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Mezzomo NF, da Silva Schmitz I, de Lima VB, Dorneles GP, Schaffer LF, Boeck CR, Romao PRT, Peroza LR. Reversal of haloperidol-induced orofacial dyskinesia and neuroinflammation by isoflavones. Mol Biol Rep 2021; 49:1917-1923. [PMID: 34854012 DOI: 10.1007/s11033-021-07003-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schizophrenia is a mental illness and its pharmacological treatment consists in the administration of antipsychotics like haloperidol. However, haloperidol often causes extrapyramidal motor disorders such as tardive dyskinesia (TD). So far, there is no effective treatment against TD and alternatives for it have been sought. Isoflafones have been studied as neuroprotector and inhibitor of monoamine oxidase enzyme. Thus, the objective is to evaluate the possible protective effect of isoflavones against the induction of involuntary movements induced by haloperidol in an animal model. METHODS AND RESULTS Male Wistar rats were treated with haloperidol (1 mg/kg/day) and/or isoflavones (80 mg/kg) for 28 days. Rats were submitted to behavioral evaluation to quantify vacuous chewing movements (VCM) and locomotor activity. In addition, the levels of pro-inflammatory cytokines were measured in the striatum. Haloperidol treatment reduced the locomotor activity and increased the number of VCM in rats. Co-treatment with isoflavones was able to reverse hypolocomotion and reduce the number of VCM. Besides, haloperidol caused significant increase in the proinflammatory cytokines (interleukin-1β:IL-1β, tumor necrosis factor-α: TNF-α and IL-6 and the co-treatment with isoflavones was able to reduce the levels of IL-1β and TNF-α, but not IL-6. CONCLUSIONS It is believed that the beneficial effect found with this alternative treatment is related to its anti-inflammatory potential and to the action on estrogen receptors (based on scientific literature findings). Finally, further studies are needed to elucidate the mechanisms of isoflavones in reducing motor disorders induced by antipsychotics.
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Affiliation(s)
| | | | | | - Gilson Pires Dorneles
- Laboratório de Imunologia Celular e Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Carina Rodrigues Boeck
- Mestrado em Ciências da Saúde e da Vida, Universidade Franciscana (UFN), Santa Maria, RS, Brazil
| | - Pedro Roosevelt Torres Romao
- Laboratório de Imunologia Celular e Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Luis Ricardo Peroza
- Mestrado em Ciências da Saúde e da Vida, Universidade Franciscana (UFN), Santa Maria, RS, Brazil.
- Universidade Franciscana (UFN), 97010-032, Santa Maria, RS, Brazil.
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2
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Marchewka TMN, Atallah AN, Valente NM, Melnik T. Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study. SAO PAULO MED J 2021; 139:624-634. [PMID: 34787297 PMCID: PMC9634833 DOI: 10.1590/1516-3180.2020.0450.r1.22042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/22/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated. OBJECTIVES To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions. DESIGN AND SETTING This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District. METHODS The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used. RESULTS None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records. CONCLUSIONS No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.
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Affiliation(s)
- Tania Maria Nava Marchewka
- PhD. Full Professor, Department of Evidence-Based Health, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Researcher and Public Attorney, Public Attorney's Office of the Federal District and Territories, Brasília (DF), Brazil
| | - Alvaro Nagib Atallah
- MD, PhD. Full Professor and Head, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Director, Cochrane Brazil, São Paulo (SP), Brazil
| | - Nathalia Marchewka Valente
- LLB. Research Assistant and Lawyer, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro (RJ), Brazil
| | - Tamara Melnik
- PsyD, PhD, Professor, Internal Medicine and Evidence-Based Medicine, Universidade Federal de Sao Paulo (UNIFESP), São Paulo (SP), Brazil; and Researcher, Cochrane Brazil, São Paulo (SP), Brazil
- PsyD, PhD, Professor, Internal Medicine and Evidence-Based Medicine, Universidade Federal de Sao Paulo (UNIFESP), São Paulo (SP), Brazil; and Researcher, Cochrane Brazil, São Paulo (SP), Brazil
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3
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Scaini G, Valvassori SS, Diaz AP, Lima CN, Benevenuto D, Fries GR, Quevedo J. Neurobiology of bipolar disorders: a review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. ACTA ACUST UNITED AC 2020; 42:536-551. [PMID: 32267339 PMCID: PMC7524405 DOI: 10.1590/1516-4446-2019-0732] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/27/2019] [Indexed: 01/10/2023]
Abstract
Bipolar disorder (BD) is a chronic mental illness characterized by changes in mood that alternate between mania and hypomania or between depression and mixed states, often associated with functional impairment. Although effective pharmacological and non-pharmacological treatments are available, several patients with BD remain symptomatic. The advance in the understanding of the neurobiology underlying BD could help in the identification of new therapeutic targets as well as biomarkers for early detection, prognosis, and response to treatment in BD. In this review, we discuss genetic, epigenetic, molecular, physiological and neuroimaging findings associated with the neurobiology of BD. Despite the advances in the pathophysiological knowledge of BD, the diagnosis and management of the disease are still essentially clinical. Given the complexity of the brain and the close relationship between environmental exposure and brain function, initiatives that incorporate genetic, epigenetic, molecular, physiological, clinical, environmental data, and brain imaging are necessary to produce information that can be translated into prevention and better outcomes for patients with BD.
