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Samalin L, Boudieu L, Llorca PM. Evaluating the efficacy and safety of the currently available once-every-two months long-acting injectable formulations of aripiprazole for the treatment of schizophrenia or as a maintenance monotherapy for bipolar I disorder in adults. Expert Rev Neurother 2024; 24:291-298. [PMID: 38299536 DOI: 10.1080/14737175.2024.2313550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION An aripiprazole long-acting injectable (LAI) antipsychotic is now available for gluteal administration every 2 months via two different formulations: aripiprazole lauroxil (AL) and aripiprazole monohydrate (Ari 2MRTU). These longer dosing regimens of aripiprazole LAI offer new potential benefits for patients. AREAS COVERED The authors review the evidence supporting the efficacy and safety of aripiprazole LAIs given every 2 months for the treatment of schizophrenia or bipolar disorder (BD) in adults. The article culminates with the authors' expert perspectives on the subject. EXPERT OPINION AL 1064 mg every 2 months has established efficacy for the treatment of schizophrenia based on pharmacokinetic bridging studies and prospective data for treatment of an acute exacerbation of schizophrenia. In an open-label trial, Ari 2MRTU showed efficacy for the treatment of schizophrenia and BD type I based on pharmacokinetic parameters (comparable to aripiprazole once-monthly 400 mg); it also showed efficacy regarding the secondary endpoints. Multiple doses of AL 1064 mg or Ari 2MRTU 960 mg are generally well tolerated, in line with the safety profile of oral aripiprazole, with the exception of the injection-site reactions. While AL may require a 1-day initiation regimen, Ari 2MRTU 960 covers all the recommended doses of oral aripiprazole (10-20 mg).
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Shuy YK, Santharan S, Chew QH, Sim K. International Trends in Lithium Use for Pharmacotherapy and Clinical Correlates in Bipolar Disorder: A Scoping Review. Brain Sci 2024; 14:102. [PMID: 38275522 PMCID: PMC10813799 DOI: 10.3390/brainsci14010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Lithium remains an effective option in the treatment of bipolar disorder (BD). Thus, we aim to characterize the pharmaco-epidemiological patterns of lithium use internationally over time and elucidate clinical correlates associated with BD using a scoping review, which was conducted using the methodological framework by Arksey and O'Malley (2005). We searched several databases for studies that examined the prescriptions for lithium and clinical associations in BD from inception until December 2023. This review included 55 articles from 1967 to 2023, which collected data from North America (n = 24, 43.6%), Europe (n = 20, 36.4%), and Asia (n = 11, 20.0%). The overall prescription rates ranged from 3.3% to 84% (33.4% before and 30.6% after the median year cutoffs). Over time, there was a decline in lithium use in North America (27.7% before 2010 to 17.1% after 2010) and Europe (36.7% before 2003 to 35.7% after 2003), and a mild increase in Asia (25.0% before 2003 to 26.2% after 2003). Lithium use was associated with specific demographic (e.g., age, male gender) and clinical factors (e.g., lower suicide risk). Overall, we found a trend of declining lithium use internationally, particularly in the West. Specific clinical correlates can support clinical decision-making for continued lithium use.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore 539747, Singapore;
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore;
| | - Kang Sim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- West Region, Institute of Mental Health, Singapore 539747, Singapore
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de Jesus JR, de Araujo Andrade T, de Figueiredo EC. Biomarkers in psychiatric disorders. Adv Clin Chem 2023; 116:183-208. [PMID: 37852719 DOI: 10.1016/bs.acc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Psychiatric disorders represent a significant socioeconomic and healthcare burden worldwide. Of these, schizophrenia, bipolar disorder, major depressive disorder and anxiety are among the most prevalent. Unfortunately, diagnosis remains problematic and largely complicated by the lack of disease specific biomarkers. Accordingly, much research has focused on elucidating these conditions to more fully understand underlying pathophysiology and potentially identify biomarkers, especially those of early stage disease. In this chapter, we review current status of this endeavor as well as the potential development of novel biomarkers for clinical applications and future research study.
