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Alvear Velásquez MJ, Sandoval Carrión IP. Adherence to psychopharmacological treatment in patients with severe and persistent mental disorders: A systematic review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:192-205. [PMID: 39127548 DOI: 10.1016/j.rcpeng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/09/2021] [Accepted: 01/03/2022] [Indexed: 08/12/2024]
Abstract
INTRODUCTION It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society. OBJECTIVE To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders. METHODS A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialised databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor >0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomised design were included. Once the articles were identified, they were analysed, extracting the information necessary to answer the research questions. RESULTS Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight. CONCLUSIONS Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.
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Greil W, de Bardeci M, Müller-Oerlinghausen B, Nievergelt N, Stassen H, Hasler G, Erfurth A, Cattapan K, Rüther E, Seifert J, Toto S, Bleich S, Schoretsanitis G. Controversies regarding lithium-associated weight gain: case-control study of real-world drug safety data. Int J Bipolar Disord 2023; 11:34. [PMID: 37840048 PMCID: PMC10577117 DOI: 10.1186/s40345-023-00313-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The impact of long-term lithium treatment on weight gain has been a controversial topic with conflicting evidence. We aim to assess reporting of weight gain associated with lithium and other mood stabilizers compared to lamotrigine which is considered free of metabolic adverse drug reactions (ADRs). METHODS We conducted a case/non-case pharmacovigilance study using data from the AMSP project (German: "Arzneimittelsicherheit in der Psychiatrie"; i.e., Drug Safety in Psychiatry), which collects data on ADRs from patients treated in psychiatric hospitals in Germany, Austria, and Switzerland. We performed a disproportionality analysis of reports of weight gain (> 10% of baseline body weight) calculating reporting odds ratio (ROR). We compared aripiprazole, carbamazepine, lithium, olanzapine, quetiapine, risperidone, and valproate to lamotrigine. Additional analyses related to different mood stabilizers as reference medication were performed. We also assessed sex and age distributions of weight-gain reports. RESULTS We identified a total of 527 cases of severe drug-induced weight gain representing 7.4% of all severe ADRs. The ROR for lithium was 2.1 (95%CI 0.9-5.1, p > 0.05), which did not reach statistical significance. Statistically significant disproportionate reporting of weight gain was reported for olanzapine (ROR: 11.5, 95%CI 4.7-28.3, p < 0.001), quetiapine (ROR: 3.4, 95%CI 1.3-8.4, p < 0.01), and valproate (ROR: 2.4, 95%CI 1.1-5.0, p = 0.03) compared to lamotrigine. Severe weight gain was more prevalent in non-elderly (< 65 years) than in elderly patients, with an ROR of 7.6 (p < 0.01) in those treated with lithium, and an ROR of 14.7 (p < 0.01) in those not treated with lithium. CONCLUSIONS Our findings suggest that lithium is associated with more reports of severe weight gain than lamotrigine, although this difference did not reach statistical significance. However, lithium use led to fewer reports of severe weight gain than some alternative drugs for long-term medication (olanzapine, quetiapine, and valproate), which is consistent with recent studies. Monitoring of weight gain and metabolic parameters remains essential with lithium and its alternatives.
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Affiliation(s)
- Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany.
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland.
