullivan AK, White MK, Foster AM, LaGasse K, Carpenter-Conlin J, Sajatovic M, Velligan DI. Unmet needs with antipsychotic treatment in schizophrenia and bipolar I disorder: patient perspectives from qualitative focus groups. BMC Psychiatry 2023; 23:245. [PMID: 37046256 PMCID: PMC10091535 DOI: 10.1186/s12888-023-04746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar I disorder (BD-I) are chronic mental health disorders often treated with antipsychotic medications. This qualitative study sought to better understand disease burden and treatment experiences with oral antipsychotic medications in participants living with SZ or BD-I. METHODS Six 90-min focus groups were conducted with participants diagnosed with SZ or BD-I. Trained moderators facilitated discussions using a semistructured guide. Participants described symptoms, impacts of disease, and experiences with oral antipsychotic medications, whether favourable or unfavourable. RESULTS Among participants with SZ (n = 15; 3 groups, 5 per group), 53% were male and 33% were white, with a mean of 18.6 years since diagnosis. Of participants with BD-I (n = 24; 3 groups, 8 per group), 33% were male and 42% were white, with a mean of 13.0 years since diagnosis. Participants described numerous symptoms of their illnesses that impacted relationships and daily life, including effects on emotional health, the ability to work, and encounters with law enforcement. Previous antipsychotic medications were deemed effective by 14/15 (93%) participants with SZ and 12/16 (75%) participants with BD-I. Most participants with SZ (13/15; 87%) or with BD-I (16/24; 67%) reported discontinuing their antipsychotic medication at some point. Side effects were a common reason for discontinuing or switching medications for participants with SZ (8/15; 53%) and for those with BD-I (11/24; 46%). The most common side effects reported in both cohorts were weight gain, drowsiness, sexual problems, and neurologic symptoms. Side effects negatively affected quality of life, leading to serious health problems and issues with self-esteem. CONCLUSIONS People living with SZ or BD-I cited a range of favourable and unfavourable experiences with oral antipsychotic medications. Most participants reported that their antipsychotics were effective at controlling their symptoms, but multiple side effects impacted their quality of life, caused additional serious health problems, and often led to discontinuation of or switching antipsychotics. Findings from this study contribute to a better understanding of patients' experiences with antipsychotics and highlight a need for new medications with favourable benefit/risk profiles.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Martha Sajatovic
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Dawn I Velligan
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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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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Gallop L, Westwood SJ, Lewis Y, Campbell IC, Schmidt U. Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02157-0. [PMID: 36764973 DOI: 10.1007/s00787-023-02157-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Transcranial direct current stimulation (tDCS) has demonstrated benefits in adults with various psychiatric disorders, but its clinical utility in children and young people (CYP) remains unclear. This PRISMA systematic review used published and ongoing studies to examine the effects of tDCS on disorder-specific symptoms, mood and neurocognition in CYP with psychiatric disorders. We searched Medline via PubMed, Embase, PsychINFO via OVID, and Clinicaltrials.gov up to December 2022. Eligible studies involved multiple session (i.e., treatment) tDCS in CYP (≤ 25 years old) with psychiatric disorders. Two independent raters assessed the eligibility of studies and extracted data using a custom-built form. Of 33 eligible studies (participant N = 517), the majority (n = 27) reported an improvement in at least one outcome measure of disorder-specific symptoms. Few studies (n = 13) examined tDCS effects on mood and/or neurocognition, but findings were mainly positive. Overall, tDCS was well tolerated with minimal side effects. Of 11 eligible ongoing studies, many are sham-controlled RCTs (n = 9) with better blinding techniques and a larger estimated participant enrolment (M = 79.7; range 15-172) than published studies. Although encouraging, the evidence to date is insufficient to firmly conclude that tDCS can improve clinical symptoms, mood, or cognition in CYP with psychiatric disorders. Ongoing studies appear of improved methodological quality; however, future studies should broaden outcome measures to more comprehensively assess the effects of tDCS and develop dosage guidance (i.e., treatment regimens).
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Affiliation(s)
- Lucy Gallop
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK.
