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Kark SM, Worthington MA, Christie RH, Masino AJ. Opportunities for digital health technology: identifying unmet needs for bipolar misdiagnosis and depression care management. Front Digit Health 2023; 5:1221754. [PMID: 37771820 PMCID: PMC10523347 DOI: 10.3389/fdgth.2023.1221754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Digital health technologies (DHTs) driven by artificial intelligence applications, particularly those including predictive models derived with machine learning methods, have garnered substantial attention and financial investment in recent years. Yet, there is little evidence of widespread adoption and scant proof of gains in patient health outcomes. One factor of this paradox is the disconnect between DHT developers and digital health ecosystem stakeholders, which can result in developing technologies that are highly sophisticated but clinically irrelevant. Here, we aimed to uncover challenges faced by psychiatrists treating patients with major depressive disorder (MDD). Specifically, we focused on challenges psychiatrists raised about bipolar disorder (BD) misdiagnosis. Methods We conducted semi-structured interviews with 10 United States-based psychiatrists. We applied text and thematic analysis to the resulting interview transcripts. Results Three main themes emerged: (1) BD is often misdiagnosed, (2) information crucial to evaluating BD is often occluded from clinical observation, and (3) BD misdiagnosis has important treatment implications. Discussion Using upstream stakeholder engagement methods, we were able to identify a narrow, unforeseen, and clinically relevant problem. We propose an organizing framework for development of digital tools based upon clinician-identified unmet need.
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Affiliation(s)
| | | | | | - Aaron J. Masino
- AiCure, New York, NY, United States
- Department of Biostatistics, Epidemiology, and Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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2
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Ortega MA, Álvarez-Mon MA, García-Montero C, Fraile-Martínez Ó, Monserrat J, Martinez-Rozas L, Rodríguez-Jiménez R, Álvarez-Mon M, Lahera G. Microbiota-gut-brain axis mechanisms in the complex network of bipolar disorders: potential clinical implications and translational opportunities. Mol Psychiatry 2023; 28:2645-2673. [PMID: 36707651 PMCID: PMC10615769 DOI: 10.1038/s41380-023-01964-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Bipolar disorders (BD) represent a severe leading disabling mental condition worldwide characterized by episodic and often progressive mood fluctuations with manic and depressive stages. The biological mechanisms underlying the pathophysiology of BD remain incompletely understood, but it seems that there is a complex picture of genetic and environmental factors implicated. Nowadays, gut microbiota is in the spotlight of new research related to this kind of psychiatric disorder, as it can be consistently related to several pathophysiological events observed in BD. In the context of the so-called microbiota-gut-brain (MGB) axis, it is shown to have a strong influence on host neuromodulation and endocrine functions (i.e., controlling the synthesis of neurotransmitters like serotonin or mediating the activation of the hypothalamic-pituitary-adrenal axis), as well as in modulation of host immune responses, critically regulating intestinal, systemic and brain inflammation (neuroinflammation). The present review aims to elucidate pathophysiological mechanisms derived from the MGB axis disruption and possible therapeutic approaches mainly focusing on gut microbiota in the complex network of BD. Understanding the mechanisms of gut microbiota and its bidirectional communication with the immune and other systems can shed light on the discovery of new therapies for improving the clinical management of these patients. Besides, the effect of psychiatric drugs on gut microbiota currently used in BD patients, together with new therapeutical approaches targeting this ecosystem (dietary patterns, probiotics, prebiotics, and other novelties) will also be contemplated.
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Affiliation(s)
- Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain.
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.
| | - Miguel Angel Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Óscar Fraile-Martínez
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Lucia Martinez-Rozas
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Roberto Rodríguez-Jiménez
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
- Institute for Health Research 12 de Octubre Hospital, (Imas 12)/CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), Alcalá de Henares, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
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3
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Tidmore LM, Keast SL, Waters HC, Pareja KL, Cothran T, Skrepnek GH. Readmissions, costs, and duration to subsequent outpatient visit after hospital discharge among Medicaid beneficiaries utilizing oral versus long-acting injectable antipsychotics in bipolar disorder or schizophrenia. Curr Med Res Opin 2022; 38:1621-1630. [PMID: 35833696 DOI: 10.1080/03007995.2022.2101819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) may reduce hospitalizations versus oral formulations (OAP) in bipolar disorder (BP) and schizophrenia/schizoaffective disorder (SCZ), but the impact on time to outpatient follow-up is less understood. OBJECTIVES To assess hospital readmissions and medical costs among Medicaid beneficiaries with BP or SCZ utilizing OAP or LAI SGAs. METHODS Cross-sectional and longitudinal analyses utilized comprehensive administrative claims of Oklahoma Medicaid beneficiaries (≥18 years) with BP or SCZ between 1 January 2013 and 31 December 2017. Readmissions, total direct medical costs, and psychiatry-related outpatient visits were assessed via generalized linear models and generalized estimating equations, controlling for demographic and clinical covariates. RESULTS Among 2523 included members, LAI utilization was associated with 1.50 and 1.73 times higher odds of any hospitalization and any readmission, respectively (p < .05). Cases involving both BP and SCZ were associated with a 2.40 times higher odds of any readmission, 2.26 times higher number of readmissions, and 24.5% higher costs (p < .001). Of the 468 members with a subsequent psychiatry-related outpatient visit, LAIs were associated with a 23.9% shorter duration to outpatient visit and 16.4% lower costs (p < .05). CONCLUSION In contrast to prior studies, this real-world investigation noted higher hospitalizations and readmissions among LAIs relative to OAP medications, but among members with a hospitalization or ED visit, LAIs were associated with shorter durations to outpatient visits and lower costs. Those with diagnoses of both BP with SCZ had higher odds of any readmission, number of readmissions, and costs relative to those with bipolar disorder alone and may be a key target for interventions.
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Affiliation(s)
- Laura M Tidmore
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Shellie L Keast
- Government Human Services Consulting, Mercer LLC, Phoenix, AZ, USA
| | - Heidi C Waters
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Kristin L Pareja
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Terry Cothran
- Department of Pharmacy, Oklahoma Health Care Authority, Oklahoma City, OK, USA
| | - Grant H Skrepnek
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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4
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Carli M, Risaliti E, Francomano M, Kolachalam S, Longoni B, Bocci G, Maggio R, Scarselli M. A 5-Year Study of Lithium and Valproic Acid Drug Monitoring in Patients with Bipolar Disorders in an Italian Clinical Center. Pharmaceuticals (Basel) 2022; 15:ph15010105. [PMID: 35056162 PMCID: PMC8780673 DOI: 10.3390/ph15010105] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 11/20/2022] Open
Abstract
Therapeutic drug monitoring (TDM) is an effective tool used to improve the pharmacological treatment in clinical practice, especially to detect subtherapeutic drug plasma concentration (Cp) in order to consider a change of dosage during treatment and reach its putative therapeutic range. In this study, we report the Cp values of lithium and valproic acid (VPA), alone and in combination, mostly in bipolar patients admitted to an Italian clinical center of the University of Pisa during the years 2016–2020, which include 12,294 samples of VPA, 7449 of lithium and 1118 of both in combination. Lithium and VPA are the most utilized drugs in treating bipolar disorders, and their TDM is strongly recommended by recent guidelines. In relation to lithium Cp monitoring, several studies have underlined that 0.5–0.8 mmol/L is the optimal range for chronic treatment, and below 0.4 mmol/L, it is unlikely to produce a clinical response. For VPA, the therapeutic range is 50–100 μg/mL and a linear correlation between Cp and clinical efficacy has been proposed, where below 50 μg/mL, the clinical efficacy of VPA has not been proven thus far. Toxic levels of both drugs were rarely found in our study, while a high percentage of patients, about one-third, had sub-therapeutic Cp during their treatments. In addition, in several cases of patients receiving multiple blood sampling, the initial subtherapeutic Cp changed only partially without reaching its therapeutic window. In relation to age, we found a higher percentage of lithium and VPA Cp values in range in the adolescents than in the adults and elderly groups. No differences were reported when analyzing the distribution of Cp values in males and females. In conclusion, this present study suggests that TDM is widely used by many specialists, but there is still a window of improvement for optimizing pharmacological treatments in clinical practice.