| | - Mateo de Bardeci
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Bruno Müller-Oerlinghausen
- Charité Universitätsmedizin-Berlin, Berlin, Germany
- Medical Faculty Brandenburg Theodor Fontane, Neuruppin, Germany
- Drug Commission of the German Medical Association, Berlin, Germany
| | - Nadja Nievergelt
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Hans Stassen
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- IFMA Preventive Health Management Inc., 80 Pine Street, 24th Floor, New York, NY, 10005, USA
| | - Gregor Hasler
- Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
| | - Andreas Erfurth
- Klinik Hietzing, 1st Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria
| | - Katja Cattapan
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
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Bauer M, Glenn T, Alda M, Grof P, Bauer R, Ebner-Priemer UW, Ehrlich S, Pfennig A, Pilhatsch M, Rasgon N, Whybrow PC. Longitudinal Digital Mood Charting in Bipolar Disorder: Experiences with ChronoRecord Over 20 Years. PHARMACOPSYCHIATRY 2023; 56:182-187. [PMID: 37678394 PMCID: PMC10484643 DOI: 10.1055/a-2156-5667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Longitudinal study is an essential methodology for understanding disease trajectories, treatment effects, symptom changes, and long-term outcomes of affective disorders. Daily self-charting of mood and other illness-related variables is a commonly recommended intervention. With the widespread acceptance of home computers in the early 2000s, automated tools were developed for patient mood charting, such as ChronoRecord, a software validated by patients with bipolar disorder. The purpose of this study was to summarize the daily mood, sleep, and medication data collected with ChronoRecord, and highlight some of the key research findings. Lessons learned from implementing a computerized tool for patient self-reporting are also discussed. METHODS After a brief training session, ChronoRecord software for daily mood charting was installed on a home computer and used by 609 patients with affective disorders. RESULTS The mean age of the patients was 40.3±11.8 years, a mean age of onset was 22±11.2 years, and 71.4% were female. Patients were euthymic for 70.8% of days, 15.1% had mild depression, 6.6% had severe depression, 6.6% had hypomania, and 0.8% had mania. Among all mood groups, 22.4% took 1-2 medications, 37.2% took 3-4 medications, 25.7 took 5-6 medications, 11.6% took 7-8 medications, and 3.1% took >8 medications. CONCLUSION The daily mood charting tool is a useful tool for increasing patient involvement in their care, providing detailed patient data to the physician, and increasing understanding of the course of illness. Longitudinal data from patient mood charting was helpful in both clinical and research settings.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine,
Technische Universität Dresden, Dresden, Germany
| | - Tasha Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA,
www.chronorecord.org
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS,
Canada
| | - Paul Grof
- Department of Psychiatry, University of Toronto, ON, Canada (retired)
and Mood Disorders Center of Ottawa, Ottawa, Canada
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine,
Technische Universität Dresden, Dresden, Germany
| | - Ulrich W. Ebner-Priemer
- Karlsruhe Institute of Technology, Institute of Sports and Sports
Science, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental
Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental
Neurosciences, Faculty of Medicine, Technische Universität Dresden,
Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine,
Technische Universität Dresden, Dresden, Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Faculty of Medicine,
Technische Universität Dresden, Dresden, Germany
| | - Natalie Rasgon
- Department of Psychiatry and Biobehavioral Sciences, Stanford School of
Medicine, Palo Alto, CA, USA
| | - 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
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Tahghighi H, Mortazavi H, Manteghi AA, Armat MR. The effect of comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorders: An experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:70. [PMID: 37113432 PMCID: PMC10127489 DOI: 10.4103/jehp.jehp_1109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/02/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND The number of older adults with bipolar disorder is increasing and medication non-adherence is a major problem that negatively impacts the course of bipolar disorder. This study aimed to determine the effect of a comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorder. MATERIALS AND METHOD An experimental study with pretest-posttest repeated measures with a control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a comprehensive motivational-educational program was administered for one month (four 30-45 minute sessions), and for the elderly in the control group, routine clinical care was performed. Medication adherence in both elderly groups was measured before, immediately after, one and two months after the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive statistics and independent t-test, Mann-Whitney, paired t-test, repeated measures analysis of variance (ANOVA), and Chi-square tests. RESULTS The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and 68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a significant difference in medication adherence scores was observed during the study period (time effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction between the medication adherence score and the time of evaluation (P < 0.001). CONCLUSION The results of the present study confirm the positive effect of a comprehensive educational-motivational program on improving medication adherence in elderly patients with bipolar disorder.
