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Bipolar polypharmacy

Roger S McIntyre, Daisy Ng-Mak, Chien-Chia Chuang, Rachel Halpern, Pankaj A Patel, Krithika Rajagopalan, Antony Loebel
BACKGROUND: To compare outcomes for individuals with major depressive disorder (MDD) with or without subthreshold hypomania (mixed features) in naturalistic settings. METHODS: Using the Optum Research Database (1/1/2009─10/31/2014), a retrospective analysis of individuals newly diagnosed with MDD was conducted. Continuous enrollment for 12-months before and after the initial MDD diagnosis was required. MDD with subthreshold hypomania (mixed features) (MDD-MF) was defined based on ≥1 hypomania diagnosis within 30 days after an MDD diagnosis during the one-year follow-up period, in the absence of bipolar I diagnoses...
December 23, 2016: Journal of Affective Disorders
S C Broeks, H Thisted Horsdal, K Glejsted Ingstrup, C Gasse
BACKGROUND: Bipolar disorder is often associated with a lifetime indication for treatment with psychotropic drugs, thus pregnant women face the dilemma whether to continue treatment or not. This study describes the psychopharmacological drug utilization patterns among women with bipolar disorder from 12 months preconception to 12 months postpartum. METHODS: We conducted a register-based cohort study among all Danish women aged 15-55 with a diagnosis of bipolar disorder, who gave birth to their first and singleton child between January 1997 and December 2012...
December 8, 2016: Journal of Affective Disorders
Martha Sajatovic, Daisy Ng-Mak, Caitlyn T Solem, Fang-Ju Lin, Krithika Rajagopalan, Antony Loebel
BACKGROUND: The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. METHODS: Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7...
December 2016: Therapeutic Advances in Psychopharmacology
Declan T Barry, Mehmet Sofuoglu, Robert D Kerns, Ilse R Wiechers, Robert A Rosenheck
OBJECTIVE: To examine the prevalence and correlates of concomitant anxiolytic prescription fills in Veterans Health Administration (VHA) patients with metastatic cancer who have extensive prescription opioid use. DESIGN, SETTING, AND PARTICIPANTS: National VHA data for fiscal year 2012 were used to identify veterans diagnosed with metastatic cancer (ICD-9 codes 196-199) who also had extensive prescription opioid use (at least 10 opioid prescriptions during the year, comprising the highest 29 percent of opioid users)...
July 2016: Journal of Opioid Management
Elisa Sophie Strasser, Paula Haffner, Jana Fiebig, Esther Quinlivan, Mazda Adli, Thomas Josef Stamm
BACKGROUND: Impulsivity as a tendency to act quickly without considering future consequences has been proposed as a dimensional factor in bipolar disorder. It can be measured using behavioral tasks and self-report questionnaires. Previous findings revealed patients to show worse performance on at least one behavioral measure of impulsivity. Additionally, self-reported impulsivity seems to be higher among bipolar patients, both parameters being possibly associated with a more severe course of illness...
December 2016: International Journal of Bipolar Disorders
Irfan Tursun, Gokhan Tazegul, Ogur Karhan, Neslihan Gunes, Ece Ulukal, Muge Arpali Atcakarlar, Tolgahan Akca, Erkan Coban
UNLABELLED: Lithium is frequently used as a mood stabilizer in patients with mood disorders. Lithium has a narrow therapeutic index and high toxicity. Predisposing factors for intoxication are advanced age, diet disturbances, comorbid medical conditions affecting heart, kidneys or central nervous system and polypharmacy. CASE REPORT: Here we present a case of a 74-year-old woman with a history of Parkinson's disease, hypertension and bipolar disorder. She was using quetiapine, valsartan with hydrochlorothiazide and levodopa with carbidopa...
