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Abedini T, Hosseyni R, Ghannadi F, Moghaddam HS, Ardakani MRK, Talaei A, Akhondzadeh S. Efficacy and safety of palmitoylethanolamide as an adjunctive treatment for acute mania: A randomized, double-blind, placebo-controlled trial. Psychiatry Clin Neurosci 2022; 76:505-511. [PMID: 35737597 DOI: 10.1111/pcn.13441] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
AIM Palmitoylethanolamide is an endogenous fatty acid amide with neuroprotective and anti-inflammatory actions. We performed a randomized, double-blind, placebo-controlled clinical trial to investigate the efficacy and safety of palmitoylethanolamide combination therapy in acute mania. METHODS Patients in the acute phase of mania were assigned into two parallel groups given either lithium (blood level of 0.8-1.1 mEq/L) and risperidone 3 mg plus palmitoylethanolamide 600 mg or placebo twice per day for 6 weeks. All participants were assessed with the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Extrapyramidal Symptom Rating Scale (ESRS) at baseline and at weeks 1, 2, 4, and 6. RESULTS A total of 63 patients (32 in palmitoylethanolamide and 31 in placebo groups) completed the trial. We found a significant effect for time×treatment interaction on the YMRS score (F = 5.22, d.f. = 2.34, P= 0.004) from baseline to study end point. Results from independent t test showed a significantly greater decrease in YMRS scores in the palmitoylethanolamide group, compared with the placebo group, from baseline to weeks 4 and 6 (P= 0.018 and P= 0.002, respectively). There was no significant difference between palmitoylethanolamide and placebo groups based on ESRS scores or ESRS changes in scores (P>0.05). CONCLUSIONS Our findings provide preliminary evidence that palmitoylethanolamide is an effective adjunctive medication that improves manic symptoms and overall clinical status in acute episodes of mania. However, larger sample sizes and more extended follow-up therapy are needed in future studies to confirm our findings.
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Affiliation(s)
- Talieh Abedini
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Hosseyni
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Ghannadi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Palacios-Garrán R, Llorca-Bofí V, Arteaga-Henriquez G, Del Agua E. Cariprazine Use in Combination With a Mood Stabilizer in First Episode Mania. Front Psychiatry 2022; 13:828088. [PMID: 35633804 PMCID: PMC9130589 DOI: 10.3389/fpsyt.2022.828088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cariprazine's efficacy and safety have been previously tested in adult patients with acute mania associated with bipolar I disorder, but there is no available data in FEM. The objective of this study is to assess the efficacy and safety of cariprazine in combination with a mood stabilizer in treating FEM as well as to evaluate patients' adherence to the treatment. METHODS FEM patients were recruited from the acute inpatient unit at Lleida University Hospital Santa Maria, between January and June 2021. Their symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Clinical Global Impressions-Severity (CGI-S) scale at admission and at discharge. Akathisia was assessed using the Barnes Akathisia Rating Scale. Patient adherence to medication treatment was assessed 30 days after discharge using the Morisky, Green and Levine Medication Adherence Scale. Socio-demographic and clinical information were further collected. RESULTS Eleven patients with FEM were involved, seven women and four men. Their mean age was 26.00+/-6.37 years. Mean hospitalization was 17.36+/-4.7 days. Cariprazine was combined with a mood stabilizer: lithium in seven patients and divalproex in four. Mean YMRS change from baseline was -24.55+/-7.5 and the mean CGI-S change from baseline was -2.55+/-0.82. Regarding adverse events, two (18.2%) patients presented with akathisia. At the 30-day treatment-adherence assessment, six (54.5%) patients were adherent and four (36.4%) had moderate adherence. CONCLUSION In this sample, cariprazine in combination with mood stabilizers proved to be safe and effective in the treatment of FEM with more than half the patients being adherent to treatment. Therefore, cariprazine add-on is a good choice for promoting the long-term adherence of patients, thus minimizing the risk of relapse and improving prognosis.