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Affiliation(s)
- Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
| | - Eleonora Risaliti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
| | - Mena Francomano
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
| | - Shivakumar Kolachalam
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
| | - Biancamaria Longoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Roberto Maggio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (M.C.); (E.R.); (M.F.); (S.K.); (B.L.)
- Correspondence:
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5
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Rysstad AL, Kildahl AN, Skavhaug JO, Dønnum MS, Helverschou SB. Case study: organizing outpatient pharmacological treatment of bipolar disorder in autism, intellectual disability and Phelan-McDermid syndrome (22q13.3 deletion syndrome). INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 68:378-387. [PMID: 35603006 PMCID: PMC9122368 DOI: 10.1080/20473869.2020.1756113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Phelan-McDermid syndrome (PHMDS)/22q13.3 deletion syndrome is a rare genetic disorder associated with autism spectrum disorder (ASD), intellectual disability (ID), and bipolar disorder. While numerous cases have been reported describing successful pharmacological treatment of bipolar disorder in PHMDS, there is currently little guidance available on how to organize and execute such treatment. The aim of the current case study was to explore how pharmacological treatment of bipolar disorder in PHMDS may be organized and evaluated in an outpatient setting. Through a complex process of try and fail, including systematic evaluation of any change to the intervention and never implementing more than one change at the time, the patient gradually improved, regaining his communicative and adaptive skills. Four years passed from referral to this result was achieved. Organizing assessment and treatment as a collaborative effort involving specialized mental health professionals, professional caregivers and the patient's family proved feasible. Many of the challenges present in assessment of psychiatric disorder in individuals with ASD and ID are likely to be present also in evaluation of treatment effects, particularly in disorders where symptoms occur in phases. The approach described in the current paper may contribute to reducing the impact of these challenges.
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Affiliation(s)
- Anne Langseth Rysstad
- Section for Intellectual Disabilities and Autism, Vestre Viken Hospital Trust, Asker, Norway
- Correspondence to: Anne Langseth Rysstad Section for Intellectual Disabilities and Autism, Seksjon utviklingshemming og autisme – Blakstad psyk. avd., Vestre Viken HF, Postboks 800, Asker, 3004Drammen.
| | - Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Jon Olav Skavhaug
- Section for Intellectual Disabilities and Autism, Vestre Viken Hospital Trust, Asker, Norway
| | - Monica Stolen Dønnum
- Section for Intellectual Disabilities and Autism, Vestre Viken Hospital Trust, Asker, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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6
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Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord 2020; 8:26. [PMID: 32869118 PMCID: PMC7459037 DOI: 10.1186/s40345-020-00190-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Background Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. Methods Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. Results There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. Conclusions This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands.
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Affiliation(s)
- Susan Zyto
- Mental Health Service Organisation North Holland North, Center for Psychosomatic Medicine, Hoorn, The Netherlands. .,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Nienke Jabben
- Department of Psychiatry, Zuyderland Medical Center, Sittard, The Netherlands
| | - Peter F J Schulte
- Mental Health Service Organisation North Holland North, Alkmaar, The Netherlands
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Peter J J Goossens
- Dimence Group Mental Health Care Center, Deventer, The Netherlands.,University Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
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7
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Averous P, Charbonnier E, Dany L. Relationship Between Illness Representations, Psychosocial Adjustment, and Treatment Outcomes in Mental Disorders: A Mini Review. Front Psychol 2020; 11:1167. [PMID: 32612557 PMCID: PMC7309516 DOI: 10.3389/fpsyg.2020.01167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/06/2020] [Indexed: 01/04/2023] Open
Abstract
Understanding and improving the psychosocial adjustments (e.g., quality of life, depression) and treatment outcomes (e.g., adherence, beliefs about treatments) of people with mental disorders are major health issues. The self-regulation model (SRM) postulates that illness representations play a central role on adjustment and treatment of people with physical illnesses. Recently, the SRM has been used with people with mental disorders. However, the manifestations of somatic and psychiatric disorders can be very different. Therefore, the use of SRM in the field of mental health is very complex. This difficulty, as well as the growing interest for illness representations in the field of mental health, justifies the utility to conduct a review on this topic. The current review shows that illness representations are related to psychosocial adjustment and/or treatment outcomes for people with various mental disorders [e.g., psychotic disorders, mood disorder, posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD)]. However, some limitations to the applicability of SRM to mental disorders have been highlighted. These limitations should be considered in future studies.
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Affiliation(s)
- Priscillia Averous
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,UNIV. NIMES, EA 7352 CHROME, Nîmes, France
| | | | - Lionel Dany
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Timone, Service d'Oncologie Médicale, Marseille, France
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8
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Hart KL, Perlis RH, McCoy TH. What do patients learn about psychotropic medications on the web? A natural language processing study. J Affect Disord 2020; 260:366-371. [PMID: 31539672 PMCID: PMC6921244 DOI: 10.1016/j.jad.2019.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/15/2019] [Accepted: 09/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low rates of medication adherence remain a major challenge across psychiatry. In part, this likely reflects patient concerns about safety and adverse effects, accurate or otherwise. We therefore sought to characterize online information about common psychiatric medications in terms of positive and negative sentiment. METHODS We applied a natural language processing tool to score the sentiment expressed in web search results for 51 psychotropic medications across 3 drug classes (antidepressants, antipsychotics, and mood stabilizers), as a means of seeing if articles referencing these medications were generally positive or generally negative in tone. We compared between medications of the same class, and across medication classes. RESULTS Across 12,733 web search results, significant within-class differences in positive (antidepressants: F(24,2682) = 2.97, p < 0.001; antipsychotics: F(16,4029) = 3.25, p < 0.001; mood stabilizers: F(8,2371) = 6.88, p < 0.001) and negative sentiment (antidepressants: F(24,6282) = 11.17, p < 0.001; antipsychotics: F(16, 4029) = 12.13, p < 0.001; mood stabilizers: F(8, 2371) = 13.28, p < 0.001) were identified. Among these were significantly greater negative sentiment for the antidepressants sertraline, duloxetine, venlafaxine, and paroxetine, and for the antipsychotics, quetiapine and risperidone. Conversely, lithium preparations and valproate exhibited less negative sentiment than other mood stabilizing medications. LIMITATIONS While these results provide a novel means of comparing medications, the present analyses cannot be linked to individual patient consumption of this information, or to its influence on their future clinical interactions. CONCLUSIONS Overall, a subset of psychotropic medications were associated with significantly more negative sentiment. Characterizing these differences may allow clinicians to anticipate patient willingness to initiate or continue medications.