July 2015: Folia Medica
Michael I Gurevich, Cassandra L Robinson
CONTEXT: Treatment-resistant bipolar disorder (TRBD) is an increasingly prevalent, debilitating condition with substandard treatment outcomes. Polypharmacy has become the mainstay among practitioners though long-term efficacy of this method has not been adequately tested. OBJECTIVE: Determine retrospectively if individualized, integrative treatment strategies applied while withdrawing pharmaceuticals were beneficial and safe among a TRBD clinic population. DESIGN: A chart review was performed for six adult patients, treated in a private psychiatric practice...
July 2016: Explore: the Journal of Science and Healing
Michele Fornaro, Domenico De Berardis, Ann Sarah Koshy, Giampaolo Perna, Alessandro Valchera, Davy Vancampfort, Brendon Stubbs
BACKGROUND: Uncertainty exists regarding the prevalence and clinical features associated with the practice of polypharmacy in bipolar disorder (BD), warranting a systematic review on the matter. METHODS: Three authors independently searched major electronic databases from inception till September 2015. Articles were included that reported either qualitative or quantitative data about the prevalence and clinical features associated with polypharmacy in adult cases of BD...
2016: Neuropsychiatric Disease and Treatment
Eric D Peselow, Lancer Naghdechi, Demetria Pizano, Waguih William IsHak
OBJECTIVES: To track the outcomes of bipolar patients who had remitted from an acute manic episode on single- and multiple-drug regimens including lithium (LI), valproate (VPA), and carbamazepine (CBZ), in order to compare relapse rates on 1, 2, or 3 medications. METHODS: Following treatment of an acute manic episode and a 1-month period of no signs of mood episodes, patients were evaluated at 1- to 2-month intervals as to the kind of regimen required to maintain their stability while continuing on this regimen for 2 years...
May 2016: Clinical Neuropharmacology
Pierre Chue, James Chue
Schizoaffective disorder (SCA) is a chronic and disabling mental illness that presents with mixed symptoms of schizophrenia and affective disorders. SCA is recognized as a discrete disorder, but with greater heterogeneity and symptom overlap, leading to difficulty and delay in diagnosis. Although the overall prognosis is intermediate between schizophrenia and mood disorders, SCA is associated with higher rates of suicide and hospitalization than schizophrenia. No treatment guidelines exist for SCA, and treatment is frequently complex, involving off-label use and polypharmacy (typically combinations of antipsychotics, mood stabilizers, and antidepressants)...
2016: Therapeutics and Clinical Risk Management
Mary C Kimmel, S Lara-Cinisomo, K Melvin, A Di Florio, A Brandon, S Meltzer-Brody
Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included...
August 2016: Archives of Women's Mental Health
Martha Sajatovic, Jennifer B Levin, Johnny Sams, Kristin A Cassidy, Kouri Akagi, Michelle E Aebi, Luis F Ramirez, Steven A Safren, Curtis Tatsuoka
OBJECTIVES: This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. METHODS: Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS)...
September 2015: Bipolar Disorders
S Dimitrakopoulos, G Konstantakopoulos
The treatment of bipolar disorder is a current challenge for clinicians and despite progress in psychopharmacology, options remain limited and results are often unsatisfactory. Current research focuses on finding new pharmaceutical agents for all phases of bipolar disorder, i.e. mania, bipolar depression and maintenance. Particularly, relapse prevention and longterm stabilization is a major therapeutic target. Combination treatment and polypharmacy are the most common choices concerning relapse prevention. Furthermore, during maintenance phase patients often experience residual mood symptoms, cognitive deficits and functional decline, which altogether illustrate the inadequate effectiveness of existing treatments and the need for new, targeted, effective and safe treatments for bipolar disorder...
July 2015: Psychiatrikē, Psychiatriki
L Baandrup, M Kruse
BACKGROUND: Treatment with antipsychotic medication is thoroughly investigated in schizophrenia and bipolar disorder but is also widely applied for a diversity of off-label conditions, despite an uncertain risk-benefit ratio. This study examined the relationship between antipsychotic prescribing patterns and labor market affiliation, considering both authority approved and off-label prescriptions and the relation to polypharmacy. METHODS: Register-based cohort study using a dataset of 71,254 new antipsychotic users with a psychiatric diagnosis...