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, W1W 6UW, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AB, UK
| | - Yael Lewis
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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8
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Lee SY, Jung KI, Park MH, Lee CU. Old Age, Female Sex, and Psychotropic Medications Predict Hyposalivation But Not Heart Rate Variability. Psychiatry Investig 2023; 20:62-68. [PMID: 36721887 PMCID: PMC9890040 DOI: 10.30773/pi.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/04/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To explore risk factors for dry mouth and examine the clinical utility of the heart rate variability (HRV) test in the prediction of dry mouth. METHODS Every outpatient, who underwent tests for both unstimulated salivary flow and HRV, was retrospectively reviewed. After excluding seven subjects, the demographics and clinical factors in 70 total patients were collected. Based on objective salivary flow rates, patients were classified into normal (≥0.2 mL/min) or hyposalivation groups (<0.2 mL/min), and inter-group comparisons were performed with a two-tailed statistical significance of 0.05. RESULTS Patients with subjective dry mouth were significantly more likely to show hyposalivation. Advanced age, female sex, and current use of psychotropic medications were identified as risk factors for dry mouth. However, dry mouth was not associated with any HRV parameters. CONCLUSION HRV test did not demonstrate a clinical utility in predicting dry mouth. Because subjective dry mouth is significantly associated with objective hyposalivation, a simple probing question would be useful for early recognition of dry mouth. Clinical attention is required for patients meeting criteria of older age, female, and/or using psychotropic prescriptions. Prompt management of hyposalivation may improve quality of life and clinical outcome by enhanced treatment adherence.
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Affiliation(s)
- Seung-Yup Lee
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Crellin NE, Priebe S, Morant N, Lewis G, Freemantle N, Johnson S, Horne R, Pinfold V, Kent L, Smith R, Darton K, Cooper RE, Long M, Thompson J, Gruenwald L, Freudenthal R, Stansfeld JL, Moncrieff J. An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders. BMC Psychiatry 2022; 22:185. [PMID: 35291964 PMCID: PMC8925064 DOI: 10.1186/s12888-022-03822-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients' views about continuing or discontinuing antipsychotic treatment. AIMS To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. METHODS We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. RESULTS We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. CONCLUSIONS This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued.
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Affiliation(s)
- Nadia E. Crellin
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK
| | - Nicola Morant
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Glyn Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Nick Freemantle
- grid.83440.3b0000000121901201Institute of Clinical Trials and Methodology, University College London, London, WC1V 6LJ UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Rob Horne
- grid.83440.3b0000000121901201School of Pharmacy, University College London, London, WC1N 1AX UK
| | | | - Lyn Kent
- Independent consultant, London, UK
| | | | | | - Ruth E. Cooper
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK ,grid.36316.310000 0001 0806 5472University of Greenwich, Faculty of Education, Health and Human Sciences, London, SE10 9LS UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, Newham Centre for Mental Health, London, E13 8SP UK
| | - Maria Long
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Jemima Thompson
- grid.83440.3b0000000121901201Faculty of Medical Sciences, University College London, London, UK
| | - Lisa Gruenwald
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Robert Freudenthal
- grid.451052.70000 0004 0581 2008Barnet Enfield Haringey Mental Health NHS Trust, London, UK
| | - Jacki L. Stansfeld
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Joanna Moncrieff
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
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Doane MJ, Bessonova L, Friedler HS, Mortimer KM, Cheng H, Brecht T, O’Sullivan AK, Cummings H, McDonnell D, Meyer JM. Weight gain and comorbidities associated with oral second-generation antipsychotics: analysis of real-world data for patients with schizophrenia or bipolar I disorder. BMC Psychiatry 2022; 22:114. [PMID: 35164737 PMCID: PMC8842889 DOI: 10.1186/s12888-022-03758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/31/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Many second-generation antipsychotics (SGAs) are associated with weight gain and cardiometabolic effects. Antipsychotic-associated weight gain is linked to treatment interruptions, potentially increasing risk of relapse and hospitalization. This retrospective study assessed clinically significant weight gain (CSWG), treatment interruptions, and development of cardiometabolic conditions in patients