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Affiliation(s)
- Roberto Palacios-Garrán
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Vicent Llorca-Bofí
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Gara Arteaga-Henriquez
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Del Agua
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
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Adri AA. The Mania Pathway Protocol: An Application of Evidence-Based Interventions for the Treatment of Acute Mania on an Inpatient Psychiatric Unit. J Am Psychiatr Nurses Assoc 2021; 27:496-501. [PMID: 32340529 DOI: 10.1177/1078390320916543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acute manic episodes are a psychiatric emergency related to violence and poor patient outcomes. Combination psychotropic therapy utilizing a mood stabilizer and an atypical antipsychotic has been shown to be more efficacious for treating acute mania compared to monotherapy with either mood stabilizers or antipsychotics alone. This quality improvement project implemented evidence-based interventions for treating acute mania. The mania pathway protocol was created as a comprehensive clinical guide for guiding mania treatment. The protocol was implemented on an inpatient psychiatric unit for patients with mania diagnoses including manic/mixed episodes of bipolar disorder or schizoaffective disorder. AIMS (1) to improve the treatment of mania by using evidence-based interventions for rapid mood stabilization and (2) to educate psychiatric providers on up-to-date interventions for treating acute manic states. METHOD Psychiatric providers were evaluated for knowledge enhancement through a pre-/post-educational session quiz. A retrospective chart review was used for data collection for patients treated with the mania pathway protocol. The retrospective chart review spanned 8 weeks post project implementation. Young Mania Rating Scale (YMRS) scores were analyzed to measure the effect on mania severity. RESULTS The percentage decrease in mean Young Mania Rating Scale scores from admission to the fifth day of hospitalization was 61%. All psychiatric providers proved knowledge attainment by scoring 100% on the postintervention quiz. CONCLUSIONS Rapid mood stabilization may be achieved by using a combination therapy-based mania protocol. Educational sessions can enhance psychiatric provider knowledge with regard to evidence-based treatments for mania.
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Affiliation(s)
- Avishay A Adri
- Avishay A. Adri, DNP, PMHNP-BC, Columbia University Medical Center, New York, NY, USA
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Shen SH, Liu HT. Takotsubo Syndrome Associated with a New Onset Manic Episode: A case report. J Int Med Res 2021; 49:3000605211034997. [PMID: 34344220 PMCID: PMC8358514 DOI: 10.1177/03000605211034997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.
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Affiliation(s)
- Shin-Heng Shen
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, 333, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, 333, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
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Haddad C, Sacre H, Hallit S, Obeid S, Al-Zein D, Nabout R, Zoghbi M, Haddad G. Prevalence of comorbidities and correlates of hospital readmission rate in patients with acute mania: A one-year retrospective data from a tertiary care. Perspect Psychiatr Care 2020; 56:753-759. [PMID: 31828814 DOI: 10.1111/ppc.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/24/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the prevalence of medical comorbidities in acute manic patients over a period of 1 year, and to evaluate correlates of the readmission rate. DESIGN/METHODS A retrospective observational study was conducted on 158 acute manic patients from 2016 to 2017. RESULTS The most common physical comorbidity was obesity (36.1%) followed by cardiovascular disorders (15.2%) and liver dysfunctions (9.3%). Male gender was associated with higher readmission rate (Beta = -0.260), while taking anticholinergic drugs (Beta = -0.338) and having a family history of psychiatric disorders (Beta = -0.222) were associated with lower readmission rate. PRACTICAL IMPLICATIONS The study results may help physicians and other clinicians understand the burden of illness recurrence in bipolar disorder type I patients and adopt effective strategies to prevent relapse, taking into account all comorbidities.
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Affiliation(s)
- Chadia Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Department of Psychology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Darine Al-Zein
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Rita Nabout
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Department of Family Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
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Weiser M, Levi L, Levine SZ, Bialer M, Shekh-Ahmad T, Matei V, Tiugan A, Cirjaliu D, Sava C, Sinita E, Zamora D, Davis JM. A randomized, double-blind, placebo- and risperidone-controlled study on valnoctamide for acute mania. Bipolar Disord 2017; 19:285-294. [PMID: 28605109 DOI: 10.1111/bdi.12506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Mood stabilizers administered for bipolar disorder during pregnancy, such as valproic acid, can increase the risk of congenital anomalies in offspring. Valnoctamide is a valproic acid derivative associated with a decreased risk for congenital abnormalities in animals. The present study evaluated the efficacy and safety of valnoctamide monotherapy, compared to placebo, in the treatment of patients in an acute manic episode. METHODS A 3-week, double-blind, randomized, placebo- and risperidone-controlled, parallel group trial was conducted on 173 patients in an acute manic episode. Patients were randomized to receive valnoctamide 1500 mg/d (n=71), risperidone 6 mg/d (n=32), or matching placebo (n=70). The primary outcome measure was the change in Young Mania Rating Scale (YMRS) scores. RESULTS Valnoctamide did not differ significantly from placebo on any of the study endpoints (YMRS, Positive and Negative Syndrome Scale, and the Clinical Global Impression Scale for Bipolar Disorder [CGI-BP] scales; all P>.60). Mixed models for repeated measures showed that risperidone produced significantly more improvement than placebo in the overall bipolar disorder CGI-BP severity scale (P=.036), and the CGI-BP severity scale for mania (P=.021). The Kaplan-Meier survival curve revealed higher all-cause discontinuation rates (mainly due to lack of efficacy) in the valnoctamide group compared to the other study groups (P=.026). Patients with higher valnoctamide plasma levels had a numerically higher YMRS response, but this was not statistically significant. CONCLUSIONS Valnoctamide was well tolerated at 1500 mg/d but lacked efficacy in the treatment of symptoms in patients with acute mania. Possible differences between the biological mechanisms of action of valproic acid and valnoctamide are discussed.