January 2016: European Psychiatry: the Journal of the Association of European Psychiatrists
Jennifer B Levin, Johnny Sams, Curtis Tatsuoka, Kristin A Cassidy, Martha Sajatovic
OBJECTIVES: Medication nonadherence occurs in 20-60% of persons with bipolar disorder (BD) and is associated with serious negative outcomes, including relapse, hospitalization, incarceration, suicide and high healthcare costs. Various strategies have been developed to measure adherence in BD. This descriptive paper summarizes challenges and workable strategies using electronic medication monitoring in a randomized clinical trial (RCT) in patients with BD. METHODS: Descriptive data from 57 nonadherent individuals with BD enrolled in a prospective RCT evaluating a novel customized adherence intervention versus control were analyzed...
April 2015: Therapeutic Advances in Psychopharmacology
Géraud Dautzenberg, Luuk Lans, Paul D Meesters, Ralph Kupka, Aartjan Beekman, Max L Stek, Annemiek Dols
OBJECTIVES: With aging, bipolar disorder evolves into a more complex illness, with increasing cognitive impairment, somatic comorbidity, and polypharmacy. To tailor treatment of these patients, it is important to study their needs, as having more unmet needs is a strong predictor of a lower quality of life. METHOD: Seventy-eight Dutch patients with bipolar I or II disorder aged 60 years and older in contact with mental health services were interviewed using the Camberwell Assessment of Need in the Elderly (CANE) to assess met and unmet needs, both from a patient and a staff perspective...
September 2016: Aging & Mental Health
Christoph U Correll, Johan Detraux, Jan De Lepeleire, Marc De Hert
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder...
June 2015: World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
René Bridler, Anne Häberle, Sabrina T Müller, Katja Cattapan, Renate Grohmann, Sermin Toto, Siegfried Kasper, Waldemar Greil
Patients with borderline personality disorder (BPD) are usually prescribed a variety of psychotropic drugs; however, none is recommended in the guidelines nor has any been approved for this indication. As data on drug prescriptions for BPD are sparse, cross-sectional data from the European Drug Safety Project AMSP were used to analyse drug prescriptions of 2195 in-patients with BPD between 2001 and 2011, and the mean values, confidence intervals and regression analyses were calculated. 70% of all BPD patients were medicated with antipsychotics and/or antidepressants, 33% with anticonvulsants, 30% with benzodiazepines, and 4% with lithium; 90% received at least one, 80%≥2, and 54%≥3 psychotropic drugs concomitantly (mean: 2...
June 2015: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
Katherine E Burdick, Terence A Ketter, Joseph F Goldberg, Joseph R Calabrese
OBJECTIVE: Neurocognitive impairment in schizophrenia has been recognized for more than a century. In contrast, only recently have significant neurocognitive deficits been recognized in bipolar disorder. Converging data suggest the importance of cognitive problems in relation to quality of life in bipolar disorder, highlighting the need for treatment and prevention efforts targeting cognition in bipolar patients. Future treatment trials targeting cognitive deficits will be met with methodological challenges due to the inherent complexity and heterogeneity of the disorder, including significant diagnostic comorbidities, the episodic nature of the illness, frequent use of polypharmacy, cognitive heterogeneity, and a lack of consensus regarding measurement of cognition and outcome in bipolar patients...
March 2015: Journal of Clinical Psychiatry
Jayesh Kamath, Sara Wakai, Wanli Zhang, Karen Kesten, Deborah Shelton, Robert Trestman
Use of medication algorithms in the correctional setting may facilitate clinical decision making, improve consistency of care, and reduce polypharmacy. The objective of the present study was to evaluate effectiveness of algorithm (Texas Implementation of Medication Algorithm [TIMA])-driven treatment of bipolar disorder (BD) compared with Treatment as Usual (TAU) in the correctional environment. A total of 61 women inmates with BD were randomized to TIMA (n = 30) or TAU (n = 31) and treated over a 12-week period...
August 2016: International Journal of Offender Therapy and Comparative Criminology
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