with schizophrenia (SZ) or bipolar I disorder (BD-I) following initiation of oral SGAs with moderate to high weight gain risk. METHODS Patients with no prior use of moderate to high weight gain risk oral SGAs were identified from patient-level medical/pharmacy claims and electronic medical records (January 2013-February 2020; OM1 Real-World Data Cloud). Those with ≥ 1 weight measurement in both the 12 months preceding and 3 months after SGA initiation (index date) were analyzed for continuous changes in weight, CSWG (≥ 7% and ≥ 10% increases from baseline), treatment interruptions (switches/discontinuations), and development of cardiometabolic conditions. RESULTS Median follow-up times in the SZ (n = 8174) and BD-I (n = 9142) cohorts were 153.4 and 159.4 weeks, respectively; 45.5% and 50.7% were obese at baseline. Mean (SD) percent weight increase during treatment was 3.3% (7.2) and 3.7% (7.0) for patients with SZ and BD-I, respectively, and was highest for underweight/normal weight patients (SZ: 4.8% [8.1]; BD-I: 5.5% [8.7]). More than 96% had treatment interruptions during follow-up, primarily discontinuations. CSWG and treatment interruptions occurred within a median of 13 and 14 weeks after treatment initiation, respectively. Of patients with CSWG and treatment interruptions, approximately 75% did not return to baseline weight during follow-up. Among those without baseline cardiometabolic conditions, 14.7% and 11.3% of patients with SZ or BD-I, respectively, developed ≥ 1 condition over 12 months post-index. Incidence was generally highest among those who were overweight/obese at baseline and those who experienced CSWG. CONCLUSIONS In this analysis of real-world data, both weight gain and treatment interruptions occurred early in treatment for patients with SZ or BD-I. Treatment-associated weight gain persisted despite switching or discontinuing index treatment. Additionally, cardiometabolic morbidity increased within 12 months of treatment initiation. Patients with SZ or BD-I are at greater risk than the general population for cardiometabolic conditions; weight gain associated with SGAs may exacerbate these health risks.
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Affiliation(s)
- Michael J. Doane
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - Leona Bessonova
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | | | | | | | | | - Amy K. O’Sullivan
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - Hannah Cummings
- grid.422303.40000 0004 0384 9317Alkermes, Inc., 825 Winter St., Waltham, MA 02451-1420 USA
| | - David McDonnell
- grid.472773.20000 0004 0384 2510Alkermes Pharma Ireland Ltd., Dublin, Ireland
| | - Jonathan M. Meyer
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego School of Medicine, CA La Jolla, USA
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11
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Madireddy S, Madireddy S. Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress–Induced Damage in Patients with Bipolar Disorder. Int J Mol Sci 2022; 23:ijms23031844. [PMID: 35163764 PMCID: PMC8836876 DOI: 10.3390/ijms23031844] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/26/2021] [Accepted: 12/30/2021] [Indexed: 01/10/2023] Open
Abstract
Bipolar disorder (BD) is characterized by mood changes, including recurrent manic, hypomanic, and depressive episodes, which may involve mixed symptoms. Despite the progress in neurobiological research, the pathophysiology of BD has not been extensively described to date. Progress in the understanding of the neurobiology driving BD could help facilitate the discovery of therapeutic targets and biomarkers for its early detection. Oxidative stress (OS), which damages biomolecules and causes mitochondrial and dopamine system dysfunctions, is a persistent finding in patients with BD. Inflammation and immune dysfunction might also play a role in BD pathophysiology. Specific nutrient supplements (nutraceuticals) may target neurobiological pathways suggested to be perturbed in BD, such as inflammation, mitochondrial dysfunction, and OS. Consequently, nutraceuticals may be used in the adjunctive treatment of BD. This paper summarizes the possible roles of OS, mitochondrial dysfunction, and immune system dysregulation in the onset of BD. It then discusses OS-mitigating strategies that may serve as therapeutic interventions for BD. It also analyzes the relationship between diet and BD as well as the use of nutritional interventions in the treatment of BD. In addition, it addresses the use of lithium therapy; novel antipsychotic agents, including clozapine, olanzapine, risperidone, cariprazine, and quetiapine; and anti-inflammatory agents to treat BD. Furthermore, it reviews the efficacy of the most used therapies for BD, such as cognitive–behavioral therapy, bright light therapy, imagery-focused cognitive therapy, and electroconvulsive therapy. A better understanding of the roles of OS, mitochondrial dysfunction, and inflammation in the pathogenesis of bipolar disorder, along with a stronger elucidation of the therapeutic functions of antioxidants, antipsychotics, anti-inflammatory agents, lithium therapy, and light therapies, may lead to improved strategies for the treatment and prevention of bipolar disorder.
