Preventive effect of aripiprazole once-monthly on relapse into mood episodes in bipolar disorder: A multicenter, one-year, retrospective, mirror image study

BACKGROUND

We conducted a one-year, retrospective, mirror-image study to investigate the clinical effectiveness and safety of aripiprazole once monthly (AOM) in patients with bipolar disorder (BD). We compared pre-treatment conditions with outcomes after 12 months of AOM treatment.

METHODS

Seventy-five bipolar patients were recruited from 12 hospitals in Korea. We included 75 patients with BD who had received at least three AOM treatments from September 2019 to September 2022 and had accessible electronic medical record (EMRs) for the year before and after the baseline visit.

RESULTS

The overall number of mood episodes significantly decreased from a mean of 1.5 ± 1.2 episodes pre-AOM to 0.5 ± 1.2 episodes post-AOM. Manic episodes significantly decreased from 0.8 ± 0.8 episodes pre-AOM to 0.2 ± 0.5 episodes post-AOM, and depressive episodes significantly decreased from 0.5 ± 0.8 episodes pre-AOM to 0.2 ± 0.6 episodes post-AOM (p = 0.017). Moreover, the number of psychiatric medications and pills and the proportion of patients treated with complex polypharmacy were significantly decreased post-AOM.

LIMITATIONS

The small sample size was insufficient to fully represent the entire population of individuals with BD, and potential selection bias was introduced due to only including subjects who received AOM three or more times.

CONCLUSION

The results of this study suggest that AOM can reduce mood episode relapse and may be clinically beneficial in the treatment of BD patients, potentially reducing issues associated with polypharmacy in some individuals.

Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective

The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST).

Methods

A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted.

Results

The internal consistency (Cronbach's alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r = -0.771), WHOQOL-BREF (r = -0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078).

Conclusion

The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

The Korean Medication Algorithm for Depressive Disorder: second revision

AIM

This study constitutes a revision of the guidelines for the treatment of major depressive disorder (MDD) issued by the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. In incorporates changes in the experts׳ consensus that occurred between 2006 and 2012 as well as information regarding newly developed and recently published clinical trials.

METHODS

Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for (1) non-psychotic MDD, (2) psychotic MDD, (3) dysthymia and depression subtypes, (4) continuous and maintenance treatment, and (5) special populations; consensus was also obtained regarding (6) the choice of an antidepressant (AD) in the context of safety and adverse effects, and (7) non-pharmacological biological therapies.

RESULTS

AD monotherapy was recommended as the first-line strategy for nonpsychotic depression in adults, children and adolescents, elderly adults, and patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression. The duration of the initial AD treatment for psychotic depression depends on the number of depressive episodes. Most experts recommended stopping the initial AD and AAP therapy after a certain period in patients with one or two depressive episodes. However, for those with three or more episodes, maintenance of the initial treatment was recommended for as long as possible. Monotherapy with various selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) was recommended for dysthymic disorder and melancholic type MDD.

CONCLUSION

The pharmacological treatment strategy of KMAP-DD 2012 is similar to that of KMAP-DD 2006; however, the preference for the first-line use of AAPs was stronger in 2012 than in 2006.

Korean medication algorithm for depressive disorder: comparisons with other treatment guidelines

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.

A review of pedestrian fatalities in Singapore from 1990 to 1994

The authors reviewed 369 consecutive pedestrian fatalities, which occurred from 1990 to 1994. This represented 28.5% (range 23.3 to 37.2; 95% CI 26% to 31%) of all road accident autopsies during that time. The mean and median ages of this population were 51 (95% CI 48.63 to 53.37) and 54 years, respectively. There were 160 (43.3%) who were in the economically productive ages of 20 to 59 years. Of the 369 victims, 224 (60.7%) were males and 145 (39.3%) females, there being a preponderance of males across all age groups. Most of these accidents occurred during the hours of daylight and in conditions of good weather and visibility. It was estimated that pedestrian behaviour contributed, in part, to at least three-quarters of these fatalities. The majority of these pedestrians died from multiple injuries (181; 49.1%) and closed head injury (146; 39.6%). The vast majority of subjects (357; 96.7%) had injury severity scores (ISS) > or = 16. A total of 100 subjects (27.1%) died at the sites of the accidents. Of these, 99 had ISS > or = 16, with 31 having had ISS = 75 (maximum score). Similarly, all 55 deaths that occurred in the A & E departments were associated with ISS > or = 16, with 6 having ISS = 75. This would imply that most of the deaths that had occurred on site and at A & E departments were not unexpected. Interestingly, no pedestrian aged < or = 12 years had an ISS < or = 16, suggesting that they may be more vulnerable to serious or life-threatening injury than adults. There were 46 (12%) victims who had detectable levels of ethanol in their blood samples, of whom, 10 had ISS = 75. However, the difference between the latter proportion and that of the rest of the pedestrian population who had no alcohol detected in their blood samples (31/323), was only marginally significant (95% CI 0.002 to 0.245). There was a high prevalence of pre-existing and intercurrent diseases, such as ischaemic heart disease (58.8%), hypertensive heart disease (30.4%), chronic obstructive airways disease (47.4%), bronchopneumonia (18.2%) and evidence of systemic hypertension (40.7%). It is submitted that the existence of these underlying conditions should be anticipated, or suspected, in the management of injured pedestrians, particularly the elderly, as they may influence the outcome of their critical care.