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Affiliation(s)
| | | | - Eduardo Costa de Figueiredo
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, Alfenas, Minas Gerais, Brazil
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Okazaki T, Nakatsu K, Asaoka S, Okamura H. Factors Associated with Long-term Medication Adherence in Patients Who Participated in a Short-term Group Psychoeducation Program for Bipolar Disorder. Psychiatr Q 2023:10.1007/s11126-023-10031-0. [PMID: 37221417 DOI: 10.1007/s11126-023-10031-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Improving adherence to medication and quality of life is a challenge in treating bipolar disorder. Therefore, psychoeducation plays an important role. This study examined factors associated with long-term medication adherence in patients with bipolar disorder who participated in a short-term psychoeducation program. Additionally, the relationships between medication adherence and medication attitudes and quality of life (QOL) were assessed. Multiple regression analysis was conducted on 67 inpatients and outpatients using medication adherence (Brief Evaluation for Medication Influences and Beliefs [BEMIB] score) as the dependent variable and clinical and demographic variables before and after the program as explanatory variables, one year after completion of the program. Pearson's correlation coefficients were calculated for associations between patients' BEMIB score and medication attitudes (Drug Attitude Inventory-10 [DAI-10]) and QOL (World Health Organization QOL-26 [WHOQOL-26] score) before and after the program and one year after program completion. The results showed that the CSQ-8 J (Client Satisfaction Questionnaire-8 Japanese) and DAI-10 scores immediately after the program were significantly related to the BEMIB score one year after program completion. Both the BEMIB and DAI-10 showed significant positive correlations with several items of the WHOQOL-26, both after the program and one year after completion of the program. The results suggest that medication attitudes acquired through psychoeducation and program satisfaction impact long-term medication adherence. The study also indicates that medication attitudes and medication adherence after a psychoeducation program are associated with QOL. Thus, patients' subjective views after a psychoeducation program can play an important role in long-term medication adherence and QOL.
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Affiliation(s)
- Tomoyuki Okazaki
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Keigo Nakatsu
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Satoshi Asaoka
- Medical Corporation Kouseikai, Kusatsu Hospital, 10-1 Kusatsu Umegadai, Nishi-ku, Hiroshima, 733-0864, Japan
| | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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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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Sim K, Baldessarini RJ. Comparative studies of psychotropic drug use over the last seven decades: Gaps and goals in global ethnopsychopharmacology. Eur Neuropsychopharmacol 2022; 60:19-21. [PMID: 35550449 DOI: 10.1016/j.euroneuro.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kang Sim
- West Region, Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Ross J Baldessarini
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorder Research, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Jain R, Kong AM, Gillard P, Harrington A. Treatment Patterns Among Patients with Bipolar Disorder in the United States: A Retrospective Claims Database Analysis. Adv Ther 2022; 39:2578-2595. [PMID: 35381965 PMCID: PMC9123057 DOI: 10.1007/s12325-022-02112-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/03/2022] [Indexed: 12/27/2022]
Abstract
Introduction Bipolar disorder is a chronic and complex disorder that can be difficult to treat. The objective of this retrospective study was to describe treatment patterns among patients with bipolar disorder. Methods Adults newly diagnosed with bipolar disorder from 2016 to 2018 were identified using the IBM® MarketScan® Commercial claims database. Patients were enrolled for at least 12 months prior to and 6 months after initial diagnosis. Lines of therapy (LOTs) were continuous treatment periods based on filled prescriptions; medications, such as antidepressants, mood stabilizers, atypical antipsychotics, benzodiazepines, stimulants, and off-label prescriptions, were recorded. All data were analyzed descriptively. Results A total of 40,345 patients met criteria. The most common initial episode types were bipolar II (38.1%), and bipolar I depression (29.8%), mania (12.8%), and mixed features (12.0%). Among all episode types, approximately 90% of patients received treatment (LOT1) and approximately 80% of these patients received at least one additional LOT. Across all episode types, the most common medication classes in LOT1 (n = 36,587) were mood stabilizers (43.8%), antidepressants (42.3%; 12.9% as monotherapy), atypical antipsychotics (31.7%), and benzodiazepines (20.7%); with subsequent LOTs, antidepressant (51.4–53.8%) and benzodiazepine (26.9–27.4%) usage increased. Also in LOT1, there were 2067 different regimens. Treatment patterns were generally similar across episode type. Conclusions Antidepressants and benzodiazepines were frequently prescribed to treat bipolar disorder despite guidelines recommending against use as frontline therapy. These results highlight the considerable heterogeneity in care and suggest that many clinicians treating bipolar disorder are not using evidence-based prescribing practices. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02112-6.
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Affiliation(s)
- Rakesh Jain
- Texas Tech University School of Medicine-Permian Basin, Midland, TX, USA
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Chen M, Zhou L, Ye L, Lin G, Pang Y, Lu L, Wang X. Initial adherence by psychiatric outpatients in a general hospital and relevant personal factors. BMC Psychiatry 2022; 22:137. [PMID: 35193529 PMCID: PMC8862299 DOI: 10.1186/s12888-022-03797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/14/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Initial adherence is a predictor of long-term adherence and thus is a crucial metric to explore and support. This study aimed to investigate initial adherence by psychiatric outpatients and relevant personal factors. METHODS The study surveyed psychiatric outpatients using a 30-day timely return visit rate (TRVR) after the first visit to indicate initial adherence. All participants agreed to engage in the self-designed survey and assessments of the Eysenck Personality Questionnaire (EPQ) and Symptoms Checklist-90 (SCL-90). Clients who missed timely return visits received telephone follow-up to determine the main reasons. RESULTS The overall TRVR was 59.4, and 40.6% of clients missed return visits. Logistic regression analysis revealed risk factors for initial adherence were work, tense family atmosphere, negative attitudes towards medication, higher EPQ psychoticism score, and lower SCL-90 phobic anxiety score. The main reasons given for non-timely return visits were improvement suggesting lack of need for a return visit, various barriers, no improvement, and side effects. CONCLUSION Psychiatric outpatients had poor initial adherence related to multiple dimensional factors, including job, family, personality characteristics, mental status, and thoughts about mental illness and treatments.
