Continuous circular cycling in bipolar disorder as a predictor of poor outcome

Tundo, Antonio; Calabrese, Joseph R.; Marchetti, Fulvia; Dell’Osso, Liliana; Proietti, Luca; Filippis, Rocco de

doi:10.1016/j.jad.2013.03.006

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…In addition, some of the excluded studies had samples that overlapped with those of the included studies. Finally, 12 studies were eligible for inclusion in the meta-analysis [4,6,8,11,23,24,25,26,27,28,29,30](online suppl. table 1).…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Raduà

Grunze

Amann

2017

Psychother Psychosom

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Background: Reported relapse and recurrence rates in bipolar disorder (BD) differ significantly between studies. Most data originate from highly selective patients participating in sponsored randomized controlled trials with narrow inclusion criteria. To estimate the true risk of a subsequent mood episode (SME) under real-world conditions, we conducted a meta-analysis of rates of SME as reported in naturalistic BD studies. Methods: PubMed, ScienceDirect, Scopus, and Web of Knowledge were searched until July 2015. Studies reporting the time until the emergence of an SME, from which individual data or Kaplan-Meier plots with censors marked could be retrieved, were included. Results: Twelve studies comprising 5,837 patients met the inclusion criteria. The median time to an SME in adults after an index episode was 1.44 years. The risk of an SME was 44% during the first year. Not having a SME during this first year lowered this risk to 19% in the second year. The risk was higher in bipolar II disorder (BD-II) than in bipolar I disorder (BD-I; HR = 1.5). In BD-I, the risk of a subsequent manic, mixed, or depressive mood episode was higher after an index episode of the same polarity (HR = 1.89-5.14). The overall risk of an SME was higher in patients with persisting subsyndromal symptoms (HR = 2.17). Conclusions: The data from this study provide a more reliable estimate of the risk of an SME in BD in real-world settings. Further research into the longitudinal course of BD-II is warranted to confirm its role as a risk factor for SME.

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Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Raduà

Grunze

Amann

2017

Psychother Psychosom

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“…More timely information could be derived from a recent prospective observational study using well-defined outcomes and modern prophylactic treatment strategies 4 . The study examined the response to long-term treatment in bipolar patients with CCC or N-CCC followed for at least 12 months (49.0+32.3 and 45.4+25.0 months, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…More timely information could be derived from a recent prospective observational study using well-defined outcomes and modern prophylactic treatment strategies. 4 The study examined the response to long-term treatment in bipolar patients with CCC or N-CCC followed for at [11][12][13] The primary outcome was the absence of a new episode during follow-up. The secondary outcomes were as follows: (1) ≥50% reduction in the number of episodes in the last year of follow-up compared to the year prior to entering the study; (2) ≥50% decrease in time spent in an episode during the last year of follow-up compared to the year prior to entering the study; and (3) a Clinical Global Impression (CGI) scale modified for bipolar disorder (CGI-BP) 14 overall bipolar severity <2 (minimal or less) in the last year of follow-up.…”

Section: Long-term Treatment Responsementioning

confidence: 99%

“…3 The studies that examined the sequence of episodes in BD showed that an average of 27% of patients experience CCC and that these patients remarkably differ from those with a free interval with respect to age at onset (later onset), polarity at onset (more likely to be depressive than mixed), polarity of recurrences (more (hypo)manic and depressive than mixed), and rate of switch (higher). 4 Taking into account these clinical differences, we argue that patients with CCC differ from patients with other patterns of cycling in treatment response, but, to our knowledge, no studies have reviewed the available evidence on this topic. The aim of the present paper is to review the results of studies that evaluated short-and long-term treatment response in patients with BD and CCC patterns of course.…”

Section: Introductionmentioning

confidence: 99%

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Continuous circular cycling as a predictor of treatment response in bipolar disorders: a comprehensive review of the current literature

Tundo

Cavalieri

2017

CNS Spectr.