Early vitrectomy and endolaser photocoagulation in patients with type I diabetes with severe vitreous hemorrhage

PURPOSE

To determine if adjunctive endolaser photocoagulation has further improved the outcome of early vitrectomy for severe vitreous hemorrhage in young patients with type I insulin-dependent diabetes.

METHOD

The authors reviewed clinical records and fundus photographs of all primary diabetic vitrectomies performed at the Yale Eye Center between July 1986 and June 1993. Only young patients with type I diabetes who underwent vitrectomy within 6 months of vitreous hemorrhage were included.

RESULTS

Of 197 vitrectomies for diabetic retinopathy, 12 eyes of ten patients met the Diabetic Retinopathy Vitrectomy Study Group criteria. Patients ranged in age from 24 to 29 years (mean, 27.3 years) and had 11 to 21 years (mean, 17.2 years) of history of diabetes. Preoperative visual acuity was 5/200 in seven eyes, 2/200 in three eyes, hand motions in one eye, and light perception in one eye. The duration of vitreous hemorrhage was approximately 1 month in two eyes, 1 to 3 months in five eyes, and 3 to 6 months in five eyes. Neovascularization was documented in 12/12 eyes. Preoperatively, all patients had received panretinal photocoagulation with 1937 to 5328 burns (mean, 4126). Postoperative follow-up ranged from 12 to 38 months (mean, 24.6 months). Best-corrected postoperative visual acuity was 20/40 or better in 7 eyes (58.33%) and 20/70 or better in 11 eyes (91.66%). Neovascularization involuted in 11/12 eyes and remained so till the last follow-up.

CONCLUSION

Patients with type I diabetes with severe vitreous hemorrhage benefit from early endolaser photocoagulation combined with current vitrectomy techniques. The authors' findings are consistent with those of the Diabetic Retinopathy Vitrectomy Study Group, and patients can expect both improved visual acuity and anatomic success.

A quantitative and qualitative assessment of the Solitaire Bifocal Contact Lens

We performed qualitative and quantitative assessments of contact lens performance at 1 and 6 months among 23 patients enrolled in the Solitaire Bifocal Contact Lens Study. Overall satisfaction and comfort at 6 months was rated good to excellent in 83% and 84% of patients, respectively. Daytime acuity at distance and near were rated very good to excellent in 75% and 83% of subjects. Quantitative measurements of distance and near acuities at 1 month revealed 83% and 88% of subjects, respectively, seeing better than or equal to 20/25 or J1. At 6 months there was a moderate decrease in the measured distance acuity. A disparity in glare disability was noted, with 53% of subjects indicating significant glare problems but only 21% of glare tested patients having acuities worse than 20/40. Attrition from the study was highest in the first month and was more common among first-time contact lens users. Overall, this segmented bifocal contact lens is well-tolerated and provides good distance and near vision for presbyopic patients.

Clinical evaluation of the anterior constant focus (ACF) annular bifocal contact lens

We evaluated the distance and near vision of 33 presbyopic patients who wore the Anterior Constant Focus (ACF) rigid gas permeable (RGP) bifocal lens. Twenty-seven patients (82%) wore the lenses for one year; the six patients who quit the study complained of unacceptable vision (four patients) and discomfort (two patients). Twenty-five patients (76%) obtained 20/25 or better distance vision, and 28 patients (85%) obtained J2 or better near vision. Contrast sensitivity was within normal limits in 24 of 33 (73%) patients. We feel the ACF lens provides good bifocal vision in a non-translating RGP design.