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Affiliation(s)
- Kamber L Hart
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, 6th Floor, Boston, MA 02114, USA
| | - Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, 6th Floor, Boston, MA 02114, USA
| | - Thomas H McCoy
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, 6th Floor, Boston, MA 02114, USA.
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9
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Ahmed S, Bachu R, Kotapati P, Adnan M, Ahmed R, Farooq U, Saeed H, Khan AM, Zubair A, Qamar I, Begum G. Use of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review. Front Psychiatry 2019; 10:228. [PMID: 31133886 PMCID: PMC6514433 DOI: 10.3389/fpsyt.2019.00228] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/27/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: Gabapentin (GBP) is an anticonvulsant medication that is also used to treat restless legs syndrome (RLS) and posttherapeutic neuralgia. GBP is commonly prescribed off-label for psychiatric disorders despite the lack of strong evidence. However, there is growing evidence that GBP may be effective and clinically beneficial in both psychiatric disorders and substance use disorders. This review aimed to perform a systematic analysis of peer-reviewed published literature on the efficacy of GBP in the treatment of psychiatric disorders and substance use disorders. Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Ovid MEDLINE literature databases were screened and filtered by using specific search terms and inclusion/exclusion criteria. The full texts of selected studies were subsequently retrieved and reviewed. The search terms generated 2,604 results from the databases. After excluding all duplicates, 1,088 citations were left. Thereafter, we applied inclusion and exclusion criteria; a total of 54 papers were retained for detailed review. Results: This literature review concludes that GBP appears to be effective in the treatment of various forms of anxiety disorders. It shows some effectiveness in bipolar disorder as an adjunctive therapeutic agent, while the evidence for monotherapy is inconclusive. In substance use disorders, GBP is effective for acute alcohol withdrawal syndrome (AWS) with mild to moderate severity; it reduces cravings, improves the rate of abstinence, and delays return to heavy drinking. GBP may have some therapeutic potential in the treatment of opioid addiction and cannabis dependence, but there is limited evidence to support its use. No significant benefit of GBP has been conclusively observed in the treatment of OCD, PTSD, depression, or cocaine and amphetamine abuse. Conclusion: GBP appears to be effective in some forms of anxiety disorders such as preoperative anxiety, anxiety in breast cancer survivors, and social phobia. GBP has shown to be safe and effective in the treatment of alcohol dependence. However, the literature suggests that GBP is effective as an adjunctive medication rather than a monotherapy. More clinical trials with larger patient populations are needed to support gabapentin's off-label use in psychiatric disorders and substance use disorders. It is worth noting that numerous clinical studies that are discussed in this review are open-label trials, which are inherently less rigorously analyzed. Therefore, more extensive investigations are required to examine not only the efficacy of GBP, but also its safety and tolerance.
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Affiliation(s)
- Saeed Ahmed
- Nassau University Medical Center, East Meadow, NY, United States
| | - Ramya Bachu
- Department of Internal Medicine, Baptist Health-UAMS, Little Rock, AR, United States
| | - Padma Kotapati
- Manhattan Psychiatric Center, New York, NY, United States
| | | | - Rizwan Ahmed
- Liaquat National Medical College, Karachi, Pakistan
| | - Umer Farooq
- John T. Mather Memorial Hospital, Port Jefferson, NYUSA
| | - Hina Saeed
- Baqai Medical University, Karachi, Pakistan
| | - Ali Mahmood Khan
- University of Texas Rio Grande Valley Edinburg, Edinburg, TX, United States
| | - Aarij Zubair
- St. John’s University, Queens, NY, United States
| | - Iqra Qamar
- Department of Cardiology Brigham & Women’s Hospital, Boston, MA, United States
| | - Gulshan Begum
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, United States
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10
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Buizza C, Candini V, Ferrari C, Ghilardi A, Saviotti FM, Turrina C, Nobili G, Sabaudo M, de Girolamo G. The Long-Term Effectiveness of Psychoeducation for Bipolar Disorders in Mental Health Services. A 4-Year Follow-Up Study. Front Psychiatry 2019; 10:873. [PMID: 31849726 PMCID: PMC6901938 DOI: 10.3389/fpsyt.2019.00873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/06/2019] [Indexed: 01/31/2023] Open
Abstract
Aims: The aims of the present study were to assess: the effectiveness of psychoeducation in mental health service (MHSs) in terms of time to first hospitalization during 4-year follow-up; the number and the days of hospitalizations, and the number of people hospitalized at 4-year follow-up; and variables associated with better outcome in BD patients. Methods: This is a controlled study involving an experimental group (N = 57) and a control group (N = 52). The treatment phase consists of 21 weeks, in which all participants received TAU, while the experimental group received additional psychoeducation. Results: The survival analysis showed significant differences in terms of time to first hospitalization of up to 4-year follow-up: the patients in the psychoeducation group showed a longer time free from hospitalizations than the control group. Concerning the predictors of time to first hospitalization, the only factor that showed a trend to statistical significance was psychoeducation. Conclusions: This is one of few studies assessing the long-term effectiveness of psychoeducation in a naturalistic setting. The data confirm that psychoeducation can impact illness course, in terms of longer time free from hospitalizations. Trial registration: ISRCTN17827459.