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Affiliation(s)
- Mark Weiser
- Division of Psychiatry, Chaim Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Division of Psychiatry, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Meir Bialer
- School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tawfeeq Shekh-Ahmad
- School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Valentin Matei
- Spitalul Clinic de Psihiatrie Obregia, Bucarest, Romania
| | - Alexandru Tiugan
- Sp. Clinic de Urgenta Militar "Dr. Stefan Odoblegea", Craiova, Romania
| | - Diana Cirjaliu
- Spitalul Judetean Constanta, Clinica de Psihiatrie Palazu Mare, Costanta, Romania
| | - Cristinel Sava
- Spitalul Judetean de Urgente, Piatra Neamt, Neamt, Romania
| | - Eugenia Sinita
- Spitalul Clinic de Psihiatrie Chisinau, Republica Moldova, Chisinau, Moldova
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
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Mayda H, Ahsen A, Bağcioğlu E, Öztürk A, Bahçeci B, Soyuçok E, Başpinar E, Ulu MS. Effect of Increased Neutrophil-to-Lymphocyte Ratio (NLR) and Decreased Mean Platelet Volume (MPV) Values on Inflammation in Acute Mania. Noro Psikiyatr Ars 2016; 53:317-320. [PMID: 28360805 DOI: 10.5152/npa.2016.10272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/15/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are simple, low-cost, and useful inflammatory markers detected in routine complete blood count (CBC), and their use has recently become widespread. In this study, we aimed to investigate the presence of an inflammatory state in manic patients on the basis of NLR and MPV values. METHODS This retrospective study was performed on 76 patients with acute mania who were admitted to the Inpatients Psychiatry Clinic of Afyon Kocatepe University Hospital in Turkey. Diagnoses were based on Diagnostic and Statistical Manuel of Mental disorder (DSM-IV). The control group consisted of 74 healthy individuals recruited from the community. They were age- and sex-matched with the study group. RESULTS NLR values of the manic patient group were 2.2±1.4 and those of the control group were 1.6±0.5. NLR values were significantly higher (p=0.004) and MPV values were significantly lower in the manic patient group than in the control group (10.0±1.2 vs. 10.9±2.3, p=0.027). CONCLUSION Increased NLR and decreased MPV levels may reflect inflammation in manic patients, and inflammation may play a role in the complex pathophysiology of acute mania.
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Affiliation(s)
- Hasan Mayda
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Ahmet Ahsen
- Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Erman Bağcioğlu
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Ahmet Öztürk
- Department of Psychiatry, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Bülent Bahçeci
- Department of Psychiatry, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Etem Soyuçok
- Department of Psychiatry, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Erol Başpinar
- Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Memnune Sena Ulu
- Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
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9
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Abstract
Cariprazine is a recently developed antipsychotic drug with a partial agonism for the D2 and D3 receptors. It shows a tenfold greater affinity for the D3 receptor. In clinical trials, its therapeutic effect has been tested in patients with an acute exacerbation of schizophrenia and in patients with acute mania in bipolar disorder. Like risperidone, cariprazine improves positive and negative schizophrenic symptoms, and ameliorates cognitive functions. Cariprazine induces extrapyramidal symptoms less often than risperidone and can cause acute akathisia. It is a prolactin-sparing antipsychotic drug and has a favorable metabolic profile. In acute mania in bipolar disorder, it treats manic symptoms significantly better than placebo. As a consequence of its improved adverse effects, cariprazine improves patients’ quality of life to a greater extent than other second-generation antipsychotic drugs. Cariprazine is a promising antipsychotic drug in the treatment of schizophrenia, acute mania in bipolar disorder, and in schizophrenia with mania. In these patients, its long-term therapeutic effect and its action in comparison with other second-generation antipsychotic drugs, above all aripiprazole, remain to be tested in clinical trials.