Current status of malaria in Malaysia

The Malaria Eradication Program was started in 1967 in Peninsular Malaysia. Since then and up to 1980, there was a reduction in the number of reported malaria cases from 160,385 in 1966 to 9,110 cases for Peninsular Malaysia. Although the concept of eradication has changed to one of control in the 1980, the anti-malaria activities have remained the same. However, additional supplementary activities such as the use of impregnated bednets, and the Primary Health Care approach, have been introduced in malarious and malaria-prone areas. Focal spraying activity is instituted in localities with outbreaks in both malaria-prone and non-malarious areas. Passive case detection has been maintained in all operational areas. In 1990, 50,500 cases of malaria were reported of which 69.7% (35,190) were from Sabah, 27.8% (14,066) from Peninsular Malaysia and 2.5% (1,244) from Sarawak. Until June 1991 a total of 18,306 cases were reported for the country. Plasmodium falciparum continues to be the predominant species, contributing to 69.6% of the parasites involved. The case fatality rate for 1990 was 0.09%. There were 43 deaths all of which were attributed to cerebral malaria. The problems faced in the prevention and control of malaria include problems associated with the opening of land for agriculture, mobility of the aborigines of Peninsular Malaysia (Orang Asli) and inaccessibility of malaria problem areas. There is need to ensure prompt investigation and complete treatment of cases especially in malarious areas. The promotion of community participation in control activities should be intensified. Primary Health Care should be continued and intensified in the malarious areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Removal of viscoelastic materials after experimental cataract surgery in vitro

The one significant complication of viscoelastic materials is that they may cause postoperative intraocular pressure rise. We investigated the rate and ease of removal of various viscoelastics using the Miyake video technique. Five viscoelastics were investigated: sodium hyaluronate (Healon), Healon GV, chondroitin sulfatesodium hyaluronate (Viscoat), hydroxypropylmethylcellulose (Occucoat), and polyacrylamide (Orcolon). The viscoelastics were dyed with fluorescein and, after filling the capsular bag with a viscoelastic material, a posterior chamber intraocular lens (IOL) was implanted. The viscoelastic was then aspirated using an automated irrigation/aspiration device. Healon and Healon GV were completely removed within 20 to 25 seconds. Viscoat adhered to the lens capsule and to the posterior surface of the IOL and cooplete removal required approximately 3.5 minutes. Most Occucoat and Orcolon was aspirated within one minute; however, removal was completed only after three minutes. Removal of Healon and Healon GV was faster and more complete than removal of the other viscoelastics. Whether a small amount of viscoelastic left in the eye or trapped behind the IOL optic has any clinical significance has to be studied.

The elastic properties of the lens capsule in capsulorhexis

We investigated the ability of the anterior lens capsule to stretch and allow removal of lens substance and intraocular lens implantation through a continuous circular capsulorhexis. Capsulorhexis of various sizes (2.5 to 7.5 mm) were performed in 50 eyes obtained post mortem from 31 patients. The nucleus and cortex were removed by either phacoemulsification (35 eyes) or manual extracapsular cataract extraction (15 eyes). The opening of the capsule was then gradually enlarged, using a modified caliper with two pins attached to its tips, until the margins were torn. The capsule was torn when the circumference at the time of rupture was 1.6 times larger than the circumference of the original circular capsulectomy or 5.0 times larger than the diameter of the capsulectomy. Manual extraction of a lens nucleus with profile circumference (sagittal or anteroposterior) of 18.0 to 22.0 mm can be performed through a 5.5-mm opening and a 6.0- to 7.0-mm optic intraocular lens (profile circumference of 13.0 to 17.0 mm) can be implanted through a 4.5-mm capsulectomy.

An analysis of flexible anterior chamber lenses with special reference to the normalized rate of lens explantation

A survey of 1204 closed-loop anterior chamber intraocular lenses (AC-IOLs) and 310 open-loop AC-IOLs accessioned between November 1982 and January 1990 was conducted at the Center for Intraocular Lens Research. An analysis of complication rates was done after normalization of data with respect to market share totals. The results establish that an unacceptable complication rate is associated with the closed-loop design when compared with either the tripod or quadripod lens styles. Furthermore, the closed-loop designs, while comprising an estimated 45% of the total number of AC-IOLs estimated to be implanted in the United States (n = 674,000), were responsible for 80% of the AC-IOLs explanted after complications and accessioned at the authors' center. A rethinking of the extreme condemnation of all anterior chamber IOLs that has surfaced in recent years is warranted. This is particularly true with respect to indications for use of sutured posterior chamber (PC) IOLs as well as with regard to possible use of open-loop AC-IOLs in less-industrialized nations.

Preparation and study of human eyes obtained postmortem with the Miyake posterior photographic technique

A modification of the original Miyake technique of posterior photography of human eyes obtained postmortem is presented. A detailed description of globe preparation and equipment is described. Use of modern technology including a high magnification microscope system and video camera permits dynamic or realtime observations of tissue effects of various surgical procedures such as the cataract operation. This technique provides both a research and educational tool that can be used by ophthalmologists to improve the quality of surgery. Most important, it is an instructional tool that should reduce the "learning curve" that is inherent when modifying one's surgical technique.