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Affiliation(s)
- Chiara Buizza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valentina Candini
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Ghilardi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Cesare Turrina
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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11
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Cochran A, Belman-Wells L, McInnis M. Engagement Strategies for Self-Monitoring Symptoms of Bipolar Disorder With Mobile and Wearable Technology: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e130. [PMID: 29748160 PMCID: PMC5968216 DOI: 10.2196/resprot.9899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/25/2018] [Accepted: 03/25/2018] [Indexed: 01/18/2023] Open
Abstract
Background Monitoring signs and symptoms in bipolar disorder (BP) is typically based on regular assessments from patient-clinician interactions. Mobile and wearable technology promises to make monitoring symptoms in BP easier, but little is known about how best to engage individuals with BP in monitoring symptoms. Objective The objective of this study was to provide the rationale and protocol for a randomized controlled trial that investigates engagement strategies for monitoring symptoms of BP, including the strategies of using activity trackers compared with self-reports and reviewing recorded symptoms weekly with an interviewer. Methods A total of 50 individuals with BP will be recruited from the Prechter Longitudinal Study of Bipolar Disorder at the University of Michigan to participate in a 6-week study. Participants will monitor their symptoms through an activity tracker (Fitbit Alta HR) and a mobile phone app designed for this study. In addition to monitoring symptoms, participants have a 50-50 chance of being assigned to an arm that reviews self-reports and activity information weekly. Statistical tests will be performed to test hypotheses that participants adhere to activity tracking significantly more than self-reporting, prefer activity tracking significantly more than self-reporting, and better adhere to both activity tracking and self-reporting when reviewing collected information weekly. Results Recruitment commenced in November 2017. The first group of participants began the study in January 2018. Conclusions This study aims to establish strategies to engage individuals with BP in monitoring their symptoms with mobile and wearable technology. Better engagement strategies are expected to aid current efforts in bipolar research and clinical care, from the development of new mobile phone apps to providing the right intervention to the right individual at the right moment. Trial Registration ClinicalTrials.gov NCT03358238; https://clinicaltrials.gov/ct2/show/NCT03358238 (Archived by WebCite at http://www.webcitation.org/6yebuNfz5) Registered Report Identifier RR1-10.2196/9899
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Affiliation(s)
- Amy Cochran
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Melvin McInnis
- Department of Psychiatry, University of Michigan - Ann Arbor, Ann Arbor, MI, United States
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12
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Ng-Mak D, Poon JL, Roberts L, Kleinman L, Revicki DA, Rajagopalan K. Patient preferences for important attributes of bipolar depression treatments: a discrete choice experiment. Patient Prefer Adherence 2018; 12:35-44. [PMID: 29343947 PMCID: PMC5749384 DOI: 10.2147/ppa.s151561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to assess patient preferences regarding pharmacological treatment attributes for bipolar depression using a discrete choice experiment (DCE). METHODS Adult members of an Internet survey panel with a self-reported diagnosis of bipolar depression were invited via e-mail to participate in a web-based DCE survey. Participants were asked to choose between hypothetical medication alternatives defined by attributes and levels that were varied systematically. The six treatment attributes included in the DCE were time to improvement, risk of becoming manic, weight gain, risk of sedation, increased blood sugar, and increased cholesterol. Attributes were supported by literature review, expert input, and results of focus groups with patients. Sawtooth CBC System for Choice-Based Conjoint Analysis was used to estimate the part-worth utilities for the DCE analyses. RESULTS The analytical sample included 185 participants (50.8% females) from a total of 200 participants. The DCE analyses found weight gain to be the most important treatment attribute (relative importance =49.6%), followed by risk of sedation (20.2%), risk of mania (13.0%), increased blood sugar (8.3%), increased cholesterol (5.2%), and time to improvement (3.7%). CONCLUSION Results from this DCE suggest that adults with bipolar depression considered risks of weight gain and sedation associated with pharmacotherapy as the most important attributes for the treatment of bipolar depression. Incorporating patient preferences in the treatment decision-making process may potentially have an impact on treatment adherence and satisfaction and, ultimately, patient outcomes.
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Affiliation(s)
- Daisy Ng-Mak
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA
- Correspondence: Daisy Ng-Mak, Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA 01752, USA, Tel +1 774 369 7010, Email
| | | | | | - Leah Kleinman
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | - Krithika Rajagopalan
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA
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13
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Fernandes TMP, Andrade SM, de Andrade MJO, Nogueira RMTBL, Santos NA. Colour discrimination thresholds in type 1 Bipolar Disorder: a pilot study. Sci Rep 2017; 7:16405. [PMID: 29180712 PMCID: PMC5703961 DOI: 10.1038/s41598-017-16752-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/16/2017] [Indexed: 11/09/2022] Open
Abstract
Although some studies have reported perceptual changes in psychosis, no definitive conclusions have been drawn about visual disturbances that are related to bipolar disorder (BPD). The purpose of the present study was to evaluate colour vision in BPD patients. Data were recorded from 24 participants: healthy control group (n = 12) and type 1 BPD group (n = 12). The participants were 20-45 years old and they were free from neurological disorders and identifiable ocular disease and had normal or corrected-to-normal visual acuity. Colour discrimination was evaluated using the Lanthony D-15d, Trivector and Ellipse tests, using a psychophysical forced-choice method. The relationship of visual measures to mood state and cognitive function was also investigated. The results showed that BPD patients had higher colour discrimination thresholds in the D15d (p < 0.001), Trivector (p < 0.001) and Ellipse (p < 0.01) tests compared with healthy controls. Linear regression analysis showed that mood state was related to colour discrimination. BPD individuals were not impaired in cognitive tasks. The present study provided new evidence of potential links between type 1 BPD and visual processing impairments. This research suggests a new direction for studies and the need for research in this field of study.
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Affiliation(s)
- Thiago Monteiro Paiva Fernandes
- Cognitive Neuroscience and Behaviour Program, Federal University of Paraiba, Joao Pessoa, Brazil.
- Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Joao Pessoa, Brazil.
| | - Suellen Marinho Andrade
- Cognitive Neuroscience and Behaviour Program, Federal University of Paraiba, Joao Pessoa, Brazil
| | | | | | - Natanael Antonio Santos
- Cognitive Neuroscience and Behaviour Program, Federal University of Paraiba, Joao Pessoa, Brazil
- Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Joao Pessoa, Brazil
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14
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Parker GB, Graham RK, Tavella G. Is there consensus across international evidence-based guidelines for the management of bipolar disorder? Acta Psychiatr Scand 2017; 135:515-526. [PMID: 28260229 DOI: 10.1111/acps.12717] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the level of agreement across professionally auspiced evidence-based guidelines for managing the bipolar disorders. METHODS A literature search in PubMed, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews and PsycInfo was undertaken using the search terms 'bipolar disorder' and 'guidelines', generating 11 evidence-based guidelines published by professional organisations over the 2002-2015 period. Each guideline was reviewed by two independent reviewers and key themes extracted via qualitative analyses. RESULTS There was agreement on issues such as the first-line treatment of mania where mood-stabilising and/or an antipsychotic medication together with tapering or ceasing antidepressant medications was most commonly recommended. Differences included the extent to which (i) the different bipolar disorders were defined or not, (ii) there were separate recommendations for bipolar I and bipolar II disorders vs. non-differentiating general bipolar management strategies, (iii) 'general' vs. severity-based recommendations were made, and (iv) narrow vs. broad sets of candidate medications were nominated, while there was variable consideration of treatments such as electroconvulsive therapy (ECT). CONCLUSIONS While there was some consistency across guidelines on key recommendations, there was also substantial inconsistencies, limiting the generation of any 'meta-consensus' model for managing the bipolar disorders.
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Affiliation(s)
- G B Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - R K Graham
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - G Tavella
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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15
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Depressive and Bipolar Disorders. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Sharma A, Satterthwaite TD, Vandekar L, Katchmar N, Daldal A, Ruparel K, Elliott MA, Baldassano C, Thase ME, Gur RE, Kable JW, Wolf DH. Divergent relationship of depression severity to social reward responses among patients with bipolar versus unipolar depression. Psychiatry Res 2016; 254:18-25. [PMID: 27295401 PMCID: PMC4992640 DOI: 10.1016/j.pscychresns.2016.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/28/2016] [Accepted: 06/05/2016] [Indexed: 01/22/2023]
Abstract
Neuroimaging studies of mood disorders demonstrate abnormalities in brain regions implicated in reward processing. However, there is a paucity of research investigating how social rewards affect reward circuit activity in these disorders. Here, we evaluated the relationship of both diagnostic category and dimensional depression severity to reward system function in bipolar and unipolar depression. In total, 86 adults were included, including 24 patients with bipolar depression, 24 patients with unipolar depression, and 38 healthy comparison subjects. Participants completed a social reward task during 3T BOLD fMRI. On average, diagnostic groups did not differ in activation to social reward. However, greater depression severity significantly correlated with reduced bilateral ventral striatum activation to social reward in the bipolar depressed group, but not the unipolar depressed group. In addition, decreased left orbitofrontal cortical activation correlated with more severe symptoms in bipolar depression, but not unipolar depression. These differential dimensional effects resulted in a significant voxelwise group by depression severity interaction. Taken together, these results provide initial evidence that deficits in social reward processing are differentially related to depression severity in the two disorders.