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Affiliation(s)
- Giselli Scaini
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Alexandre P Diaz
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth, Houston, TX, USA
| | - Camila N Lima
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Deborah Benevenuto
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gabriel R Fries
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center for Precision Health, School of Biomedical Informatics, UTHealth, Houston, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, UTHealth, Houston, TX, USA
| | - Joao Quevedo
- Translational Psychiatry Program Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.,Center of Excellence on Mood Disorders Louis A. Faillace, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth, Houston, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, UTHealth, Houston, TX, USA
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4
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Tóth K, Csukly G, Sirok D, Belic A, Kiss Á, Háfra E, Déri M, Menus Á, Bitter I, Monostory K. Optimization of Clonazepam Therapy Adjusted to Patient's CYP3A Status and NAT2 Genotype. Int J Neuropsychopharmacol 2016; 19:pyw083. [PMID: 27639091 PMCID: PMC5203763 DOI: 10.1093/ijnp/pyw083] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The shortcomings of clonazepam therapy include tolerance, withdrawal symptoms, and adverse effects such as drowsiness, dizziness, and confusion leading to increased risk of falls. Inter-individual variability in the incidence of adverse events in patients partly originates from the differences in clonazepam metabolism due to genetic and nongenetic factors. METHODS Since the prominent role in clonazepam nitro-reduction and acetylation of 7-amino-clonazepam is assigned to CYP3A and N-acetyl transferase 2 enzymes, respectively, the association between the patients' CYP3A status (CYP3A5 genotype, CYP3A4 expression) or N-acetyl transferase 2 acetylator phenotype and clonazepam metabolism (plasma concentrations of clonazepam and 7-amino-clonazepam) was evaluated in 98 psychiatric patients suffering from schizophrenia or bipolar disorders. RESULTS The patients' CYP3A4 expression was found to be the major determinant of clonazepam plasma concentrations normalized by the dose and bodyweight (1263.5±482.9 and 558.5±202.4ng/mL per mg/kg bodyweight in low and normal expressers, respectively, P<.0001). Consequently, the dose requirement for the therapeutic concentration of clonazepam was substantially lower in low-CYP3A4 expresser patients than in normal expressers (0.029±0.011 vs 0.058±0.024mg/kg bodyweight, P<.0001). Furthermore, significantly higher (about 2-fold) plasma concentration ratio of 7-amino-clonazepam and clonazepam was observed in the patients displaying normal CYP3A4 expression and slower N-acetylation than all the others. CONCLUSION Prospective assaying of CYP3A4 expression and N-acetyl transferase 2 acetylator phenotype can better identify the patients with higher risk of adverse reactions and can facilitate the improvement of personalized clonazepam therapy and withdrawal regimen.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Katalin Monostory
- Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary (Ms Tóth, Mr Sirok, Mr Kiss, Ms Háfra, Mr Déri, and Dr Monostory); Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary (Drs Csukly, Menus, and Bitter); Toxi-Coop Toxicological Research Center, Budapest, Hungary (Mr Sirok); University of Ljubljana, Ljubljana, Slovenia (Dr Belic). .,K.T. and G.C. contributed equally to the content of the work.
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Naaldijk YM, Bittencourt MC, Sack U, Ulrich H. Kinins and microglial responses in bipolar disorder: a neuroinflammation hypothesis. Biol Chem 2016; 397:283-96. [DOI: 10.1515/hsz-2015-0257] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Bipolar disorder (BD) is a severe psychiatric disorder that affects up to 15% of the worldwide population. Characterized by switches in mood between mania and depression, its etiology is still unknown and efforts have been made to elucidate the mechanisms involved in first episode, development and progression of the disorder. Microglia activation, abnormal activity of GSK-3β and reduction in neurotrophic factor expression related to neuroinflammatory processes have been indicated to be part of the disorder’s pathophysiology. Lithium, the main mood stabilizer used for the treatment and prevention of relapses, acts as an anti-inflammatory agent. Based on that, here we suggest a neuroinflammatory pathway for would be BD progression, in which microglia activation states modulated via constitutive induction of kinin-B1 receptor and reduction of kinin-B2 receptor expression and activity.