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Evidence from the literature suggests that, on average, 27% of patients with a bipolar disorder (BD) experience a continuous cycling course (CCC) and that this subgroup differs significantly from patients with a noncontinuous cycling course (N-CCC) with respect to sociodemographic characteristics and clinical presentation. The aim of the present paper is to review the studies that evaluated short- and long-term treatment responses in BD patients with CCC. The retrieved studies indicate that CCC is a significant predictor of poor response to long-term treatment with lithium (the odds of a response in the CCC group were 57% less than in the N-CCC group; p<0.01), as well as to polytherapies including lithium and/or an antiepileptic augmented, when necessary, with an antipsychotic and/or antidepressant. The percentage of patients without new episodes during follow-up was significantly lower in the CCC group compared with the N-CCC group (15.4 vs. 37.6% , p<0.01). Compared with patients in the N-CCC group, members of the CCC group had a poorer response and lower remission rates after 12-week antidepressant treatments for a major depressive episode (82.3 vs. 50%, p =0.002; 69.6 vs. 40.9%, p=0.013). These findings, underlining that CCC is a predictor of poor response to short- and long-term treatment in BD, should be interpreted considering the limitations of the reviewed studies (the small sample sizes, the small number of trials and their observational nature, the lack of randomization or placebo controls, and the unblinded nature of the outcomes). Clinical trials and observational studies with larger samples are warranted to confirm the conclusions of our review.

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“…In 1990s, two anticonvulsants, valproate (VA) and carbamazepine (CBZ), were approved for BD prophylaxis (for a review, see Fountoulakis et al, 2016;Goodwin et al, 2016). Clinical predictors of good response to VA or CBZ are the presence of mixed or psychotic features (Fountoulakis et al, 2012;Goodwin & Consensus Group of the British Association for Psychopharmacology, 2009; Grunze et al, 2009;Masi et al, 2010;Swann et al, 1997;Tundo et al, 2013;Yatham et al, 2013) and of anxiety disorders comorbidity (Malhi, McAulay, Das, & Fritz, 2015). However, there is some evidence that does not support the efficacy of VA or CBZ monotherapy in the maintenance treatment of BD or their efficacy advantages over lithium monotherapy (Hartong et al, 2003;Hayes et al, 2016;Kessing et al, 2018Kessing et al, , 2011.…”

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confidence: 99%

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

Musetti

Tundo

Benedetti

et al. 2018

Human Psychopharmacology

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Objective This study aims to describe the prescription patterns of the mood stabilizers most commonly used for the treatment of bipolar I and II disorders (lithium, valproate, and carbamazepine) and to analyze the treatment outcomes. Methods Two hundred and thirty‐four outpatients with bipolar disorders receiving prophylactic treatment with lithium, valproate, carbamazepine, or their combination were followed up for at least 18 months in two Italian psychiatric centers specialized in mood disorders. Results The combination of lithium and valproate or carbamazepine was the most common prophylactic treatment (54.3%), followed by valproate or carbamazepine (24%) and lithium monotherapy (22%). Polytherapy was prescribed mainly to patients with bipolar I disorder, a high number of previous episodes and lifetime psychotic symptoms, whereas valproate or carbamazepine monotherapy was prescribed to patients with anxiety comorbidity. The annual frequency of recurrences decreased significantly after entering the study in the overall sample, and the reduction was significantly higher in patients on lithium plus valproate or carbamazepine compared with the valproate or carbamazepine group, but not with the lithium monotherapy group. The number of mixed recurrences during the follow‐up was significantly higher in patients on lithium plus valproate or carbamazepine. Conclusions Our findings may help clinicians to personalize long‐term treatment to prevent relapses of bipolar disorder according to clinical presentation.

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Continuous circular cycling in bipolar disorder as a predictor of poor outcome

Cited by 7 publications

References 17 publications

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Meta-Analysis of the Risk of Subsequent Mood Episodes in Bipolar Disorder

Continuous circular cycling as a predictor of treatment response in bipolar disorders: a comprehensive review of the current literature

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

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