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Affiliation(s)
- Hossein Tahghighi
- Student Research Committee, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hamed Mortazavi
- Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | | | - Mohammad Reza Armat
- Geriatric Care Research Center, Department of Medical-Surgical Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Khandker R, Chekani F, Limone B, Riehle E. Prevalence and impact of antipsychotic discontinuation among commercially-insured patients with bipolar disorder. J Med Econ 2023; 26:878-885. [PMID: 37455610 DOI: 10.1080/13696998.2023.2228165] [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: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Antipsychotic discontinuation is common among patients with bipolar disorder, especially when psychotic symptoms are remitted. This analysis describes the prevalence, predictors, and economic impact of antipsychotic discontinuation among patients with bipolar disorder. METHODS A retrospective, observational study was conducted using administrative claims data in the IBM MarketScan Commercial Database. Patients with ≥1 claim with a diagnosis for bipolar disorder (manic or mixed) and newly-initiating antipsychotic therapy between 1 January 2011 and 30 June 2016 were included. Baseline characteristics were assessed in the 12 months prior to the initiation. Outcomes were assessed during a 24-month follow-up. Discontinuation of antipsychotic therapy was utilized as a predictor of healthcare costs in models adjusted for baseline characteristics. Using limited set of variables in the claims database, predictors of discontinuation were also assessed. RESULTS A total of 18,259 commercially-insured patients were identified as initiators of antipsychotics. Common comorbidities among the cohorts included major depressive disorder and dyslipidemia. Discontinuation was very common among these patients (85%). Major depressive disorder, drug abuse, and other substance abuse/dependency were predictive of discontinuation. Controlling for differences in baseline characteristics, discontinuation was associated with 33% higher inpatient and emergency visit costs (p <.001) among those using these services, and 24% higher total healthcare costs (p <.001) for the overall cohort. CONCLUSIONS Most patients with bipolar mania or mixed states discontinue antipsychotic treatment in less than 2 years. Antipsychotic discontinuation contributes to excess healthcare costs. Future research focusing on the reasons for discontinuation and tailoring disease management based on comorbidities may inform adherence improvement initiatives.
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Affiliation(s)
- Rezaul Khandker
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Rahway, NJ, USA
| | - Farid Chekani
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Rahway, NJ, USA
| | | | - Ellen Riehle
- Health Analytics, IBM Watson Health, Ann Arbor, MI, USA
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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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Hatzioannou A, Chatzittofis A, Koutroubas VS, Papastavrou E, Karanikola M. Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25168. [PMID: 34494969 PMCID: PMC8459218 DOI: 10.2196/25168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. OBJECTIVE This protocol describes the study "Management of my Bipolarity" (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. METHODS The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). RESULTS A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors. CONCLUSIONS Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25168.
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Affiliation(s)
- Anna Hatzioannou
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | - Evridiki Papastavrou
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Maria Karanikola
- Nursing Department, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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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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Kurtz M, Mohring P, Förster K, Bauer M, Kanske P. Deficits in explicit emotion regulation in bipolar disorder: a systematic review. Int J Bipolar Disord 2021; 9:15. [PMID: 33937951 PMCID: PMC8089068 DOI: 10.1186/s40345-021-00221-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients. Methods To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state. Results In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks. Conclusion We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.
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Affiliation(s)
- Marcel Kurtz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Pia Mohring
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Katharina Förster
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Consoloni JL, M'Bailara K, Perchec C, Aouizerate B, Aubin V, Azorin JM, Bellivier F, Correard N, Courtet P, Dubertret C, Etain B, Gard S, Haffen E, Leboyer M, Llorca PM, Olié E, Polosan M, Roux P, Schwan R, Samalin L, Belzeaux R. Trajectories of medication adherence in patients with Bipolar Disorder along 2 years-follow-up. J Affect Disord 2021; 282:812-819. [PMID: 33601722 DOI: 10.1016/j.jad.2020.12.192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and severe mental illness. It requires a non-discontinued pharmacological treatment to prevent mood recurrences but nonadherence to medication is frequent. To this date, medication adherence in BD has been mostly evaluated in cross-sectional studies and often considered as a stable trait. We aimed to study medication adherence using a prospective person-oriented approach. METHODS 1627 BD patients were followed on a 2 years period and assessed every 6 months. Medication adherence was evaluated at each visit with the Medication Adherence Rating Scale (MARS). A latent class mixed model (LCMM) was used to identify trajectory classes of adherence over time. Regression analyses and linear mixed model were used to search for predictors and covariables of the trajectories. RESULTS Three distinct and robust trajectories of medication adherence have been identified: one that starts poorly and keeps deteriorating (4.8%), one that starts poorly but improves (9%) and one that starts well and keeps improving (86.2%). A good tolerance to psychotropic medications, low depressive symptoms, the absence of comorbid eating disorders and anticonvulsant medication were associated to a better prognosis of adherence. Along the follow-up, the lower were the depressive symptoms, the better was the medication adherence (p < .001) LIMITATIONS: The use of a single measure of medication adherence although it is a validated instrument and a possible positive selection bias that might limit the generalization of our findings. CONCLUSIONS This study demonstrates that medication adherence in BD patients is a heterogeneous and potentially variable phenomenon.