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Affiliation(s)
- Anup Sharma
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | - Lillie Vandekar
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Natalie Katchmar
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aylin Daldal
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mark A Elliott
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Claudia Baldassano
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph W Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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17
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Baftiu A, Johannessen Landmark C, Rusten IR, Feet SA, Johannessen SI, Larsson PG. Changes in utilisation of antiepileptic drugs in epilepsy and non-epilepsy disorders-a pharmacoepidemiological study and clinical implications. Eur J Clin Pharmacol 2016; 72:1245-1254. [PMID: 27411937 DOI: 10.1007/s00228-016-2092-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate changes in utilisation of antiepileptic drugs (AEDs) in epilepsy and non-epilepsy disorders in Norway and furthermore to study the retention rates of the most commonly used AEDs in these indications in long-term use. METHODS The data consisted of all prescriptions of AEDs from Norwegian pharmacies in the Norwegian Prescription Database (NorPD) (2004-2012). Variables included anonymous data regarding age, gender, diagnosis specific reimbursement codes and utilisation of AEDs. RESULTS In recent years (2008-2012), the utilisation of AEDs in non-epilepsy disorders accounted for 45-53 % of the total use. In epilepsy, the most commonly used AED was lamotrigine, followed by levetiracetam, carbamazepine and valproate. Lamotrigine was also the predominant AED used in psychiatry, while pregabalin and gabapentin were mostly used in neuropathic pain. In migraine, topiramate predominated but accounted for <1 % of the total utilisation of AEDs. The majority of prescriptions were by general practitioners and only 20 % by specialists. Regardless of indication, newer AEDs had higher retention rates (34-48 %) and were used for a longer period before discontinuation. CONCLUSIONS The use of AEDs in non-epilepsy disorders is increasing and accounted for 53 % in 2012. Newer AEDs were predominantly used and demonstrated higher retention rates than older AEDs in all indications. This nationwide study demonstrates an increased exposure to AEDs in new patient groups, and details in prescription patterns and clinical and safety considerations should be closely monitored. This contributes to long-term post-marketing data of AED and accordingly improved pharmacovigilance.
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Affiliation(s)
- Arton Baftiu
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Cecilie Johannessen Landmark
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. .,The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway. .,Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
| | - Ida Rudberg Rusten
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Silje Andrea Feet
- Programme for Pharmacy, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Svein I Johannessen
- The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Pål G Larsson
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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18
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Gawlik-Kotelnicka O, Mielicki W, Rabe-Jabłońska J, Strzelecki D. Impact of lithium alone or in combination with haloperidol on selected oxidative stress parameters in human plasma in vitro. Redox Rep 2016; 21:45-49. [PMID: 26193071 DOI: 10.1179/1351000215y.0000000030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Lithium may inhibit lipid peroxidation (LP) and protein oxidation, stimulate cell proliferation, increase neurogenesis, and delay cell death. Oxidative stress (OxS) is a state of imbalance between oxidative processes and antioxidant defenses, which may play an important role in the pathophysiology and disease course of bipolar disorder (BD). The aim of this study was to estimate the influence of lithium, administered alone or in combination with haloperidol, on selected OxS parameters in human plasma in vitro. METHODS The OxS parameters evaluated were thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC). Plasma samples from healthy volunteers were incubated with drug concentrations used in psychiatry. RESULTS Incubation of plasma with lithium or haloperidol alone did not produce statistically significant changes of TBARS levels in comparison with control samples. However, significantly higher TBARS levels were observed in samples incubated with haloperidol plus lithium compared to control, haloperidol, or lithium samples. The TAC value did not differ between samples. CONCLUSIONS Lithium does not influence OxS parameters in human plasma in vitro during short-term observation when applied at concentrations used in psychiatry. However, lithium increased the TBARS level in the samples when given in combination with haloperidol, which may be one of the mechanisms behind the neurotoxicity associated with combined lithium and haloperidol administration.
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Affiliation(s)
- Oliwia Gawlik-Kotelnicka
- a Department of Affective and Psychotic Disorders , Medical University of Lodz , Czechoslowacka 8/10, 92-216 Lodz , Poland
| | - Wojciech Mielicki
- b Department of Pharmaceutical Biochemistry , Medical University of Lodz , Muszynskiego 1, 90-151 Lodz , Poland
| | - Jolanta Rabe-Jabłońska
- a Department of Affective and Psychotic Disorders , Medical University of Lodz , Czechoslowacka 8/10, 92-216 Lodz , Poland
| | - Dominik Strzelecki
- a Department of Affective and Psychotic Disorders , Medical University of Lodz , Czechoslowacka 8/10, 92-216 Lodz , Poland
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Li DJ, Tseng PT, Chen YW, Wu CK, Lin PY. Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants: A Meta-Analysis Following the PRISMA Guidelines. Medicine (Baltimore) 2016; 95:e3165. [PMID: 27043678 PMCID: PMC4998539 DOI: 10.1097/md.0000000000003165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis. Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants. We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other antidepressants as previously thought, which should serve to remind clinicians of the risk of phase shifting when prescribing bupropion to BD patients regardless of the suggestions of current clinical practice guidelines.
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Affiliation(s)
- Dian-Jeng Li
- From the Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (D-JL), Kaohsiung; Department of Psychiatry (P-TT, C-KW), Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home; Department of Neurology (Y-WC), E-Da Hospital; Department of Psychiatry (P-YL), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; and Institute for Translational Research in Biomedical Sciences (P-YL), Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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20
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Cristancho MA, Thase ME. Critical appraisal of selegiline transdermal system for major depressive disorder. Expert Opin Drug Deliv 2016; 13:659-65. [DOI: 10.1517/17425247.2016.1140145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mario A. Cristancho
- The Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E. Thase
- The Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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21
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Kim KH, Liu J, Sells Galvin RJ, Dage JL, Egeland JA, Smith RC, Merchant KM, Paul SM. Transcriptomic Analysis of Induced Pluripotent Stem Cells Derived from Patients with Bipolar Disorder from an Old Order Amish Pedigree. PLoS One 2015; 10:e0142693. [PMID: 26554713 PMCID: PMC4640865 DOI: 10.1371/journal.pone.0142693] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/26/2015] [Indexed: 01/24/2023] Open
Abstract
Fibroblasts from patients with Type I bipolar disorder (BPD) and their unaffected siblings were obtained from an Old Order Amish pedigree with a high incidence of BPD and reprogrammed to induced pluripotent stem cells (iPSCs). Established iPSCs were subsequently differentiated into neuroprogenitors (NPs) and then to neurons. Transcriptomic microarray analysis was conducted on RNA samples from iPSCs, NPs and neurons matured in culture for either 2 weeks (termed early neurons, E) or 4 weeks (termed late neurons, L). Global RNA profiling indicated that BPD and control iPSCs differentiated into NPs and neurons at a similar rate, enabling studies of differentially expressed genes in neurons from controls and BPD cases. Significant disease-associated differences in gene expression were observed only in L neurons. Specifically, 328 genes were differentially expressed between BPD and control L neurons including GAD1, glutamate decarboxylase 1 (2.5 fold) and SCN4B, the voltage gated type IV sodium channel beta subunit (-14.6 fold). Quantitative RT-PCR confirmed the up-regulation of GAD1 in BPD compared to control L neurons. Gene Ontology, GeneGo and Ingenuity Pathway Analysis of differentially regulated genes in L neurons suggest that alterations in RNA biosynthesis and metabolism, protein trafficking as well as receptor signaling pathways may play an important role in the pathophysiology of BPD.