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Affiliation(s)
- Sahithi Madireddy
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Correspondence:
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12
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Cullen C, Kappelmann N, Umer M, Abdolizadeh A, Husain MO, Bonato S, Sharma G, Xue S, Ortiz A, Kloiber SM, Mulsant BH, Husain MI. Efficacy and acceptability of pharmacotherapy for comorbid anxiety symptoms in bipolar disorder: A systematic review and meta-analysis. Bipolar Disord 2021; 23:754-766. [PMID: 34506075 DOI: 10.1111/bdi.13125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/29/2021] [Accepted: 08/28/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Anxiety symptoms are highly prevalent among individuals with bipolar disorder (BD) but there is little guidance on pharmacotherapy for these symptoms. The objective of this systematic review and meta-analysis was to evaluate the available evidence for pharmacotherapy of comorbid anxiety symptoms in BD. METHODS Completed randomized clinical trials (RCTs) of medications for BD published prior to December 2020 were identified through a systematic search of MEDLINE, Embase, PsycInfo, Web of Science, clinicaltrials.gov, and the ISRCTN. Data from RCTs measuring anxiety symptoms at baseline and endpoint and all-cause discontinuation were pooled to compare the efficacy and acceptability of medications with control conditions. RESULTS Thirty-seven RCTs met our inclusion criteria; 13 placebo-controlled RCTs with 2175 participants had sufficient data to be included in the meta-analysis assessing anxiety symptoms. Compared with placebo, the overall effect size of medications (primarily atypical antipsychotics) on anxiety symptoms was small with a standardized mean difference (SMD) = -0.22 (95% CI: -0.34 to -0.11). Study heterogeneity was low (I2 = 26%). The acceptability of these medications was comparable with placebo with odds ratio of discontinuation from all causes = 0.98 (95% CI: 0.91-1.06). CONCLUSION There is limited evidence for a small anxiolytic effect and good acceptability of pharmacotherapy (primarily atypical antipsychotics) in the treatment of comorbid anxiety symptoms in BD. These results highlight the need for further research on medications other than atypical antipsychotics.
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Affiliation(s)
- Clare Cullen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nils Kappelmann
- Department of Research in Translational Psychiatry, Max- Planck- Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Madeha Umer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ali Abdolizadeh
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad Omair Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Bonato
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gaurav Sharma
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Siqi Xue
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefan M Kloiber
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad I Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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13
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Citrome L, Graham C, Simmons A, Jiang Y, Todtenkopf MS, Silverman B, DiPetrillo L, Cummings H, Sun L, McDonnell D. An Evidence-Based Review of OLZ/SAM for Treatment of Adults with Schizophrenia or Bipolar I Disorder. Neuropsychiatr Dis Treat 2021; 17:2885-2904. [PMID: 34526769 PMCID: PMC8437420 DOI: 10.2147/ndt.s313840] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/14/2021] [Indexed: 12/19/2022] Open
Abstract
