Rapid Antimanic Effect of Risperidone Monotherapy: A 3-Week Multicenter, Double-Blind, Placebo-Controlled Trial

Hirschfeld, Robert M. A.; Keck, Paul E.; Kramer, Michelle; Karcher, Keith; Canuso, Carla M.; Eerdekens, Mariëlle; Grossman, Fred

doi:10.1176/appi.ajp.161.6.1057

Cited by 229 publications

(202 citation statements)

References 18 publications

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“…There is no evidence of superiority of any first‐line monotherapy treatment in comparison to other monotherapy options in treating patients with psychotic features. Similarly, there is no evidence that any first‐line combination therapy of lithium or divalproex plus an atypical antipsychotic is more effective than other first‐line combination therapy 174, 193, 213, 214. However, clinical experience suggests that the combination of lithium or divalproex plus an atypical antipsychotic is more appropriate for manic patients with mood‐incongruent psychotic features (ie, other than grandiose delusions).…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

“…Divalproex and atypical antipsychotics are most likely to lead to these effects, with 30%‐50% of patients on atypical antipsychotics experiencing sedation, compared to 8%‐13% with placebo164, 214, 849, 850, 851 and 21%‐29% of patients on divalproex 852, 853. This is not a concern with all antipsychotics, however; quetiapine, clozapine, and olanzapine will generally have higher rates of sedation compared to ziprasidone, risperidone, and aripiprazole 810.…”

Section: Safety and Monitoringmentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…Risperidone monotherapy was more effective than placebo and as effective as lithium or haloperidol in patients with acute mania. [13][14][15][16][17] Since 2003, the FDA has approved the use of oral risperidone for the treatment of acute mania. The combination of lithium or valproate with risperidone has demonstrated superior efficacy compared with lithium or valproate alone.…”

Section: Second-generation Antipsychotics and Bipolar Disordermentioning

confidence: 99%

Patient perspectives on use of long-acting antipsychotics in bipolar disorder: focus on risperidone injection

Samalin

Charpeaud

Lorabi³

et al. 2010

PPA

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Abstract:In the last few years, oral second-generation antipsychotics have demonstrated mood-stabilizing properties and are now widely used in the treatment of bipolar disorder. Unfortunately, treatment of this chronic and complex illness is hampered with poor adherence on the part of patients. Long-acting injectable formulations of second-generation antipsychotics could combine the effect of oral second-generation antipsychotics in patients with bipolar disorder and the benefits of depot formulation with the assurance of steady medication delivery and thereby improve adherence. In this context, the efficacy and tolerance of risperidone long-acting injection (RLAI) for maintenance treatment in patients with bipolar disorder is assessed. The relevant studies found RLAI to be effective in preventive treatment of manic but not depressive recurrences in bipolar patients, with good tolerance. RLAI appeared to be particularly suitable for patients with known poor adherence to treatment or severe bipolar disorder (such as patients who relapse frequently). Lastly, if RLAI, unlike the first-generation antipsychotics, does not induce depressive symptoms, the different studies do not enable us to consider its use in monotherapy in the preventive treatment of patients with depressive polarity. Long-acting second-generation antipsychotics in bipolar patients are therefore associated with long-term benefits, but their use in clinical practice needs to be improved.

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“…A total of 13, short-term, randomized, placebo-controlled trials, ranging from 3 to 4 weeks, have been conducted using atypical antipsychotic monotherapy in patients with bipolar disorder in acute manic or mixed episodes (4 studies with aripiprazole, 3 studies with risperidone, and 2 studies each with olanzapine, quetiapine, and ziprasidone) [92][93][94][95][96][97][98][99][100][101][102][103][104] (Table 4). At 3 weeks, treatment with atypical antipsychotics was shown to be efficacious in reducing manic symptoms, assessed using either the change in Young Mania Rating Scale (YMRS) total score or, for the studies using ziprasidone, the change in Mania Rating Scale scores.…”

Section: Overview Of Efficacy Evidence From Key Clinical Trialsmentioning

confidence: 99%

“…The AE profiles of quetiapine and olanzapine in the bipolar depression studies reflect those already established in the bipolar mania studies, with the exception that quetiapine is associated with EPS significantly more often than placebo in depression trials. In terms of effects on metabolic parameters, all of the atypical antipsychotics have been associated with weight gain [92][93][94][95][96][97][98][99][100][101][102]104,106 ; however, levels varied according to the different atypical antipsychotics. 66,[93][94][95]97,106 Compared with haloperidol, atypical antipsychotics (olanzapine and quetiapine) were associated with lower rates of akathisia in monotherapy trials of 12 weeks.…”

Section: Overview Of Safety Evidence From Clinical Trialsmentioning

confidence: 99%

Treating Bipolar Disorder in the Primary Care Setting

Manning¹,

McElroy²

2009

Prim. Care Companion J. Clin. Psychiatry

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Rapid Antimanic Effect of Risperidone Monotherapy: A 3-Week Multicenter, Double-Blind, Placebo-Controlled Trial

Abstract: Risperidone monotherapy was significantly more efficacious than placebo in the treatment of acute mania and demonstrated a rapid onset of action. Risperidone was well tolerated by patients in this study.

Cited by 229 publications

References 18 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Patient perspectives on use of long-acting antipsychotics in bipolar disorder: focus on risperidone injection

Treating Bipolar Disorder in the Primary Care Setting

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