Depressive Illness Burden Associated With Complex Polypharmacy in Patients With Bipolar Disorder

Goldberg, Joseph F.; Brooks, John O.; Kurita, Keiko; Hoblyn, Jennifer; Ghaemi, S. Nassir; Perlis, Roy H.; Miklowitz, David J.; Ketter, Terence A.; Sachs, Gary S.; Thase, Michael E.

doi:10.4088/jcp.08m04301

Cited by 138 publications

(131 citation statements)

References 33 publications

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“…20,21 The cutoff point used to define polypharmacy was mean plus 1 standard deviation of the number of prescribed medications. 22 Urinary incontinence and depression were defined using ICD-9-CM codes from existing studies. 23 Details of the ICD-9-CM codes for disease conditions are available from the authors upon request.…”

Section: Independent Variablesmentioning

confidence: 99%

30-Day Readmission Among Elderly Medicare Beneficiaries with Type 2 Diabetes

Raval

Zhou

Wei

et al. 2015

Population Health Management

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This study retrospectively assessed rates and risk factors for all-cause hospital readmission among elderly Medicare beneficiaries with type 2 diabetes mellitus (T2DM) aged ‡ 65 years. Associations between 30-day readmission and patients' demographic, insurance, index hospital, and clinical characteristics; patient complexities specific to the elderly; and health care utilization were examined using multivariable logistic regressions. Of 202,496 elderly Medicare beneficiaries, 52% were female, 76% were white, the mean age was 75.8 years, and 13.2% had all-cause 30-day readmissions. Elderly patients with cognitive impairment (adjusted odds ratio [aOR] = 1.06, 95% confidence interval [CI] = 1.01-1.12), falls and falls risk (aOR = 1.15, 95% CI = 1.08-1.22), polypharmacy (aOR = 1.20, 95% CI = 1.14-1.27), and urinary incontinence (aOR = 1.08, 95% CI = 1.01-1.15) were at higher risk for all-cause 30-day readmission than their counterparts without these complexities. As elderly-specific complexities are associated with greater risk for readmission, intervention programs to reduce readmission risk among elderly patients with T2DM should be tailored to suit the needs of elderly patients with

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Section: Independent Variablesmentioning

confidence: 99%

30-Day Readmission Among Elderly Medicare Beneficiaries with Type 2 Diabetes

Raval

Zhou

Wei

et al. 2015

Population Health Management

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“…Theoretically, patients with manic predominant polarity (MPP) would be receiving treatments with higher PI than patients with depressive predominant polarity (DPP). As combination drug regimens are ubiquitous in clinical practice (19,20), polarity index was calculated as a mean of polarity index of all the prescribed drugs in each patient.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study

Popović

Torrent

Goikolea

et al. 2013

Acta Psychiatr Scand

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Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study.Objective: Predominant polarity (PP) is an important variable in maintenance treatment of bipolar disorder (BD). This study aimed at determining the role of polarity index (PI), a metric indicating antimanic versus antidepressive prophylactic potential of drugs, in clinical decision-making. Method: Two hundred and fifty-seven of 604 (43%) of patients with BD-I or II fulfilled criteria for manic (MPP) or depressive PP (DPP). The PI, representing the ratio of number needed to treat (NNT) for depression prevention to NNT for mania prevention, was calculated for patients' current treatment. MPP and DPP groups were compared regarding sociodemographic, clinical and therapeutic characteristics. Results: One hundred and forty-three patients (55.6%) fulfilled criteria for DPP and 114 (44.4%) for MPP. Total PI, Antipsychotics' PI, and mood stabilizers PI were higher, indicating a stronger antimanic action, in MPP. MPP presented higher prevalence of BD-I, male gender, younger age, age at onset and at first hospitalization, more hospitalizations, primary substance misuse, and psychotic symptoms. DP correlated with BD-II, depressive onset, primary life events, melancholia, and suicide attempts. Conclusion:The results confirm the usefulness of the PI. In this large sample, clinical differences among these groups justify differential treatment approach. The PI appears to be a useful operationalization of what clinicians do for maintenance therapy in BD.

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“…Several studies have highlighted the seriousness of the high prescription rate of antidepressants to treat bipolar disorder worldwide [33][34][35] , and the mainland of China is no exception. In China,…”

mentioning

confidence: 99%

“…antidepressants are prescribed in many cases, even though their long-term use can have markedly negative outcomes, e.g., the risk of manic switch or suicide [34,36] .…”

mentioning

confidence: 99%

Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China

et al. 2015

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In this study, we examined the point prevalence rate of atypical features in bipolar disorder, and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches, including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B, the overall rate increased to 11.8%. Interestingly, among patients with the mixed state and remission subtypes, there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These fi ndings indicate a trend of using antidepressants for these two types of patients with atypical features. Further, for both mixed state and remission patients, treatment approaches were related to atypical features B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses.

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Depressive Illness Burden Associated With Complex Polypharmacy in Patients With Bipolar Disorder

Cited by 138 publications

References 33 publications

30-Day Readmission Among Elderly Medicare Beneficiaries with Type 2 Diabetes

30-Day Readmission Among Elderly Medicare Beneficiaries with Type 2 Diabetes

Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study

Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China

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