Olanzapine effectively treats schizophrenia and bipolar I disorder (BD-I); however, its use is limited by the risk of significant weight gain and metabolic effects. OLZ/SAM, a combination of olanzapine and samidorphan, was recently approved in the United States for the treatment of adults with schizophrenia or BD-I. OLZ/SAM provides the efficacy of olanzapine while mitigating olanzapine-associated weight gain through opioid-receptor blockade. Here, we summarize OLZ/SAM clinical data characterizing pharmacokinetics, antipsychotic efficacy, weight mitigation efficacy, safety, and long-term treatment effects. In an acute exacerbation of schizophrenia, OLZ/SAM and olanzapine provided similar symptom improvements versus placebo at week 4. In stable outpatients with schizophrenia, OLZ/SAM treatment resulted in significantly less weight gain, reducing the risk for clinically significant weight gain and waist circumference increases of ≥5 cm by half, compared with olanzapine at week 24. Based on open-label extension studies, OLZ/SAM is safe and well tolerated for up to 3.5 years of treatment, while maintaining schizophrenia symptom control and stabilizing weight. The olanzapine component of OLZ/SAM was bioequivalent to branded olanzapine (Zyprexa); adjunctive OLZ/SAM had no clinically significant effects on lithium or valproate pharmacokinetics. Additionally, OLZ/SAM had no clinically relevant effect on electrocardiogram parameters in a dedicated thorough QT study. Overall, safety and tolerability findings from clinical studies with OLZ/SAM indicate a similar safety profile to that of olanzapine, with the exception of less weight gain. As OLZ/SAM contains the opioid antagonist samidorphan, it is contraindicated in patients using opioids and in those undergoing acute opioid withdrawal. Clinical trial results from more than 1600 subjects support the use of OLZ/SAM as a new treatment option for patients with schizophrenia or BD-I.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | | | | | | | | | | | - Lei Sun
- Alkermes, Inc., Waltham, MA, USA
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14
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Nierenberg AA, Harris MG, Kazdin AE, Puac-Polanco V, Sampson N, Vigo DV, Chiu WT, Ziobrowski HN, Alonso J, Altwaijri Y, Borges G, Bunting B, Caldas-de-Almeida JM, Haro JM, Hu CY, Kiejna A, Lee S, McGrath JJ, Navarro-Mateu F, Posada-Villa J, Scott KM, Stagnaro JC, Viana MC, Kessler RC. Perceived helpfulness of bipolar disorder treatment: Findings from the World Health Organization World Mental Health Surveys. Bipolar Disord 2021; 23:565-583. [PMID: 33638300 PMCID: PMC8387507 DOI: 10.1111/bdi.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine patterns and predictors of perceived treatment helpfulness for mania/hypomania and associated depression in the WHO World Mental Health Surveys. METHODS Face-to-face interviews with community samples across 15 countries found n = 2,178 who received lifetime mania/hypomania treatment and n = 624 with lifetime mania/hypomania who received lifetime major depression treatment. These respondents were asked whether treatment was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Patterns and predictors of treatment helpfulness were examined separately for mania/hypomania and depression. RESULTS 63.1% (mania/hypomania) and 65.1% (depression) of patients reported ever receiving helpful treatment. However, only 24.5-22.5% were helped by the first professional seen, which means that the others needed to persist in help seeking after initial unhelpful treatments in order to find helpful treatment. Projections find only 22.9% (mania/hypomania) and 43.3% (depression) would persist through a series of unhelpful treatments but that the proportion helped would increase substantially if persistence increased. Few patient-level significant predictors of helpful treatment emerged and none consistently either across the two components (i.e., provider-level helpfulness and persistence after earlier unhelpful treatment) or for both mania/hypomania and depression. Although prevalence of treatment was higher in high-income than low/middle-income countries, proportional helpfulness among treated cases was nearly identical in the two groups of countries. CONCLUSIONS Probability of patients with mania/hypomania and associated depression obtaining helpful treatment might increase substantially if persistence in help-seeking increased after initially unhelpful treatments, although this could require seeing numerous additional treatment providers. In addition to investigating reasons for initial treatments not being helpful, messages reinforcing the importance of persistence should be emphasized to patients.
