Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder

Joas, Erik; Karanti, Alina; Song, Jie; Goodwin, Guy M.; Lichtenstein, Paul; Landén, Mikael

doi:10.1192/bjp.bp.116.187989

Cited by 63 publications

(73 citation statements)

References 22 publications

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“…For instance, lithium showed strongest antimanic properties, unlike AC agents, particularly lamotrigine, appeared to be more effective for prevention of depressive episodes (Popovic et al, 2012). Valproate and lithium were considered to be the only agents in terms of preventing all three types of episodes (manic, depressive and mixed) (Joas et al, 2017). Trials comparing the efficacies of combined treatment and monotherapies in bipolar disorder is scarce in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Randomized controlled trials have demonstrated benefits of these agents in long-term management, however, their results were often criticised and disqualified. This condition was reasonably attributed to their study design, which often limited generalisation to routine clinical practice (Joas et al, 2017). Additionally, growing body of studies examining maintenance treatment agents, debilitated the wide belief on the high-efficacy of these conventional drugs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

Berkol¹,

Balcıoğlu²,

Kirlooglu³

et al. 2017

JNBS

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Özetİki uçlu bozuklukta uzun dönem tedavisine ilişkin kanıtlar yeterince tatmin edici değildir. İyilik döneminde başta lityum ve valproat olmak üzere, antipsikotik ve antikonvülzan ajanlar sürdürüm tedavisi seçeneklerindendir. Bu tedavilerle olumlu sonuçlar literatürde gösterilse de, farklı klinik özellikler gösteren hastaların farklı ajanlara yanıtlarına dair çalışmalar yetersizdir. Bu çalışmada, söz konusu ajanların duygudurum ataklarından koruyuculuğunu belirlemek ve daha uygun ilaç seçimi sağlamak için; ilaçların kullanım sıklıklarının, elde edilen yanıt düzeylerinin ve bunların klinik özellikler ile ilişkisinin araştırılması amaçlanmıştır. Haseki Eğitim ve Araştırma Hastanesi Psikiyatri Polikliniği'nde izlenmekte olan yüz seksen altı bipolar bozukluk tanılı hasta çalışmaya alınmıştır. Hastaların tümüne SCID-I (Structured Clinical Interview for DSM-IV); uygulanmış; İki uçlu bozukluğa eşlik eden ek psikiyatrik tanılar saptanmıştır. Her iki hasta grubunun sosyodemografik ve klinik özelliklerini ve yaşam boyu farmakolojik tedavilerini değerlendiren yarı yapılandırılmış görüşme çizelgesi doldurulmuştur. Bu çizelgeler klinik görüşme ile yeniden değerlendirilmiş ve gözden geçirilmiştir. Hastaların sürdürüm tedavisinde %71 lityum, %44 antikonvülzan, %18 antipsikotik monoterapileri ve %23 lityum-antikonvülzan, %15 lityum-antipsikotik, %25 antikonvülzan-antipsikotik kombine tedavilerinin hastalığın herhangi bir döneminde kullanıldığı belirlenmiştir. Lityum monoterapisi alan hastaların %61'inin, antikonvülzan monoterapisi alan hastaların %62'sinin tedaviye yanıt verdiği saptanmıştır. Antikonvülzan-antipsikotik kombine sürdürüm tedavisi alan hastalarda daha yüksek yanıt oranı bulunmuştur. Evli olmak, psikotik belirtilerin yokluğu, mevsimsellik ve atakların hafif seyretmesi lityum tedavisine yanıtın öngörücüleri olarak saptanmıştır. cevap vermiştir. Erkek, boşanmış, intihar girişimi olan ve duygudurum ataklarında karma AbstractThe evidence base data regarding long-term treatment of bipolar disorder (BD) is less than satisfactory. With the first-line rank of lithium and valproate; antipsychotics (AP) and anticonvulsants (AC) considered options for prolonged treatment in remitted bipolar patients. Literature demonstrates various treatment options in remitted patients with different clinical features. The aim of this study to present and assess clinical outcomes of maintenance treatment for BD with various clinical features. In total 186 bipolar patients in remission were enrolled in this study. All the patients were evaluated with SCID-I (Structured Clinical Interview for DSM-IV) ; and lifelong psychiatric comorbidities were determined. Sociodemographical and clinical features, and lifelong pharmacological treatment of the patients were assessed. Semi-structured interview schedules were filled. 71% lithium, 44% AC, 18% AP monotherapies and 23% lithium-AC, 15% lithium-AP, 25% AC-AP combination therapies were used as maintenance treatment. 61% and 62% of the patients were responders of lithium and AC monotherapies respectiv...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