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Affiliation(s)
- Kwi Hye Kim
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
| | - Jiangang Liu
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
| | - Rachelle J. Sells Galvin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
| | - Jeffrey L. Dage
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
| | - Janice A. Egeland
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, Florida, United States of America
| | - Rosamund C. Smith
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Kalpana M. Merchant
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, United States of America
| | - Steven M. Paul
- Mind and Brain Institute, Weill Cornell Medical College, New York, New York, United States of America
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22
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Common and Dissociable Dysfunction of the Reward System in Bipolar and Unipolar Depression. Neuropsychopharmacology 2015; 40:2258-68. [PMID: 25767910 PMCID: PMC4613620 DOI: 10.1038/npp.2015.75] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/03/2015] [Accepted: 02/13/2015] [Indexed: 12/30/2022]
Abstract
Unipolar and bipolar depressive episodes have a similar clinical presentation that suggests common dysfunction of the brain's reward system. Here, we evaluated the relationship of both dimensional depression severity and diagnostic category to reward system function in both bipolar and unipolar depression. In total, 89 adults were included, including 27 with bipolar depression, 25 with unipolar depression, and 37 healthy comparison subjects. Subjects completed both a monetary reward task and a resting-state acquisition during 3T BOLD fMRI. Across disorders, depression severity was significantly associated with reduced activation for wins compared with losses in bilateral ventral striatum, anterior cingulate cortex, posterior cingulate cortex, and right anterior insula. Resting-state connectivity within this reward network was also diminished in proportion to depression severity, most notably connectivity strength in the left ventral striatum. In addition, there were categorical differences between patient groups: resting-state connectivity at multiple reward network nodes was higher in bipolar than in unipolar depression. Reduced reward system task activation and resting-state connectivity therefore appear to be a brain phenotype that is dimensionally related to depression severity in both bipolar and unipolar depression. In contrast, categorical differences in reward system resting connectivity between unipolar and bipolar depression may reflect differential risk of mania. Reward system dysfunction thus represents a common brain mechanism with relevance that spans categories of psychiatric diagnosis.
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McCormick U, Murray B, McNew B. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. J Am Assoc Nurse Pract 2015; 27:530-42. [PMID: 26172568 PMCID: PMC5034840 DOI: 10.1002/2327-6924.12275] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/01/2015] [Indexed: 12/19/2022]
Abstract
Purpose This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs). Data sources PubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals. Conclusions BD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients. Implications for practice Awareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients.
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Affiliation(s)
| | | | - Brittany McNew
- Medical Services, Centerstone of Indiana, Bloomington, Indiana
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Thermolia C, Bei ES, Petrakis EGM, Kritsotakis V, Tsiknakis M, Sakkalis V. Designing a patient monitoring system for bipolar disorder using Semantic Web technologies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:6788-6791. [PMID: 26737852 DOI: 10.1109/embc.2015.7319952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The new movement to personalize treatment plans and improve prediction capabilities is greatly facilitated by intelligent remote patient monitoring and risk prevention. This paper focuses on patients suffering from bipolar disorder, a mental illness characterized by severe mood swings. We exploit the advantages of Semantic Web and Electronic Health Record Technologies to develop a patient monitoring platform to support clinicians. Relying on intelligently filtering of clinical evidence-based information and individual-specific knowledge, we aim to provide recommendations for treatment and monitoring at appropriate time or concluding into alerts for serious shifts in mood and patients' non response to treatment.
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Schwartz ER, Allespach HH. Depressive and Bipolar Disorders. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_33-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Depressive and Bipolar Disorders. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_33-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jann MW. Diagnosis and treatment of bipolar disorders in adults: a review of the evidence on pharmacologic treatments. AMERICAN HEALTH & DRUG BENEFITS 2014; 7:489-99. [PMID: 25610528 PMCID: PMC4296286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Patients with bipolar disorder are exceptionally challenging to manage because of the dynamic, chronic, and fluctuating nature of their disease. Typically, the symptoms of bipolar disorder first appear in adolescence or early adulthood, and are repeated over the patient's lifetime, expressed as unpredictable recurrences of hypomanic/manic or depressive episodes. The lifetime prevalence of bipolar disorder in adults is reported to be approximately 4%, and its management was estimated to cost the US healthcare system in 2009 $150 billion in combined direct and indirect costs. OBJECTIVE To review the published literature and describe the personal and societal burdens associated with bipolar disorder, the impact of delays in accurate diagnosis, and the evidence for the clinical effectiveness of available pharmacologic therapies. METHODS The studies in this comprehensive review were selected for inclusion based on clinical relevance, importance, and robustness of data related to diagnosis and treatment of bipolar disorder. The search terms that were initially used on MEDLINE/PubMed and Google Scholar were restricted to 1994 through 2014 and included "bipolar disorder," "mania," "bipolar depression," "mood stabilizer," "atypical antipsychotics," and "antidepressants." High-quality, recent reviews of major relevant topics were included to supplement the primary studies. DISCUSSION Substantial challenges facing patients with bipolar disorder, in addition to their severe mood symptoms, include frequent incidence of psychiatric (eg, anxiety disorders, alcohol or drug dependence) and general medical comorbidities (eg, diabetes, cardiovascular disease, obesity, migraine, and hepatitis C virus infection). It has been reported that more than 75% of patients take their medication less than 75% of the time, and the rate of suicide (0.4%) among patients with bipolar disorder is more than 20 times greater than in the general US population. Mood stabilizers are the cornerstone of treatment of bipolar disorder, but atypical antipsychotics are broadly as effective; however, differences in efficacy exist between individual agents in the treatment of the various phases of bipolar disorder, including treatment of acute mania or acute depression symptoms, and in the prevention of relapse. CONCLUSION The challenges involved in managing bipolar disorder over a patient's lifetime are the result of the dynamic, chronic, and fluctuating nature of this disease. Diligent selection of a treatment that takes into account its efficacy in the various phases of the disorder, along with the safety profile identified in clinical trials and in the real world can help ameliorate the impact of this devastating condition.