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Missio G, Moreno DH, Fernandes F, Bio DS, Soeiro-de-Souza MG, Rodrigues dos Santos D, David DP, Costa LF, Demétrio FN, Moreno RA. The ARIQUELI study: potentiation of quetiapine in bipolar I nonresponders with lithium versus aripiprazole. Trials 2013; 14:190. [PMID: 23805994 PMCID: PMC3706295 DOI: 10.1186/1745-6215-14-190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of bipolar disorder (BD) remains a challenge due to the complexity of the disease. Current guidelines represent an effort to assist clinicians in routine practice but have several limitations, particularly concerning long-term treatment. The ARIQUELI (efficacy and tolerability of the combination of lithium or aripiprazole in young bipolar non or partial responders to quetiapine monotherapy) study aims to evaluate two different augmentation strategies for quetiapine nonresponders or partial responders in acute and maintenance phases of BD treatment. METHODS/DESIGN The ARIQUELI study is a single-site, parallel-group, randomized, outcome assessor-blinded trial. BD I patients according to the DSM-IV-TR, in depressive, manic/hypomanic or mixed episode, aged 18 to 40 years, are eligible. After diagnostic assessments, patients initiated treatment in phase I with quetiapine. Nonresponders or partial responders after 8 weeks are allocated into one of two groups, potentiated with either lithium (0.5 to 0.8 mEq/l) or aripiprazole (10 or 15 mg). Patients will be followed up for 8 weeks in phase I (acute treatment), 6 months in phase II (continuation treatment) and 12 months in phase III (maintenance treatment). Outcome assessors are blinded to the treatment. The primary outcome is the evaluation of changes in mean scores on the CGI-BP-M between baseline and the endpoint at the end of each study phase. DISCUSSION The ARIQUELI study is currently in progress, with patients undergoing acute treatment (phase I), potentiation (phase II) and maintenance (phase III). The study will be extended until January 2015. Trials comparing lithium and aripiprazole with potentiate treatment in young BD I nonresponders to quetiapine in monotherapy can provide relevant information on the safety of these drugs in clinical practice. Long-term treatment is an issue of great importance and should be evaluated further through more in-depth studies given that BD is a chronic disease. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01710163.
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Affiliation(s)
- Giovani Missio
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Doris Hupfeld Moreno
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Fernando Fernandes
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Danielle Soares Bio
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Márcio Gehardt Soeiro-de-Souza
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Domingos Rodrigues dos Santos
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Denise Petresco David
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Luis Felipe Costa
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Frederico Navas Demétrio
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
| | - Ricardo Alberto Moreno
- Department and Institute of Psychiatry, Clinicas Hospital, University of Sao Paulo School of Medicine, Mood Disorder Unit (GRUDA), Rua Dr. Ovídio Pires de Campos, 785, Third Floor,North Wing, Room 12, São Paulo, 05403-010, Brazil
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Zain MA, Jahan SN, Reynolds GP, Zainal NZ, Kanagasundram S, Mohamed Z. Peripheral PDLIM5 expression in bipolar disorder and the effect of olanzapine administration. BMC MEDICAL GENETICS 2012; 13:91. [PMID: 23031404 PMCID: PMC3502145 DOI: 10.1186/1471-2350-13-91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/28/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND One of the genes suggested to play an important role in the pathophysiology of bipolar disorder (BPD) is PDLIM5, which encodes LIM domain protein. Our main objective was to examine the effect of olanzapine treatment on PDLIM5 mRNA expression in the peripheral blood leukocytes of BPD patients. METHODS We measured the expression of PDLIM5 mRNA from 16 patients with BPD Type I after 0, 4, and 8 weeks of treatment with olanzapine using quantitative real-time PCR. The Young Mania Rating Scale was used to evaluate the severity of manic symptoms in BPD patients. We also compared PDLIM5 mRNA expression in treatment-naïve BPD patients with that in healthy control subjects. RESULTS No significant difference was found in PDLIM5 mRNA expression between patients before olanzapine treatment and following 4 and 8 weeks of treatment (p>0.05). Although we observed a significant reduction in the severity of manic symptoms in all BPD patients (p<0.05), the effectiveness of the medication did not significantly correlate with the expression of PDLIM5 mRNA (p>0.05). Interestingly, PDLIM5 mRNA expression differed significantly between treatment-naïve BPD patients and healthy control subjects (p=0.002). CONCLUSION PDLIM5 mRNA expression did not appear to be a reflection of the efficacy of olanzapine in reducing the manic symptoms of BPD. The significant difference in expression of PDLIM5 mRNA in the peripheral blood leukocytes of treatment-naïve BPD patients versus that of healthy control subjects, however, suggests that it may be a good biological marker for BPD.
