Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Abstract

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middleincome countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

“…In addition, our principal aim was to provide a comprehensive analysis of the current situation across Africa, including the potential implications for other infectious and non-infectious disease areas within the African continent, to stimulate ongoing debates regarding potential future activities. This is important across Africa with high prevalence rates for both infectious and non-infectious diseases, We have successfully used this dual approach in previous publications to stimulate debate in important healthcare areas and situations to provide future guidance as countries seek to improve the quality and efficiency of their approaches to medicine use, including during pandemics ( Godman et al., 2014a ; Godman et al., 2014b ; Godman et al., 2015 ; Ermisch et al., 2016 ; Bochenek et al., 2017 ; Ferrario et al., 2017 ; Moorkens et al., 2017 ; Godman et al., 2018 ; Godman et al., 2019 ; Godman et al., 2020b ; Godman et al., 2020c ; Godman et al., 2020d ; Miljković et al., 2020 ).…”

“…However, we need to be mindful of a range of healthcare issues including the unintended consequences on both health and socioeconomic circumstances. This builds on Table 3, as well as Tables 3A and 4A, for individual African countries combined with recommendations for all key stakeholder groups in Africa going forward in the management of both infectious and non-infectious diseases as well as clinical and economic issues surrounding fixed dose combinations (Godman et al, 2019;Godman et al, 2020a;Godman et al, 2020b;Godman et al, 2020c;Godman et al, 2020d).…”

“…Alongside this, there are ongoing challenges with available financial and human resources across Africa ( Craven et al., 2020 ; Glied and Levy, 2020 ; Jayaram et al., 2020 ; Shepherd and van der Mark, 2020 ) including more limited availability of healthcare personnel and hospital beds including intensive care unit (ICU) beds ( Murthy et al., 2015 ; Bates et al., 2018 ; Godman et al., 2019 ; El-Sadr and Justman, 2020 ; Godman et al., 2020c ; Godman et al., 2020d ; Martinez-Alvarez et al., 2020 ; United Nations, 2020b ). Reports suggest there were just 1.8 hospital beds per 1,000 people across Africa before the pandemic, less than a third of those in France ( Bavier, 2020 ).…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…A systematic review was not performed as there has already been an appreciable number of recent publications, including systematic reviews, discussing ongoing research in this area, which includes current self-purchasing rates as well as public awareness campaigns 29 Consequently, our findings and suggested activities for key stakeholder groups are based on relevant publications known to the authors, coupled with their considerable knowledge of ongoing activities in their own countries (and more broadly) to improve the prescribing and dispensing of antibiotics for patients with URTIs. This approach has been used successfully to stimulate debate in other priority healthcare areas to provide future guidance [161][162][163][164][165][166][167][168][169][170][171] .…”

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

“…We combined the data collected with the experience of the co-authors regarding issues of health policy, health, pharmaceutical care, and self-purchasing in LMICs, to provide future direction, building on comments from the interviewees. We have successfully used this approach before to provide future direction [143][144][145][146][147][148] . The findings on the purchasing patterns, issues of shortages, and price changes will be compiled into tabular format.…”