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Affiliation(s)
- Minhua Chen
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Lina Zhou
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Li Ye
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Gelin Lin
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Yongli Pang
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Liyun Lu
- grid.412558.f0000 0004 1762 1794Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, N0. 600, Tianhe Road, Guangzhou, 510630 China
| | - Xianglan Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, N0. 52, East Meihua Road, Zhuhai, 519000, China.
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Li NC, Alcusky M, Masters GA, Ash AS. Association of Social Determinants of Health With Adherence to Second-generation Antipsychotics for People With Bipolar Disorders in a Medicaid Population. Med Care 2022; 60:106-112. [PMID: 34908010 DOI: 10.1097/mlr.0000000000001670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND About 7 million people, 2.8% of US adults, have bipolar disorder (BD). While second-generation antipsychotics (SGA) are indicated as acute and maintenance treatments for BD, therapeutic success requires medication adherence and reported nonadherence estimates to range as high as 60%. Identifying patient risk factors for nonadherence is important for reducing it. OBJECTIVE The objective of this study was to quantify the associations of risk factors, including social determinants of health, with SGA nonadherence among patients with BD. METHODS In this cross-sectional study of 2015-2017 MassHealth Medicaid data, we examined several definitions of adherence and used logistic regression to identify risk factors for nonadherence (medication possession ratio <0.8) among all adults aged 18-64 diagnosed with BD who could be followed for 12 months following SGA initiation. RESULTS Among 5197 patients, the mean (±SD) age was 37.7 (±11.4) years, and 42.3% were men. Almost half (47.7%) of patients were nonadherent to SGAs when measured by medication possession ratio. The prevalence of nonadherence peaked at middle age for men and younger for women. Nonadherence was less common among Massachusetts' Department of Mental Health clients (odds ratio=0.60, 95% confidence limit: 0.48-0.74) and among those who used other psychotropic medications (odds ratios between 0.45 and 0.81); in contrast, increase in neighborhood socioeconomic stress was associated with increased odds of nonadherence. CONCLUSIONS/IMPLICATIONS Adherence to SGA treatment is suboptimal among people with BD. Recognizing risk factors, including those related to social determinants of health, can help target interventions to improve adherence for people at high risk and has implications for adherence-based quality measures.
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Affiliation(s)
- Nien Chen Li
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences
| | - Matthew Alcusky
- Division of Epidemiology, Department of Population and Quantitative Health Sciences
| | - Grace A Masters
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences
| | - Arlene S Ash
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Mirhaj Mohammadabadi MS, Mohammadsadeghi H, Eftekhar Adrebili M, Partovi Kolour Z, Kashaninasab F, Rashedi V, Shalbafan M. Factors associated with pharmacological and psychotherapy treatments adherence in patients with borderline personality disorder. Front Psychiatry 2022; 13:1056050. [PMID: 36582255 PMCID: PMC9793988 DOI: 10.3389/fpsyt.2022.1056050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Borderline personality disorder is a major mental illness characterized by sustained relationship instability, impulsive behavior, and intense affects. Adherence is a complex behavior, from minor refusals to abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and psychotherapy adherence, patients' attitude toward medication, and assessing medication and treatment adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran. METHODS The study was a cross-sectional study. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. Data were collected using the Drug Attitude Inventory-10 (DAI-10) questionnaire and a questionnaire to determine the attitude of patients toward pharmacological and psychotherapy treatment as well as therapeutic adherence. After collecting data, patients' therapeutic adherence was divided into poor, partial, and good compliance. RESULTS Ninety-four patients were involved in the study, and fifty-four were women. Findings of DAI showed that 54 (57.4%) participants had negative attitudes toward medication, while 38 (40.4%) participants showed a negative attitude toward psychotherapy treatment. Additionally, the percentage of patients with good psychotherapy adherence (44.7%) was higher than that of patients with good medication adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%), and then fear of medication dependence (40%). Patients with higher education levels and a positive history of hospitalization in a psychiatric ward had better adherence to psychotherapy (P < 0.05). CONCLUSION Results of the current study show that attitude toward psychotherapy is more favorable than pharmacotherapy among patients with BPD. The rationale may be that medications are mainly prescribed for comorbid conditions and do not have substantial effects on the BPD symptoms, resulting in low medication adherence.