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Affiliation(s)
- Felix-Martin Werner
- Euro Akademie Pößneck, Higher Vocational School for Elderly Care and Occupational Therapy, Pößneck, Germany ; Institute of Neurosciences of Castilla y León (INCYL), Laboratory of Neuroanatomy of the Peptidergic Systems (Lab. 14), University of Salamanca, Salamanca, Spain
| | - Rafael Coveñas
- Institute of Neurosciences of Castilla y León (INCYL), Laboratory of Neuroanatomy of the Peptidergic Systems (Lab. 14), University of Salamanca, Salamanca, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Abstract
OBJECTIVE In patients with bipolar disorder, olanzapine is commonly used to prevent episodes of acute mania. The drug pramipexole can, in theory, undermine the protective effect of olanzapine. Olanzapine is a dopamine D2 receptor antagonist and pramipexole is a mixed dopamine D2 /D3 receptor agonist. These drugs may therefore theoretically counteract their pharmacological effects. To date, there are no known cases in the literature where this interaction has been described. METHODS We report on a case where a patient with bipolar disorder developed mania after taking pramipexole in combination with olanzapine, and describe the pharmacological background of this interaction. RESULTS A patient with bipolar I disorder was hospitalized with a manic episode characterized by agitation and insomnia after taking pramipexole for restless leg syndrome (RLS) in combination with olanzapine. Co-medication, i.e., lithium and mirtazapine, and other circumstances are not likely to have contributed to this effect. CONCLUSION There is a probable interaction between pramipexole and olanzapine, where pramipexole undermines the protective effect of olanzapine, provoking an episode of acute mania and hospitalization. This interaction is of clinical importance since pramipexole is the treatment of choice for RLS, a condition often seen in end-stage renal disease, and has also been investigated as an antidepressant therapy in patients with bipolar disorder.
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Affiliation(s)
- Pierre M Bet
- Departments of Clinical Pharmacology and Pharmacy, Amsterdam, The Netherlands
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Chen J, Lu Z, Zhang M, Zhang J, Ni X, Jiang X, Xu H, Heeramun-Aubeeluck A, Hu Q, Jin H, Davis JM. A randomized, 4-week double-blind placebo control study on the efficacy of donepezil augmentation of lithium for treatment of acute mania. Neuropsychiatr Dis Treat 2013; 9:839-45. [PMID: 23807849 PMCID: PMC3688436 DOI: 10.2147/ndt.s40503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION A significant number of mania patients fail to respond to current pharmacotherapy, thereby there is need for novel augmentation strategies. The results of some early studies showed the effectiveness of cholinomimetics in the treatment of mania. One open case series suggested the efficacy of donepezil in the treatment of bipolar disorder. Our aim was to explore whether an oral cholinesterase inhibitor, donepezil, administered during a 4-week treatment period, would benefit patients with acute mania. METHODS We conducted a 4-week double-blind, placebo-controlled trial of donepezil as an adjunctive treatment to lithium in patients with acute mania. Eligible subjects were randomly assigned to receive donepezil or placebo in addition to lithium. Donepezil was started at 5 mg/day, and increased to 10 mg/day in the first week. Patients were rated with the Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS) at baseline, day 1, week 1, week 2, and week 4. RESULTS Out of the 30 patients who were enrolled, 15 were on donepezil and 15 were on placebo. All patients completed the 4-week trial. On the first day, there was a difference of 1.97 units on the psychomotor symptoms scale of the YMRS in the donepezil group as compared to the placebo group (t = 2.39, P = 0.02). There was a difference of 0.57 units (t = 2.09, P = 0.04) in the speech item and a difference of 0.29 units in the sexual interest item (t = 2.11, P = 0.04) in the donepezil group as compared to the placebo group. The total YMRS difference on the first day approached the conventional significance level (1.97 units, t = 1.84, P = 0.07). Over the course of 4 weeks, we failed to find that donepezil produced any significant difference in the YMRS (6.71 units difference, t = -1.44, P = 0.16) or the BPRS scale (1.29 units difference, t = -0.33, P = 0.75) as compared to placebo. Ten subjects (66.67%) in both groups met the criteria for clinical response (Fisher's exact P = 1.00). Five subjects (33.33%) in the donepezil group met the criteria for clinical remission while nine subjects (60.00%) in the placebo group met the remission criteria (Fisher's exact P = 0.27). CONCLUSION Use of the oral anticholinergic donepezil had some benefit in the augmentation of lithium treatment on the first day, but did not provide any significant benefits in the long-term.
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Affiliation(s)
- Jing Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Suresh KP, Prasad KM, Mohan R, Andrade C, Ashok MV, Chaturvedi SK, Sreenivas KN. Once-daily versus divided dosage lithium therapy in acute mania. Indian J Psychiatry 1995; 37:9-12. [PMID: 21743707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to compare once-daily with divided dosage lithium treatment in acute mania. In 79 retrospectively studied subjects who met the DSMIII-R criteria for mania, 26 independent and dependent variables were analyzed. The two groups of patients (categorized according to dosage schedule) were broadly comparable with respect to demographic and clinical characteristics. The two groups also did not differ on the outcome measures of lithium efficacy and lithium adverse effects. It is concluded that single dose lithium therapy is clinically comparable with divided dose lithium therapy in acute mania. Possible advantages of switching over to once-daily lithium regimes are discussed.
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