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Affiliation(s)
- Mohd Aizat Zain
- The Pharmacogenomics Laboratory, Department of Pharmacology, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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8
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Miasso AI, Cassiani SHDB, Pedrão LJ. [Affective bipolar disorder and ambivalence in relation to the drug treatment: analyzing the causal conditions]. Rev Esc Enferm USP 2011; 45:433-41. [PMID: 21655795 DOI: 10.1590/s0080-62342011000200019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/15/2010] [Indexed: 12/17/2022] Open
Abstract
This study was performed with an aim to understand the conditions causing the ambivalence of the person with bipolar affective disorder (BAD) regarding following the drug treatment. A qualitative approach was used, with the Grounded Theory as the methodology framework, under the light of Symbolic Interactionism. Participants were 14 individuals with BAD who were being followed at an Outpatient Clinic for Mood Disorders of a university hospital and 14 relatives they indicated. Interviews and observation were the main forms of obtaining data. Results revealed three categories that described the referred causal conditions: experiencing the crises of the disorder; needing the drug; and living with the side effects of the drugs. It was found that there is a need to change the attitude of some health professionals from blaming the patient for interrupting the treatment to one of listening, valuing their symbolic and affective universe as well as the partnership in the treatment.
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Affiliation(s)
- Adriana Inocenti Miasso
- Departamento de Enfermagem Psiquiátrica e Ciências Humanas, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
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9
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Mazza M, Di Nicola M, Martinotti G, Taranto C, Pozzi G, Conte G, Janiri L, Bria P, Mazza S. Oxcarbazepine in bipolar disorder: a critical review of the literature. Expert Opin Pharmacother 2007; 8:649-56. [PMID: 17376019 DOI: 10.1517/14656566.8.5.649] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Oxcarbazepine (OXC) is a keto-congener of carbamazepine, which has fewer side effects and drug interactions. However, the efficacy of OXC in treating bipolar disorder is not as well established as that of carbamazepine. This article is a systematic literature review of all studies regarding OXC and bipolar disorders, with particular attention to papers published in the last 6 years. Using the terms 'oxcarbazepine and bipolar disorder', 'oxcarbazepine and mania' or 'oxcarbazepine and bipolar depression', a computer-aided search of MEDLINE for the years 2000-2006 has been conducted. Since its introduction as an antiepileptic drug in early 2000, clinical research regarding the potential role of OXC in the treatment of bipolar disorder remains limited. There is a lack of double-blind, placebo-controlled studies. Studies recently published have small samples of patients, with insufficient follow-up periods and other methodological weaknesses. The efficacy of OXC in bipolar disorder has not been widely studied. Some authors recommend using OXC as monotherapy or as add-on therapy in refractory mania, although results are not conclusive. It is unknown whether OXC has efficacy in the maintenance treatment of bipolar disorder. OXC can be particularly useful as an add-on treatment in bipolar disorder patients for whom previous treatments have failed, or in patients who have difficulty tolerating adequate dosages of standard approved treatments.
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Affiliation(s)
- Marianna Mazza
- Institute of Psychiatry, Bipolar Disorders Unit, Catholic University of Sacred Heart, Rome, Italy.
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10
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Barreto M, Souery D. Role of risperidone in the treatment of bipolar disorder. FUTURE NEUROLOGY 2006. [DOI: 10.2217/14796708.1.5.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bipolar disorder is a serious illness, distinguished by marked variations in mood, energy and functional capability. The primary goals in the management of bipolar disorder are to treat acute episodes and to prevent recurrence. Many studies have demonstrated that atypical antipsychotic drugs can provide alternatives to traditional mood stabilizers in the treatment of this disorder. Risperidone is an atypical antipsychotic that is approved in the USA and in most European countries for use in bipolar mania or bipolar I disorder-manic/mixed episode. Preliminary data exist on the efficacy of risperidone in long-term treatment. However, randomized controlled trials are required to confirm the role of this agent in bipolar depression, and to validate efficacy as in the maintenance setting. This article focuses on the use of risperidone in the treatment of bipolar disorder, with an emphasis on randomized, placebo-controlled trials, and presents a brief overview of other atypical antipsychotic drugs. To conclude, we provide a perspective on the potential future role of risperidone in this disorder.
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Affiliation(s)
- Mara Barreto
- University Clinics of Brussels, Erasme Hospital, Department of Psychiatry, 808 Route de Lennik, 1070 Brussels, Belgium
| | - Daniel Souery
- University Clinics of Brussels, Erasme Hospital, Department of Psychiatry, 808 Route de Lennik, 1070 Brussels, Belgium
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