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Affiliation(s)
- Motahareh Sadat Mirhaj Mohammadabadi
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Mohammadsadeghi
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Eftekhar Adrebili
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Partovi Kolour
- Students Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kashaninasab
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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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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Patoz MC, Hidalgo-Mazzei D, Pereira B, Blanc O, de Chazeron I, Murru A, Verdolini N, Pacchiarotti I, Vieta E, Llorca PM, Samalin L. Patients' adherence to smartphone apps in the management of bipolar disorder: a systematic review. Int J Bipolar Disord 2021; 9:19. [PMID: 34081234 PMCID: PMC8175501 DOI: 10.1186/s40345-021-00224-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Despite an increasing number of available mental health apps in the bipolar disorder field, these tools remain scarcely implemented in everyday practice and are quickly discontinued by patients after downloading. The aim of this study is to explore adherence characteristics of bipolar disorder patients to dedicated smartphone interventions in research studies. Methods A systematic review following PRISMA guidelines was conducted. Three databases (EMBASE, PsychInfo and MEDLINE) were searched using the following keywords: "bipolar disorder" or "mood disorder" or “bipolar” combined with “digital” or “mobile” or “phone” or “smartphone” or “mHealth” or “ehealth” or "mobile health" or “app” or “mobile-health”. Results Thirteen articles remained in the review after exclusion criteria were applied. Of the 118 eligible studies, 39 did not provide adherence characteristics. Among the selected papers, study length, sample size and definition of measures of adherence were strongly heterogeneous. Activity rates ranged from 58 to 91.6%. Conclusion The adherence of bipolar patients to apps is understudied. Standardised measures of adherence should be defined and systematically evaluated in future studies dedicated to these tools. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-021-00224-6.
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Affiliation(s)
- Marie-Camille Patoz
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Bruno Pereira
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Olivier Blanc
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Andrea Murru
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France.,Fondation FondaMental, Créteil, France
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France. .,Fondation FondaMental, Créteil, France. .,Service de Psychiatrie B, Centre Hospitalier Universitaire, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
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Niu X, Veeranki P, Dennen S, Dembek C, Laubmeier K, Liu Y, Williams GR, Loebel A. Hospitalization risk among adults with bipolar I disorder treated with lurasidone versus other oral atypical antipsychotics: a retrospective analysis of Medicaid claims data. Curr Med Res Opin 2021; 37:839-846. [PMID: 33682547 DOI: 10.1080/03007995.2021.1897557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the risk of hospitalization for adult Medicaid beneficiaries with bipolar I disorder treated with lurasidone vs. other oral atypical antipsychotics (AAPs) as monotherapy. METHODS A retrospective cohort study of the IBM MarketScan Multi-State Medicaid Claims database identified adults with bipolar I disorder who initiated an AAP (index date) between 1 January 2014 and 30 June 2019. Patients were continuously enrolled 12 months pre- and 24 months post-index date. Each month during the post-index period was categorized as monotherapy with lurasidone, aripiprazole, olanzapine, quetiapine or risperidone, no/minimal treatment, or other. Marginal structural models were performed to estimate hospitalization risk and length of stay (LOS) (all-cause and bipolar I disorder-related) compared to lurasidone. RESULTS The analysis included 8262 adults. Compared to lurasidone, the adjusted odds ratios (aORs) of all-cause hospitalization were significantly higher for olanzapine (aOR = 1.60, 95% CI = 1.09-2.10) and quetiapine (aOR = 1.54, 95% CI = 1.18-1.89). The risk was significantly higher for bipolar I disorder-related hospitalization for quetiapine (aOR = 1.57, 95% CI = 1.10-2.04) and risperidone (aOR = 1.80, 95% CI = 1.04-2.56) compared to lurasidone. The bipolar I disorder-related LOS per 100 patient-months was more than twice as long for quetiapine (8.42 days) compared to lurasidone (3.97 days, p < .01). CONCLUSIONS Lurasidone-treated adult Medicaid patients with bipolar I disorder had significantly lower risk of all-cause hospitalization than those treated with olanzapine and quetiapine and lower risk of bipolar I disorder-related hospitalization than quetiapine and risperidone. Bipolar I disorder-related hospital LOS was significantly shorter for patients treated with lurasidone compared to quetiapine.
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Lee SE, Lee NY, Kim SH, Kim KA, Kim YS. Effect of liraglutide 3.0mg treatment on weight reduction in obese antipsychotic-treated patients. Psychiatry Res 2021; 299:113830. [PMID: 33677189 DOI: 10.1016/j.psychres.2021.113830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients treated with antipsychotics experience significant weight gain and accompanying metabolic disorders. We investigated the efficacy of liraglutide 3.0 mg in reducing the weight of antipsychotic-treated obese patients. METHOD We retrospectively reviewed 16 obese patients with schizophrenia or bipolar disorder who were treated with 3.0 mg of liraglutide each. During the 16 weeks of treatment, changes in body weight and Clinical Global Impression-Severity scale (CGI-S) were analyzed. The participants were divided into responders (lost at least 5% of body weight) and non-responders for analysis. RESULTS Treatment with liraglutide 3.0 mg significantly decreased body weight (estimated marginal mean, 93.2 kg at baseline and 88.9 kg at 16 weeks; p < 0.001) as well as waist circumference, BMI and plasma glucose levels. Six of 16 patients (37.5%) complained of a modest degree of nausea. Six of the 12 subjects (50%) completing 16 weeks of treatment were responders. There were no significant differences in baseline characteristics between responders and non-responders. There was no worsening of CGI-S scores. CONCLUSION Liraglutide 3.0 mg significantly decreased body weight in obese patients treated with antipsychotics without altering the status of psychiatric diseases. A randomized controlled study is required to corroborate the results of this study.