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Affiliation(s)
- Michael W Jann
- Dr Jann is Professor and Chair, Department of Pharmacotherapy, University of North Texas System College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX
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Bourin MS, Severus E, Schronen JP, Gass P, Szamosi J, Eriksson H, Chandrashekar H. Lithium as add-on to quetiapine XR in adult patients with acute mania: a 6-week, multicenter, double-blind, randomized, placebo-controlled study. Int J Bipolar Disord 2014; 2:14. [PMID: 25505693 PMCID: PMC4224669 DOI: 10.1186/s40345-014-0014-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022] Open
Abstract
Quetiapine extended release (XR) and lithium are treatments with proven efficacy in acute mania. This randomized study evaluated the efficacy and safety of lithium or placebo as add-on to quetiapine XR in adult patients with manic or mixed symptoms of bipolar I disorder. In this 6-week, double-blind study (Trial D144AC00003), adult patients with DSM-IV-TR-diagnosed bipolar I disorder (current episode manic or mixed), a Young Mania Rating Scale (YMRS) total score ≥20, and score ≥4 on two of four core YMRS items were administered quetiapine XR (400 to 800 mg/day) and randomly assigned to receive add-on lithium (600 to 1,800 mg/day) or placebo. The primary efficacy end point was change in the YMRS total score from baseline to day 43, analyzed using a mixed-model for repeated measures (MMRM) approach. Secondary efficacy and safety end points were also measured. Rating scales were administered by trained staff. Three hundred fifty-six patients treated with quetiapine XR were randomized to add-on lithium (n = 173) or placebo (n = 183). Two hundred ninety-one patients (81.7%) completed the study. At day 43, least squares mean change in YMRS total score was −22.8 for add-on lithium and −20.1 for add-on placebo, a statistically significant treatment group difference of −2.69 (p < 0.001). On secondary measures, add-on lithium was associated with significant improvements in response, remission, illness severity, and overall illness versus add-on placebo (p < 0.05). The number needed to treat was 9.1 for response and 7.9 for remission for add-on lithium compared with add-on placebo. Lithium in combination with quetiapine XR was generally well tolerated, with a similar profile to quetiapine XR in combination with placebo. The addition of lithium to quetiapine XR therapy was associated with significantly greater efficacy than placebo as add-on and was generally well tolerated in patients with acute bipolar I mania. This study was registered under Clinicaltrials.gov Identifier NCT00931723.
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Affiliation(s)
- Michel S Bourin
- Department of Pharmacology, Faculty of Medicine, University of Nantes, 98, rue Joseph Blanchart, 44100 Nantes, France
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | | | - Peter Gass
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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Karamustafalıoğlu O, Reif A, Atmaca M, Gonzalez D, Moreno-Manzanaro M, Gonzalez MA, Medina E, Bellomo A. Hospital stay in patients admitted for acute bipolar manic episodes prescribed quetiapine immediate or extended release: a retrospective non-interventional cohort study (HOME). BMC Psychiatry 2014; 14:246. [PMID: 25174996 PMCID: PMC4159508 DOI: 10.1186/s12888-014-0246-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/19/2014] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Bipolar manic episodes often require hospital admission to ensure patient safety. The antipsychotic quetiapine is a common treatment for bipolar mania and is available in immediate release (IR) and extended release (XR) formulations; however, outcomes in patients receiving these different formulations have not been directly compared in an acute hospital setting. METHODS We conducted a multinational, observational, retrospective cohort study to describe and compare hospital stay in patients admitted for an acute bipolar manic episode treated with quetiapine IR or XR from 1 October 2009-1 October 2010. The primary outcome measure was comparison of length of stay (LOS) using zero-truncated negative binomial regression. RESULTS In total, 1230 patients were included (659 in the IR cohort; 571 in the XR cohort). The median LOS (interquartile range) was 18.0 days (12.0, 28.0) in the IR cohort and 20.0 days (12.0, 34.0) in the XR cohort, respectively. LOS was not significantly associated with quetiapine formulation irrespective of whether or not clinical characteristics were taken into account (p = 0.820 and p = 0.386, respectively). Overall, 84.2% and 84.4% of patients in the IR and XR cohorts, respectively, had not previously used quetiapine; of these patients, 78.7% and 68.9% received one total daily dose, and 14.4% and 23.9% received dose titration. Over half of patients received antipsychotic monotherapy (53.1% and 58.3% in the IR and XR cohorts, respectively) and most received a daily quetiapine dose ≥ 400 mg (64.9% and 71.8%, respectively, for quetiapine monotherapy and 59.9% and 80.3%, respectively, for combination treatment). As a secondary outcome, multivariate analysis was used to identify other factors that affect LOS. Factors associated with a longer hospital stay included public funding versus private, maximum number of new medications administered, did not receive lithium and did not receive anxiolytics, sedatives/hypnotics (all p < 0.0001). Factors associated with a shorter hospital stay included presence of drug/alcohol abuse, living accompanied and having a psychiatric medical history (all p < 0.05). CONCLUSIONS LOS was not found to be associated with quetiapine formulation. However, most patients received only one total daily dose of quetiapine without dose titration, which was unexpected and contrary to current recommendations. TRIAL REGISTRATION TRIAL REGISTRATION NCT01239589.
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Affiliation(s)
- Oğuz Karamustafalıoğlu
- />Department of Psychiatry, Şişli Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Andreas Reif
- />Department of Psychiatry, Psychosomatics and Psychotherapy, Head Psychiatric Neurobiology and Bipolar Disorder Program, University of Würzburg, Würzburg, Germany
| | - Murad Atmaca
- />Department of Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | - Domingo Gonzalez
- />Assertive Outreach, Birmingham & Solihull Mental Health Trust, Birmingham, UK
| | | | | | | | - Antonello Bellomo
- />Department of Clinical and Experimental Sciences, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
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Culpepper L. The diagnosis and treatment of bipolar disorder: decision-making in primary care. Prim Care Companion CNS Disord 2014; 16:PCC.13r01609. [PMID: 25317368 PMCID: PMC4195640 DOI: 10.4088/pcc.13r01609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/27/2014] [Indexed: 01/26/2023] Open
Abstract
Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University Medical Center, Boston, Massachusetts
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Tidemalm D, Haglund A, Karanti A, Landén M, Runeson B. Attempted suicide in bipolar disorder: risk factors in a cohort of 6086 patients. PLoS One 2014; 9:e94097. [PMID: 24705630 PMCID: PMC3976403 DOI: 10.1371/journal.pone.0094097] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients. METHOD This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004-2011 and followed-up annually 2005-2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up. RESULTS Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76-7.51; women: odds ratio = 2.81, 95% CI = 1.78-4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48-6.24; women: odds ratio = 4.24, 95% CI = 3.06-5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59-8,01; women: odds ratio = 2.68, 95% CI = 1.60-4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women. CONCLUSION The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.
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Affiliation(s)
- Dag Tidemalm
- Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Axel Haglund
- Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Alina Karanti
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
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Fatty Acid desaturase gene polymorphisms and metabolic measures in schizophrenia and bipolar patients taking antipsychotics. Cardiovasc Psychiatry Neurol 2013; 2013:596945. [PMID: 24455201 PMCID: PMC3880735 DOI: 10.1155/2013/596945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/18/2022] Open
Abstract
Atypical antipsychotics have become a common therapeutic option in both schizophrenia and bipolar disorder. However, these medications come with a high risk of metabolic side effects, particularly dyslipidemia and insulin resistance. Therefore, identification of patients who are at increased risk for metabolic side effects is of great importance. The genetics of fatty acid metabolism is one area of research that may help identify such patients. Therefore, in this present study, we aimed to determine the effect of one commonly studied genetic polymorphism from both fatty acid desaturase 1 (FADS1) and FADS2 gene on a surrogate measure of insulin resistance and lipid levels in a metabolically high-risk population of patients largely exposed to atypical antipsychotics. This study used a cross-sectional design, fasting blood draws, and genetic analysis to investigate associations between polymorphisms, haplotypes, and metabolic measures. A total of 320 subjects with schizophrenia (n = 226) or bipolar disorder (n = 94) were included in this study. The mean age of the population was 42.5 years and 45% were male. A significant association between FADS1 and FADS2 haplotypes was found with insulin resistance while controlling for confounders. Further investigation is required to replicate this finding.