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Affiliation(s)
- Julia-Lou Consoloni
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Fondation FondaMental, fondation de coopération scientifique, Créteil, France
| | - Katia M'Bailara
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Laboratoire de Psychologie EA 4139, Université de Bordeaux, Bordeaux, France; Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Cyrille Perchec
- Laboratoire de Psychologie EA 4139, Université de Bordeaux, Bordeaux, France
| | - Bruno Aouizerate
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France; Laboratoire NutriNeuro UMR 1286 INRAE, Université de Bordeaux, France
| | - Valérie Aubin
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Jean-Michel Azorin
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Fondation FondaMental, fondation de coopération scientifique, Créteil, France; INT-UMR7289, CNRS, Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; AP-HP Nord, DMU Neurosciences, GHU Saint-Louis - Lariboisière - Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; INSERM UMRS 1144, Université de Paris, Paris, France
| | - Nadia Correard
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Fondation FondaMental, fondation de coopération scientifique, Créteil, France
| | - Philippe Courtet
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Département d'Urgence et Post Urgence Psychiatrique, CHU Montpellier, Montpellier, France; INSERM U1061, Université de Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; AP-HP, Département de Psychiatrie, Hôpital Louis Mourier, Colombes, France; INSERM U894, Université Paris Diderot, Sorbonne, Paris, France
| | - Bruno Etain
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; AP-HP Nord, DMU Neurosciences, GHU Saint-Louis - Lariboisière - Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; INSERM UMRS 1144, Université de Paris, Paris, France
| | - Sébastien Gard
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Emmanuel Haffen
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Département de Psychiatrie Clinique, CIC-1431 INSERM, CHU de Besançon, Besançon, France; EA481 Neurosciences, Université Bourgogne Franche-Comté, Besançon, France
| | - Marion Leboyer
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Université Paris-Est, UMR_S955, UPEC, Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France; AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Centre Hospitalier et Universitaire, Département de Psychiatrie, 63000 Clermont-Ferrand, France; Université d'Auvergne, EA 7280, 63000 Clermont-Ferrand, France
| | - Emilie Olié
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Département d'Urgence et Post Urgence Psychiatrique, CHU Montpellier, Montpellier, France; INSERM U1061, Université de Montpellier, Montpellier, France
| | - Mircea Polosan
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Clinique Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, Grenoble, France
| | - Paul Roux
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 78157 Le Chesnay, France; Laboratoire HandiRESP - EA4047, UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, France; CESP, Team "Developmental Psychiatry", Université Paris-Saclay, Inserm, 78157 Le Chesnay, France
| | - Raymund Schwan
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Centre Hospitalier Universitaire de Nancy - Hôpitaux de Brabois, Université de Lorraine, Nancy, France
| | - Ludovic Samalin
- Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Centre Hospitalier et Universitaire, Département de Psychiatrie, 63000 Clermont-Ferrand, France; Université d'Auvergne, EA 7280, 63000 Clermont-Ferrand, France
| | - Raoul Belzeaux
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Fondation FondaMental, fondation de coopération scientifique, Créteil, France; INT-UMR7289, CNRS, Aix-Marseille Université, Marseille, France.