Berkol¹,

Balcıoğlu²,

Kirlooglu³

et al. 2017

JNBS

View full text Add to dashboard Cite

show abstract

“…Based on a recent review of clinical practice guidelines (CPGs) and pharmaco‐epidemiological data for all ages, lithium remains the first‐line treatment for maintenance monotherapy despite the availability of several other choices for mood stabilization . Treatment with lithium has been shown to reduce the risk of suicide and psychiatric admissions .…”

Section: Introductionmentioning

confidence: 99%

Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: An ISBD task force report

et al. 2018

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Objectives Despite the growing numbers and proportion of older adults with bipolar disorder (OABD), there are very limited guidelines for the use of lithium with its double‐edged potential for effectiveness and toxicity in this population. The primary aims of this Delphi survey were: (a) To determine the place of lithium among the preferred choices for maintenance treatment of OABD. (b) To provide detailed clinical guidelines for the safe and effective use of lithium in OABD. Methods In the face of limited evidence, the Delphi survey method was used to achieve consensus by a group of 25 experts in OABD from nine countries. An oversight committee monitored and analyzed the results of each survey and formulated more focused questions with each subsequent iteration. Results A 100% response rate was achieved for all three iterations of the survey. Lithium was the preferred choice for maintenance monotherapy in OABD. Serum levels of 0.4‐0.8 mmol/L were recommended for ages 60‐79 and serum levels of 0.4‐0.7 mmol/L were recommended for ages 80 and over. Specific recommendations achieved consensus for second line monotherapy as well as for other drugs to be used in combination with lithium if necessary. Guidelines for routine monitoring of lithium in OABD were provided for laboratory investigations and clinical assessments. Conclusions Lithium remains the preferred choice for maintenance monotherapy in OABD. Laboratories should report the therapeutic range for serum levels of lithium separately for older adults.

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“…Long‐term pharmacological treatment may actually reduce number and severity of psychotic or affective relapse, the social costs of the disorder, and may also improve the quality of life for such patients. It has even been suggested that repeated psychotic or affective relapses are neurotoxic, and may aggravate the long‐term course of illnesses …”

Section: Discussionmentioning

confidence: 99%

Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

Gentile

2019

Psychiatry Clin Neurosci

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Aim The aim of this review was to analyze the discontinuation rates during long‐term treatment with second‐generation antipsychotic long‐acting injection (SGA‐LAI) in adults with either schizophrenia spectrum or bipolar disorders. Methods A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (1 January 2001–12 October 2018) identified 1214 abstracts, which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥36 weeks. Data were extracted from 51 articles meeting the inclusion criteria. Results In all head‐to‐head comparisons, and studies on patients with schizophrenia spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA‐LAI was, at best, similar to that recorded in patients treated with first‐generation antipsychotics in either oral or LAI formulations or with oral SGA. In particular, in most of the SGA‐LAI long‐term studies, the rate of premature dropout was higher than 50%. Conclusion Reviewed data suggest that SGA‐LAI show no clear superiority over less expensive drugs (including first‐generation antipsychotic LAI and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long‐term pharmacological treatment regimens.

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Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder

Cited by 63 publications

References 22 publications

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: An ISBD task force report

Discontinuation rates during long‐term, second‐generation antipsychotic long‐acting injection treatment: A systematic review

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