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Affiliation(s)
- Andrew A. Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel V. Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chi-yi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Andrzej Kiejna
- Psychology Research Unit for Public Health, WSB University, Torun, Poland
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J. McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud, Murcia, Región de Murcia, Spain
- IMIB-Arrixaca, Murcia, Región de Murcia, Spain
- CIBERESP, Murcia, Región de Murcia, Spain
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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15
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Sleem A, El-Mallakh RS. Advances in the psychopharmacotherapy of bipolar disorder type I. Expert Opin Pharmacother 2021; 22:1267-1290. [PMID: 33612040 DOI: 10.1080/14656566.2021.1893306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Research into the pharmacologic management of bipolar type I illness continues to progress. AREAS COVERED Randomized clinical trials performed with type I bipolar disorder in the years 2015 to August 2020 are reviewed. There are new indications for the use of cariprazine, for bipolar mania and depression, and a long-acting injectable formulation of aripiprazole has also been approved for relapse prevention in bipolar illness. Most of the randomized clinical trials are effectiveness studies. EXPERT OPINION Over the 20 years from 1997 through 2016, the use of lithium and other mood stabilizers has declined by 50%, while the use of both second-generation antipsychotics (SGAs) and antidepressants has increased considerably. Over the same time period (1990-2017), disability-adjusted life years (DALYs) increased by 54.4%, from 6.02 million in 1990 to 9.29 million in 2017 which is greater than the 47.74% increase in incidence of the disease, suggesting that the changes in prescribing patterns have not been helpful for our patients. Furthermore, recent effectiveness studies continue to confirm the superiority of lithium and other mood stabilizers in the management of bipolar illness for both psychiatric and medical outcomes, reaffirming their role as foundational treatments in the management of type I bipolar disorder. Clinicians need to reassess their prescribing habits.
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Affiliation(s)
- Ahmad Sleem
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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16
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Doane MJ, Ogden K, Bessonova L, O'Sullivan AK, Tohen M. Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review. Neuropsychiatr Dis Treat 2021; 17:515-531. [PMID: 33623386 PMCID: PMC7896797 DOI: 10.2147/ndt.s280051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Treatment with second-generation antipsychotics (SGAs) for bipolar disorder, including bipolar I disorder (BD-I), is common. This review evaluated real-world utilization patterns with oral SGAs in the United States (US) for bipolar disorder (and BD-I specifically when reported) and economic burden associated with these patterns. METHODS Structured, systematic searches of MEDLINE®, EMBASE®, and National Health Service Economic Evaluation Database identified primary research studies (published 2008-2018) describing real-world SGA use in adults with bipolar disorder/BD-I. RESULTS Among 769 studies screened, 39 met inclusion criteria. Most studies (72%) were analyses of commercial or Medicare/Medicaid claims databases. Patient-related (eg, demographic, comorbidities) and disease-related (eg, mania, psychosis) factors were associated with prescribed SGA. Suboptimal utilization patterns (ie, nonadherence, nonpersistence, treatment gaps, medication switching, and discontinuation) were common for patients treated with SGAs. Also common were SGAs prescribed with another psychotropic medication and SGA combination treatment (use of ≥2 SGAs concurrently). Suboptimal adherence and SGA combination treatment were both associated with increased health care resource use (HCRU); suboptimal adherence was associated with higher total direct medical and indirect costs. LIMITATIONS Different definitions for populations and concepts limited between-study comparisons. Focusing on SGAs limits contextualizing findings within the broader treatment landscape (eg, lithium, anticonvulsants). Given the nature of claims data, prescribing rationale (eg, acute episodes vs maintenance) and factors influencing observed utilization patterns could not be fully derived. CONCLUSION Despite increased use of SGAs to treat bipolar disorder over the last decade, reports of suboptimal utilization patterns of SGAs (eg, nonadherence, nonpersistence) were common as was combination treatment. Patterns of SGA use associated with additional HCRU and/or costs were suboptimal adherence and SGA combination treatment; economic consequences associated with other utilization patterns (eg, nonpersistence) were unclear. Strategies to improve SGA treatment continuity, particularly adherence, may improve clinical and economic outcomes among people living with bipolar disorder.
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Affiliation(s)
- Michael J Doane
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Kristine Ogden
- Evidence, Worldwide Clinical Trials, Morrisville, NC, USA
| | - Leona Bessonova
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Amy K O'Sullivan
- Health Economics and Outcomes Research, Alkermes, Inc., Waltham, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
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