Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice

Goi, Pedro Domingues; Bücker, Joana; Vianna-Sulzbach, Miréia; Rosa, Adriane Ribeiro; Grande, Iría; Chendo, Inês; Sodré, Leonardo; Kauer-Sant’Anna, Márcia; Silveira, Leonardo Evangelista da; Kunz, Maurício; Ceresér, Keila Maria Mendes; Gama, Clarissa Severino; Massuda, Raffael

doi:10.1590/1516-4446-2014-1554

Cited by 22 publications

(22 citation statements)

References 25 publications

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“…Another study assessed pharmacological maintenance treatment across the stages proposed by Kapczinski and colleagues . Authors reported that monotherapy was more frequent in stage I, and two‐drug combinations in stage II, while patients at stages III and IV needed three or more medications or clozapine .…”

Section: Resultsmentioning

confidence: 99%

Areas of controversy in neuroprogression in bipolar disorder

Passos

Mwangi

Vieta

et al. 2016

Acta Psychiatr Scand

185

103

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Illness trajectories are largely variable, and illness progression is not a general rule in BD. The number of manic episodes seems to be the clinical marker more robustly associated with neuroprogression in BD. However, the majority of the evidence came from cross-sectional studies that are prone to bias. Longitudinal studies may help to identify signatures of neuroprogression and integrate findings from the field of neuroimaging, neurocognition, and biomarkers.

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Section: Resultsmentioning

confidence: 99%

Areas of controversy in neuroprogression in bipolar disorder

Passos

Mwangi

Vieta

et al. 2016

Acta Psychiatr Scand

185

103

View full text Add to dashboard Cite

show abstract

“…Another limitation may have been that the approach to assigning stages in model B was not yet validated. Earlier applications of model B by Goi et al and Rosa et al used a semi‐structural interview and the Functional Assessment Short Test to classify subjects according to model B; we used similar items from the QBP . A possible restriction of our study was that for model B the level of functioning was based on a limited amount of self‐rated parameters.…”

Section: Discussionmentioning

confidence: 99%

“…40 The increasing number of medication classes over the stages is in line with earlier studies on treatment resistance. 21,37 Future studies may focus on selecting those variables putting individuals at a higher risk of progressing to more advanced stages, adjusting clinical interventions accordingly.…”

Section: Clinical Markersmentioning

confidence: 99%

“…Model B is based on McEwan and Stellar´s concept of allostatic load, attributing cognitive damage to the attempt of an individual to deal with chronic exposure to fluctuating or heightened neural or neuroendocrine activity. When this model was applied to outpatients, Goi et al found a decrease in treatment response with increasing stages and Rosa et al found progressive neuropsychological and functional changes from stage I to stage IV, with greater impairment in later stages of the illness.…”

Section: Introductionmentioning

confidence: 99%

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Exploring the clinical utility of two staging models for bipolar disorder

et al. 2019

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Objective To assess the clinical utility of two staging models for bipolar disorder by examining distribution, correlation, and the relationship to external criteria. These are primarily defined by the recurrence of mood episodes (model A), or by intra‐episodic functioning (model B). Methods In the Dutch Bipolar Cohort, stages according to models A and B were assigned to all patients with bipolar‐I‐disorder (BD‐I; N = 1396). The dispersion of subjects over the stages was assessed and the association between the two models calculated. For both models, change in several clinical markers were concordant with the stage was investigated. Results Staging was possible in 87% of subjects for model A and 75% for model B. For model A, 1079 participants (93%) were assigned to stage 3c (recurrent episodes). Subdividing stage 3c with cut‐offs at 5 and 10 episodes resulted in subgroups containing 242, 510, and 327 subjects. For model B, most participants were assigned to stage II (intra‐episodic symptoms, N = 431 (41%)) or stage III (inability to work, N = 451 (43%)). A low association between models was found. For both models, the clinical markers “age at onset,” “treatment resistance,” and “episode acceleration” changed concordant with the stages. Conclusion The majority of patients with BD‐I clustered in recurrent stage 3 of Model A. Model B showed a larger dispersion. The stepwise change in several clinical markers supports the construct validity of both models. Combining the two staging models and sub‐differentiating the recurrent stage into categories with cut‐offs at 5 and 10 lifetime episodes improves the clinical utility of staging for individual patients.

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“…Likewise, a post hoc analysis from a 15-month randomized controlled trial reported that psychoeducation for caregiver in the prophylaxis of mood episodes appeared beneficial only in patients at early stages [14]. Last, a cross-sectional study reported that monotherapy was more frequent in stage I, and combination of two drugs in stage II, while patients at stages III and IV needed either clozapine or a combination of more than three medications [15].…”

Section: Treatment Refractorinessmentioning

confidence: 99%