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Affiliation(s)
- Seung Eun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, South Korea
| | - Nam Young Lee
- Department of Neuropsychiatry, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, South Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyoung-Ah Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, South Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Hospital, Eulji University College of Medicine, Seoul, South Korea; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Gyeonggi-do, South Korea.
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Kotzalidis GD, Rapinesi C, Chetoni C, De Filippis S. Aripiprazole IM depot as an option for the treatment of bipolar disorder. Expert Opin Pharmacother 2021; 22:1407-1416. [PMID: 33847183 DOI: 10.1080/14656566.2021.1910236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Long-acting injectable (LAI) antipsychotic drugs are developed to reduce daily intake need and to overcome treatment non-adherence. Aripiprazole IM depot refers to two long-acting aripiprazole formulations, once monthly monohydrate (AOM) and aripiprazole lauroxil. AOM has been approved for schizophrenia since 2012 and for bipolar disorder since 2017. Aripiprazole lauroxil is approved for schizophrenia, not for bipolar disorder.Areas covered: To assess the effect of AOM in bipolar disorder, the authors searched PubMed and ClinicalTrials.gov for randomized trials using AOM in patients with bipolar disorder. Included were four studies covering efficacy, functioning, quality of life, and safety/tolerability. Studies lasted 12 months.Expert opinion: AOM reduced symptoms of patients with bipolar disorder and a manic episode, increased functioning and quality of life, and protected from recurrence of manic episodes. It proved to be safe/tolerable, with only akathisia occurring in ≥10% of cases and more frequently than with placebo. However, there were only 143 patients receiving AOM in the considered studies. Included studies were backed in their conclusions by other literature, but they come from 2017-2018. No studies are expected or planned in the near future. Aripiprazole lauroxil has not applied for approval in bipolar disorder and there is no sign it will.
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Affiliation(s)
- Georgios D Kotzalidis
- NESMOS Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.,Department of Neuropsychiatry, Villa Von Siebenthal Neuropsychiatric Hospital, Genzano Di Roma, Italy
| | - Chiara Rapinesi
- NESMOS Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Chiara Chetoni
- NESMOS Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Sergio De Filippis
- Department of Neuropsychiatry, Villa Von Siebenthal Neuropsychiatric Hospital, Genzano Di Roma, Italy
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Niu X, Dennen S, Dembek C, Laubmeier K, Liu Y, Veeranki P, Tocco M, Williams GR. Hospitalization Risk for Adults with Bipolar I Disorder Treated with Oral Atypical Antipsychotics as Adjunctive Therapy with Mood Stabilizers: A Retrospective Analysis of Medicaid Claims Data. CURRENT THERAPEUTIC RESEARCH 2021; 94:100629. [PMID: 34306269 PMCID: PMC8296072 DOI: 10.1016/j.curtheres.2021.100629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/18/2021] [Indexed: 01/03/2023]
Abstract
Background: Atypical antipsychotics (AAPs) with mood stabilizers are recommended as a first-line treatment for patients with bipolar disorder. No studies have compared the inpatient health care resource utilization for patients with bipolar disorder treated with lurasidone as adjunctive therapy with mood stabilizers compared with other oral AAPs. Objective: To compare the risk of hospitalization for adult Medicaid beneficiaries with bipolar I disorder when treated with lurasidone compared with other oral AAPs as adjunctive therapy with mood stabilizers. Methods: This retrospective cohort study used the MarketScan Research Databases Multi-State Medicaid Database (IBM, Armonk, NY) claims data to assess patients with bipolar I disorder between January 1, 2014, and June 30, 2019. Adult patients who initiated oral AAP treatment with mood stabilizers (index date) and who were continuously enrolled 12 months before (pre-index) and 24 months after (post-index) the index date were included. Treatment categories assigned by patient-month included lurasidone, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone with mood stabilizers; no/minimal treatment; AAP monotherapy; and other. Marginal structural models were performed to estimate the all-cause and psychiatric hospitalization rates and hospital length of stay associated with each adjunctive AAP therapy by controlling for both time-invariant and time-varying confounders. Results: Adults with bipolar I disorder (N = 11,426; mean age = 39.4 years; female=73%) treated with an adjunctive oral AAP with mood stabilizers during the index month were categorized into lurasidone (12%), aripiprazole (17%), olanzapine (7%), quetiapine (32%), risperidone (11%), ziprasidone (7%), or other (15%) treatment groups. The adjusted odds of all-cause and psychiatric hospitalization were significantly higher for olanzapine (all causes: adjusted odds ratio [aOR] = 1.59; 95% CI, 1.13-2.25; psychiatric: aOR = 1.61, 95% CI, 1.12-2.32), quetiapine (all-causes: aOR = 1.27, 95% CI, 1.01-1.58; psychiatric: aOR = 1.28, 95% CI, 1.02-1.59), and ziprasidone (all-causes: aOR = 1.68, 95% CI, 1.05-2.66; psychiatric: aOR = 1.55, 95% CI, 1.02-2.35) compared with lurasidone with mood stabilizers. The adjusted odds of all-cause and psychiatric hospitalizations were numerically lower for lurasidone compared with aripiprazole. The all-cause hospital length of stay per 100 patient-months was significantly higher for olanzapine (20.3 days) and quetiapine (16.0 days) compared with lurasidone (12.2 days, both P values < 0.05). Conclusions: In a Medicaid population, adults with bipolar I disorder treated with lurasidone as adjunctive therapy with mood stabilizers had significantly lower all-cause and psychiatric hospitalization rates compared with olanzapine, quetiapine, and ziprasidone. Fewer hospitalizations may reduce the economic burden associated with bipolar disorder. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | | | - Carole Dembek