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11
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Inoue T, Sano H, Kojima Y, Yamada S, Shirakawa O. Real-World Treatment Patterns and Adherence to Oral Medication Among Patients with Bipolar Disorders: A Retrospective, Observational Study Using a Healthcare Claims Database. Neuropsychiatr Dis Treat 2021; 17:821-833. [PMID: 33776438 PMCID: PMC7987324 DOI: 10.2147/ndt.s299005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to describe real-world treatment patterns and medication adherence among patients with bipolar disorder (BD) in Japan. PATIENTS AND METHODS Adult patients with a BD diagnosis were identified between July 2013 and February 2018, using an employment-based health insurance claims database from the JMDC Inc. Treatment patterns of target drugs (mood stabilizers, antipsychotics) and adherence (measured by the proportion of days covered [PDC]) were assessed during the first- through third-year follow-up. Adherence was also assessed for patient subgroups. RESULTS The analyzed population included 13,788 patients with BD. They were mostly prescribed sodium valproate, lithium, or aripiprazole (range: 21.1-27.4%) across 3 years of follow-up, whereas lamotrigine was prescribed to 11.2-12.8% of patients. Benzodiazepines (70-87%) and antidepressants (52-71%) were commonly prescribed during all three follow-up periods. The mean PDC among all patients with BD was 0.51 during the first and increased to 0.61 during the third year. The mean PDC was 0.42 (first year) in patients aged <30 years and 0.49 in those aged 30-40 years. The PDC was 0.44-0.61 (depending on the drug class) in those who were prescribed a single-class target drug and 0.68-0.83 in those prescribed two drug classes concomitantly. CONCLUSION This study documented generally low medication adherence among patients with BD, and those at young age. These patients may require more attention.
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Affiliation(s)
- Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Hiromi Sano
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Osaka, Japan
| | | | - Sakiko Yamada
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Osamu Shirakawa
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
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12
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Bauer M, Glenn T, Alda M, Grof P, Monteith S, Rasgon N, Severus E, Whybrow PC. Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder. PHARMACOPSYCHIATRY 2020; 54:75-80. [PMID: 33202423 DOI: 10.1055/a-1257-0813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Using U.S. pharmacy and medical claims, medication adherence patterns of patients with serious mental illness suggest that adherence to atypical antipsychotics may be related to adherence to other prescription drugs. This study investigated whether adherence to an atypical antipsychotic was related to adherence to other prescribed psychiatric drugs using self-reported data from patients with bipolar disorder. METHODS Daily self-reported medication data were available from 123 patients with a diagnosis of bipolar disorder receiving treatment as usual who took at least 1 atypical antipsychotic over a 12-week period. Patients took a mean of 4.0±1.7 psychiatric drugs including the antipsychotic. The adherence rate for the atypical antipsychotic was compared to that for other psychiatric drugs to determine if the adherence rate for the atypical antipsychotic differed from that of the other psychiatric drug by at least ±10%. RESULTS Of the 123 patients, 58 (47.2%) had an adherence rate for the atypical antipsychotic that differed from the adherence rate for at least 1 other psychiatric drug by at least±10%, and 65 (52.8%) patients had no difference in adherence rates. The patients with a difference took a larger total number of psychiatric drugs (p<0.001), had a larger daily pill burden (p=0.020) and a lower adherence rate with the atypical antipsychotic (p=0.007), and were more likely to take an antianxiety drug (p<0.001). CONCLUSION Adherence with an atypical antipsychotic was not useful for estimating adherence to other psychiatric drugs in about half of the patients with bipolar disorder.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, 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
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13
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Monteith S, Glenn T, Gitlin M, Bauer M. Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs. PHARMACOPSYCHIATRY 2020; 53:220-227. [DOI: 10.1055/a-1156-4193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AbstractBackground Patients with bipolar disorder frequently experience polypharmacy, putting them at risk for clinically significant drug-drug interactions (DDI). Online drug interaction database programs are used to alert physicians, but there are no internationally recognized standards to define DDI. This study compared the category of potential DDI returned by 6 commercial drug interaction database programs for drug interaction pairs involving drugs commonly prescribed for bipolar disorder.Methods The category of potential DDI provided by 6 drug interaction database programs (3 subscription, 3 open access) was obtained for 125 drug interaction pairs. The pairs involved 103 drugs (38 psychiatric, 65 nonpsychiatric); 88 pairs included a psychiatric and nonpsychiatric drug; 37 pairs included 2 psychiatric drugs. Every pair contained at least 1 mood stabilizer or antidepressant. The category provided by 6 drug interaction database programs was compared using percent agreement and Fleiss kappa statistic of interrater reliability.Results For the 125 drug pairs, the overall percent agreement among the 6 drug interaction database programs was 60%; the Fleiss kappa agreement was slight. For drug interaction pairs with any category rating of severe (contraindicated), the kappa agreement was moderate. For drug interaction pairs with any category rating of major, the kappa agreement was slight.Conclusion There is poor agreement among drug interaction database programs for the category of potential DDI involving psychiatric drugs. Drug interaction database programs provide valuable information, but the lack of consistency should be recognized as a limitation. When assistance is needed, physicians should check more than 1 drug interaction database program.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Michael Gitlin