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Korczyn AD, Schachter SC, Brodie MJ, Dalal SS, Engel J, Guekht A, Hecimovic H, Jerbi K, Kanner AM, Landmark CJ, Mares P, Marusic P, Meletti S, Mula M, Patsalos PN, Reuber M, Ryvlin P, Štillová K, Tuchman R, Rektor I. Epilepsy, cognition, and neuropsychiatry (Epilepsy, Brain, and Mind, part 2). Epilepsy Behav 2013; 28:283-302. [PMID: 23764496 PMCID: PMC5016028 DOI: 10.1016/j.yebeh.2013.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 12/13/2022]
Abstract
Epilepsy is, of course, not one disease but rather a huge number of disorders that can present with seizures. In common, they all reflect brain dysfunction. Moreover, they can affect the mind and, of course, behavior. While animals too may suffer from epilepsy, as far as we know, the electrical discharges are less likely to affect the mind and behavior, which is not surprising. While the epileptic seizures themselves are episodic, the mental and behavioral changes continue, in many cases, interictally. The episodic mental and behavioral manifestations are more dramatic, while the interictal ones are easier to study with anatomical and functional studies. The following extended summaries complement those presented in Part 1.
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Affiliation(s)
- Amos D. Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Steven C. Schachter
- Center for Integration of Medicine and Innovative Technology, Harvard Medical School, Boston, MA, USA
| | | | - Sarang S. Dalal
- Zukunftskolleg & Department of Psychology, University of Konstanz, Germany
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon I, Brain Dynamics and Cognition Team, Lyon, France
| | | | - Alla Guekht
- Russian National Research Medical University, Moscow City Hospital No. 8 for Neuropsychiatry, Moscow, Russia
| | - Hrvoje Hecimovic
- Zagreb Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia
| | - Karim Jerbi
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon I, Brain Dynamics and Cognition Team, Lyon, France
| | - Andres M. Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, Miami FL, USA
| | - Cecilie Johannessen Landmark
- Department of Pharmacy and Biomedical Science, Oslo, Norway
- Akershus University College of Applied Sciences, Oslo, Norway
| | - Pavel Mares
- Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Petr Marusic
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Stefano Meletti
- Department of Biomedical Sciences, Metabolism, and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Mula
- Amedeo Avogadro University, Novara, Italy
| | - Philip N. Patsalos
- Department of Clinical and Experimental Epilepsy, UCL-Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Philippe Ryvlin
- Service de neurologie fonctionnelle et d’épileptologie, Hôpital Neurologique, HCL TIGER, CRNL, INSERM U1028, UMR-CNRS 5292, Université Lyon-1, Lyon, France
| | - Klára Štillová
- Masaryk University, Brno Epilepsy Center, St. Anne’s Hospital and School of Medicine, and Central European Institute of Technology (CEITEC), Brno, Czech Republic
| | - Roberto Tuchman
- Autism and Neurodevelopment Program, Miami Children’s Hospital Dan Marino Center, Departments of Neurology and Psychiatry, Herbert Wertheim College of Medicine, Florida International University, FL, USA
| | - Ivan Rektor
- Masaryk University, Brno Epilepsy Center, St. Anne’s Hospital and School of Medicine, and Central European Institute of Technology (CEITEC), Brno, Czech Republic
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Rummel-Kluge C, Kluge M, Kissling W. Frequency and relevance of psychoeducation in psychiatric diagnoses: results of two surveys five years apart in German-speaking European countries. BMC Psychiatry 2013; 13:170. [PMID: 23777594 PMCID: PMC3698181 DOI: 10.1186/1471-244x-13-170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 06/12/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychoeducation has been shown to reduce relapse rates in several psychiatric disorders. Studies investigating for which psychiatric diagnoses psychoeducation is offered and assessing its perceived relevance compared to other interventions are lacking. METHODS A two-part questionnaire addressing these questions was sent to the heads of all psychiatric hospitals in Germany, Austria and Switzerland. Results were compared with those from a similar survey 5 years earlier. RESULTS 289 of 500 (58%) institutions responded. Significantly (p = 0,02) more institutions (93%) offer any type of psychoeducation as compared to 5 years before (86%). Psychoeducation is mainly offered for schizophrenia (86%) and depression (67%) and less frequently for anxiety disorders (18%) and substance abuse (17%). For the following specific diagnoses it is offered by less than 10% of the institutions: Personality disorder, bipolar disorder, posttraumatic stress disorder, dementia, obsessive compulsive disorder, sleeping disorders, eating disorders, schizophrenia plus substance abuse, pain, attention deficit hyperactivity disorder and early psychosis. 25% offer diagnosis-unspecific psychoeducation. 'Pharmacotherapy' (99%), 'basic occupational therapy' (95%) and 'psychoeducation for patients' (93%) were the therapies being most often, 'light therapy' (24%) and 'sleep deprivation' (16%) the therapies being least often perceived as relevant by the respondents when asked about the value of different interventions offered in their hospitals. Art therapy (61%) and psychoanalytically oriented psychotherapy (59%), two therapies with a smaller evidence base than light therapy or sleep deprivation, were perceived as relevant by more than the half of the respondents. CONCLUSION Psychoeducation for patients is considered relevant and offered frequently in German-speaking countries, however, mostly only for schizophrenia and depression. The ranking of the perceived relevance of different treatment options suggests that the evidence base is not considered crucial for determining their relevance.
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Affiliation(s)
- Christine Rummel-Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie am Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - Michael Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Werner Kissling
- Klinik und Poliklinik für Psychiatrie und Psychotherapie am Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Abstract
The effective treatment of depression in people with bipolar disorder remains a clinical challenge. The role of antidepressant medication in treating bipolar depression has been controversial. While early studies and meta-analyses supported a role for antidepressant medication, more recent, high quality randomized controlled trials in bipolar depression have generally not demonstrated efficacy for antidepressant medications. Although the risk of affective switch and long-term de-stabilization remains a concern when using antidepressant medications in bipolar disorder, the magnitude of this risk has been difficult to ascertain with confidence. Maintenance use of antidepressant medication has generally not demonstrated a favorable risk-benefit ratio. Future studies should explore the patient characteristics and response patterns that predict a more favorable response profile to antidepressants amongst patients with bipolar disorder so that the medications can be rationally used in those who are most likely to benefit.
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Affiliation(s)
- Michelle M Sidor
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Song D, Li B, Yan E, Man Y, Wolfson M, Chen Y, Peng L. Chronic Treatment with Anti-bipolar Drugs Causes Intracellular Alkalinization in Astrocytes, Altering Their Functions. Neurochem Res 2012; 37:2524-40. [DOI: 10.1007/s11064-012-0837-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 07/03/2012] [Accepted: 07/08/2012] [Indexed: 12/26/2022]
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