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
| | | | | | | | - Michael Tocco
- Sunovion Pharmaceuticals Inc, Marlborough, Massachusetts
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Bohlken J, Riedel-Heller S, Bauer M, Kostev K. Bipolar Disorder and Outcomes of Monotherapy with Lithium, Valproate, Quetiapine, Olanzapine, Venlafaxine, and Citalopram. PHARMACOPSYCHIATRY 2021; 54:126-130. [PMID: 33494115 DOI: 10.1055/a-1348-1523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim of this study was to compare the outcomes of monotherapy in individuals with bipolar disorder who are prescribed lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in private psychiatric practices in Germany. METHODS This retrospective study included bipolar disorder patients who had initially started on a monotherapy with lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in 93 private neuropsychiatric practices in Germany between January 2006 and December 2017. Treatment failure was defined as time to discontinuation of medication or addition of another mood stabilizer, antipsychotic, antidepressant, or benzodiazepine. RESULTS A total of 4990 bipolar patients was examined for the period between 2006 and 2019. Initially, monotherapy with lithium (n=1.098), valproate (n=502), quetiapine (n=927), olanzapine (n=927), venlafaxine (n=574), or citalopram (n=962) was prescribed. Within 24 months, treatment failure had occurred in 76.3% (lithium), 85.1% (valproate), 84.6% (quetiapine), 85.2% (venlafaxine), 92.1% (olanzapine), and 86.6% (citalopram) of patients, respectively. The hazard ratio for treatment failure compared to lithium as reference was highest for olanzapine at 1.66 (1.46-1.88), followed by citalopram 1.27 (1.15-1.39), quetiapine 1.18 (1.07-1.29), valproate 1.18 (1.06-1.33), and venlafaxine 1.14 (1.02-1.27). CONCLUSIONS Our results underline the importance of lithium in the maintenance treatment of bipolar disorders.
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Affiliation(s)
- Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
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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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Marrero RJ, Fumero A, de Miguel A, Peñate W. Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2116-2131. [PMID: 32402489 DOI: 10.1016/j.pec.2020.04.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Psychopharmacological medication adherence is essential for psychiatric patients' treatment and well-being. OBJECTIVE This review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients. METHODS A literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included. RESULTS The search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence. CONCLUSION Psychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors. PRACTICE IMPLICATIONS These findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.
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Affiliation(s)
- Rosario J Marrero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain.
| | - Ascensión Fumero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Adelia de Miguel
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Wenceslao Peñate
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
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Predictors of 1-year rehospitalization in inpatients with bipolar I disorder treated with atypical antipsychotics. Int Clin Psychopharmacol 2020; 35:263-269. [PMID: 32459726 DOI: 10.1097/yic.0000000000000318] [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: 11/26/2022]
Abstract
Bipolar disorder (BPD) is debilitating disorder, and patients can experience multiple relapses and subsequent hospitalizations. Since pharmacotherapy is the mainstay of treatment for patients with BPD, investigations on the effects of atypical antipsychotics (AAP) on reducing rehospitalization risk are crucial. The objective of study is to explore predictors of 1-year rehospitalization in patients with bipolar I disorder treated with AAP. A retrospective chart review on inpatients with bipolar I disorder was conducted. All participants were followed up for 1 year, and they were subdivided into three AAP treatment groups (olanzapine, risperidone, and quetiapine group). Kaplan-Meier survival analysis was implemented to detect time to rehospitalization due to any mood episodes within 1 year after discharge. Cox proportional regression model was adopted to find predictors of 1-year hospitalization in patients who experienced rehospitalization. One hundred thirty-eight participants were included in the study, and a 1-year rehospitalization rate was 18.1%. Time to rehospitalization did not differ between three AAP treatment groups. Predictors of rehospitalization due to any episode within 1 year were family history of depression and number of previous admission. Our findings can be conducive to understanding prognosis, and predicting rehospitalization risk in patients with BPD on AAP.