- 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, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
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14
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Bohlken J, Konrad M, Kostev K. Adherence to neuroleptic treatment in psychiatric practices: A retrospective study of 55 practices with more than 5000 bipolar and schizophrenic patients in Germany. Psychiatry Res 2020; 284:112758. [PMID: 31955056 DOI: 10.1016/j.psychres.2020.112758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effect that treating physicians have on the compliance of their psychiatric (schizophrenia (SP) and bipolar disorder (BP)) patients. METHODS This retrospective study was based on data from the Disease Analyzer database (IQVIA). It included 2870 SP and 2327 BD patients who had received at least two neuroleptic prescriptions from 55 psychiatric practices between January 2016 and December 2018. The average proportion of days covered (PDC) per patient was calculated. Patients were considered adherent if their PDC was greater than or equal to 80%. Practice adherence was considered high if at least 70% of patients in the practice of interest were adherent. RESULTS The mean PDC was 59.8% (SD: 13.9%) in SP and 65.0% (SD: 11.5%) in BD patients. The share of patients with an optimal PDC value (≥80%) differed considerably between practices (between 28% and 92% for SP and between 33% and 92% for BP). The prevalence of practices with high adherence was lower for schizophrenia than for bipolar disorder (21.9% versus 45.5%). CONCLUSION Psychiatrists play an important role in the compliance of SP and BP patients treated with neuroleptics.
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Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie - Berlin Germany; Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig, Germany
| | - Marcel Konrad
- FOM University of Applied Sciences for Economics and Management, Frankfurt, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549 Frankfurt, Germany.
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15
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Simonetti A, Koukopoulos AE, Kotzalidis GD, Janiri D, De Chiara L, Janiri L, Sani G. Stabilization Beyond Mood: Stabilizing Patients With Bipolar Disorder in the Various Phases of Life. Front Psychiatry 2020; 11:247. [PMID: 32395107 PMCID: PMC7197486 DOI: 10.3389/fpsyt.2020.00247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There are different ways to define stabilization and currently, the main standpoint regards it as no-depression/no-mania. Furthermore, each person is physiologically different from childhood to adulthood, and in old age, thus the meaning of stabilization should take into account both growth and maturity. We aimed to review systematically studies focusing on mood stabilization in all phases of bipolar disorder (BD) and across all life phases, including pregnancy and the perinatal period, which is still a different phase in women's life cycles. METHODS We carried out a PubMed search focusing on studies of bipolar disorder treated with drugs and aimed at stabilization with the following search strategy stabiliz*[ti] OR stabilis*[ti] OR stable[ti] OR stability[ti]) AND mood[ti] AND bipolar. In conducting our review, we followed the PRISMA statement. Agreement on inclusion was reached by consensus of all authors through a Delphi rounds procedure. RESULTS The above search strategy produced 509 records on January 25, 2020. Of them, 58 fitted our inclusion criteria and were discussed. The eligible studies spanned from September 1983 to July 6, 2019. CONCLUSIONS No clear-cut indications could be drawn due to a number of limitations involving sample inconsistency and different methods of assessing mood stabilization. The evidence collected so far does not allow recommended treatments for Adolescents, pregnant or perinatal women, and aged patients. However, adults, not within these groups, better focused upon. For their manic/mixed phases, second generation antipsychotic drugs may be useful in the short-to-medium run, alone or combined with mood stabilizers (MSs). However, MSs, and especially lithium, continue to be pivotal in chronic treatment. Bipolar depression should rely on MSs, but an antidepressant may be added on and can prove to be helpful. However, there are concerns with the tendency of antidepressants to induce the opposite polarity or mood instability, rendering the need for concurrent MS prescription mandatory.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Alexia E Koukopoulos
- Centro Lucio Bini, Rome, Italy.,Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza School of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Georgios D Kotzalidis
- Centro Lucio Bini, Rome, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Delfina Janiri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Lavinia De Chiara
- Centro Lucio Bini, Rome, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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