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Bohlken J, Bauer M, Kostev K. Drug treatment for patients with bipolar disorders in psychiatric practices in Germany in 2009 and 2018. Psychiatry Res 2020; 289:112965. [PMID: 32388174 DOI: 10.1016/j.psychres.2020.112965] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study was to describe the treatment of bipolar disorder patients in psychiatric private practices in Germany in 2009 and 2018. METHODS This retrospective study included patients with bipolar disorder who had received at least one prescription for antidepressants, antipsychotics, antiepileptic drugs or benzodiazepines in 93 neuropsychiatric private practices in Germany between January 2009 and December 2018. Outcomes of this study were the prevalence of prescriptions for defined mood stabilizers, antipsychotics, antidepressants, and benzodiazepines, and the prevalence of mono and combination therapy in 2009 and 2018. RESULTS 1,815 and 2,322 patients with bipolar disorder were examined in 2009 and 2018, respectively. Compared to 2009, there was a decrease in the proportion of prescriptions for mood stabilizers by 2018 (58.6% to 49.5%) especially for lithium (from 31.4% to 26.2%) and an increase in the prescription of antipsychotics (38.4% in 2009 and 53.1% in 2018) and antidepressants (32.6% in 2009 and 45.1% in 2018). The share of combination therapy increased moderately from 39.3% to 41%. CONCLUSIONS Quetiapine has displaced lithium from the number one medication of the most commonly prescribed drugs in patients with bipolar disorders. The rate of patients in this study receiving monotherapy was surprisingly high.
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Affiliation(s)
- Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials. EVIDENCE-BASED MENTAL HEALTH 2020; 23:2-7. [PMID: 32046986 PMCID: PMC10231585 DOI: 10.1136/ebmental-2019-300106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD). OBJECTIVES To (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones. METHODS Patients with BD (n=117) evaluated adherence to medication daily for 6-9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers' Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. FINDINGS During the study 90.50% of the days were evaluated as 'medication taken', 6.91% as 'medication taken with changes' and 2.59% as 'medication not taken'. Adherence to medication measured via smartphones was valid compared with the MARS (B: -0.049, 95% CI -0.095 to -0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. CONCLUSIONS Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. CLINICAL IMPLICATIONS Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. TRIAL REGISTRATION NUMBER NCT01446406 and NCT02221336.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
| | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
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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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Singh S, Kumar S, Mahal P, Vishwakarma A, Deep R. Self-reported medication adherence and its correlates in a lithium-maintained cohort with bipolar disorder at a tertiary care centre in India. Asian J Psychiatr 2019; 46:34-40. [PMID: 31590007 DOI: 10.1016/j.ajp.2019.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lithium remains a cornerstone of prophylaxis in bipolar disorder (BD), but adherence continues to be a major clinical challenge and merits a closer attention. There is scant literature available in Indian as well as Asian context. METHODS This study was conducted at Department of Psychiatry, AIIMS, New Delhi with an aim to assess the self-reported medication adherence and its correlates among a naturalistic, lithium-maintained cohort (n = 76) with bipolar disorder. Subjects were included if they were on lithium therapy ≥1 year, met DSM-5 diagnosis of bipolar disorder and were in clinical remission (≥1 month). Besides sociodemographic and clinical performa, participants were assessed on medication adherence rating scale (MARS), lithium questionnaire for knowledge and lithium attitude questionnaire (LAQ). RESULTS Mean age was 35.7 ± 10.6 years (males: 59.2%); median duration of illness and lithium therapy was 84 months and 24.5 months, respectively. Mean MARS score was 6.95 ± 2.81. Regression analysis (with MARS total as dependent variable) found LAQ score to be the single most significant predictor variable (β=-0.681, p < 0.0001), explaining over 75% of the total variance. In regression model with MARS factor-1 score as dependent variable, the 'LAQ score' (β=-0.601, p < 0.0001) and 'being accompanied by family during psychiatric visits (always/mostly) in the past year' (β = 0.193, p = 0.010) emerged as significant predictor variables. CONCLUSION Adherence in lithium-maintained treatment-seeking cohort of patients with BD remains far from ideal as observed in this naturalistic setting. Lithium-related attitudes and being accompanied by family during psychiatric visits were found to be significant predictors for adherence.
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Affiliation(s)
- Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Saurabh Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Anuranjan Vishwakarma
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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25
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Fung VC, Overhage LN, Sylvia LG, Reilly-Harrington NA, Kamali M, Gao K, Shelton RC, Ketter TA, Bobo WV, Thase ME, Calabrese JR, Tohen M, Deckersbach T, Nierenberg AA. Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. J Affect Disord 2019; 257:17-22. [PMID: 31299400 PMCID: PMC6711795 DOI: 10.1016/j.jad.2019.06.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. METHODS We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). RESULTS 43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. LIMITATIONS There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. CONCLUSIONS BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.
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Affiliation(s)
- Vicki C. Fung
- Corresponding Author: Vicki Fung, PhD, , 100 Cambridge St. Suite 1600
- Boston, MA 02108, 617-726-5212 (phone)
- 617-726-4120 (fax)
| | - Lindsay N. Overhage
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA USA
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Keming Gao
- Adult Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH USA
| | | | - Terence A. Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA USA
| | - Joseph R. Calabrese
- Adult Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Albuquerque, NM USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
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26
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Bauer M, Glenn T, Alda M, Bauer R, Grof P, Marsh W, Monteith S, Munoz R, Rasgon N, Sagduyu K, Whybrow PC. Trajectories of adherence to mood stabilizers in patients with bipolar disorder. Int J Bipolar Disord 2019; 7:19. [PMID: 31482209 PMCID: PMC6722168 DOI: 10.1186/s40345-019-0154-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/24/2019] [Indexed: 01/27/2023] Open
Abstract
Background Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes. Methods This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient. Results Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found. Conclusion In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - T Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - R Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - P Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - W Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - S Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - R Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - N Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - K Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - P 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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Ellegaard PK, Licht RW, Nielsen RE, Dean OM, Berk M, Poulsen HE, Mohebbi M, Nielsen CT. The efficacy of adjunctive N-acetylcysteine in acute bipolar depression: A randomized placebo-controlled study. J Affect Disord 2019; 245:1043-1051. [PMID: 30699846 DOI: 10.1016/j.jad.2018.10.083] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/10/2018] [Accepted: 10/05/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the efficacy of adjunctive N-acetylcysteine (NAC) for the treatment of acute bipolar depression. METHOD A randomized, double-blind, multicentre, placebo-controlled trial including adult subjects diagnosed with bipolar disorder, currently experiencing a depressive episode. Participants were treated with 3 g/day NAC or placebo as an adjunctive to standard treatment for 20 weeks, followed by a 4-week washout where the blinding was maintained. The primary outcome was the mean change in the Montgomery Asberg Depression Rating Scale (MADRS) score over the 20-week treatment phase. Linear Mixed Effects Repeated Measures (LMERM) was used for analysing the primary outcome. RESULTS A total of 80 subjects were included. The mean MADRS score at baseline was 30.1 and 28.8 in participants randomized to NAC and placebo, respectively. Regarding the primary outcome measure, the between-group difference (NAC vs. placebo) was 0.5, which was statistically non-significant (95% CI: -7.0-5.9;p = 0.88). All findings regarding secondary outcomes were statistically or clinically insignificant. LIMITATIONS The study had a placebo response rate of 55.6% - high placebo response rates are associated with failure to separate from placebo. CONCLUSIONS Based on our primary outcome measure, we could not confirm previous studies showing a therapeutic effect of adjunctive NAC treatment on acute bipolar depression. Further studies with larger samples are needed to elucidate if specific subgroups could benefit from adjunctive NAC treatment.
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Affiliation(s)
- Pernille Kempel Ellegaard
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Research Unit, Mental Health Service Esbjerg, The Region of Southern Denmark, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Denmark.
| | - Rasmus Wentzer Licht
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Olivia May Dean
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Henrik Enghusen Poulsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Clinical Pharmacology, Bispebjerg Frederiksberg Hospital, Denmark
| | | | - Connie Thuroee Nielsen
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Mental Health Service Vejle, The Region of Southern Denmark, Denmark
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Larsen-Barr M, Seymour F, Read J, Gibson K. Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success. Psychiatry Res 2018; 270:365-374. [PMID: 30300866 DOI: 10.1016/j.psychres.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023]
Abstract
Few studies explore subjective experiences of attempting to discontinue antipsychotic medication, the withdrawal methods people use, or how their efforts affect their outcomes. People who take antipsychotics for off-label purposes are poorly represented in the literature. This study investigates experiences of attempting to discontinue antipsychotics in a cross-sectional sample and explores potential associations between withdrawal methods, relapse, and success. An anonymous online survey was completed by 105 adults who had taken antipsychotics for any reason and had attempted discontinuation at least once. A mixed methods approach was used to interpret the responses. Just over half (55.2%) described successfully stopping for varying lengths of time. Half (50.5%) reported no current use. People across diagnostic groups reported unwanted withdrawal effects, but these were not universal. Withdrawing gradually across more than one month was positively associated, and relapse was negatively associated with both self-defined successful discontinuation and no current use. Gradual withdrawal was negatively associated with relapse during withdrawal. We conclude it is possible to successfully discontinue antipsychotic medication, relapse during withdrawal presents a major obstacle to successfully stopping AMs, and people who withdraw gradually across more than one month may be more likely to stop and to avoid relapse during withdrawal.
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Affiliation(s)
- Miriam Larsen-Barr
- The University of Auckland, School of Psychology, Auckland, New Zealand.
| | - Fred Seymour
- The University of Auckland, School of Psychology, Auckland, New Zealand
| | - John Read
- University of East London, School of Psychology, London, England
| | - Kerry Gibson
- The University of Auckland, School of Psychology, Auckland, New Zealand
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