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Bipolar Polytherapy

Louise Wingård, Heidi Taipale, Johan Reutfors, Anna Westerlund, Robert Bodén, Jari Tiihonen, Antti Tanskanen, Morten Andersen
OBJECTIVES: Increasing evidence points to the harmful effects of long-term benzodiazepine treatment. Our objective was to study the incidence of, and predictors for, long-term use of benzodiazepines and Z-drugs in bipolar disorder. METHODS: We conducted a population-based cohort study, using data from Swedish national registers. Swedish residents aged 18-75 years with a recorded diagnosis of bipolar disorder or mania between July 2006 and December 2012, and no history of benzodiazepine/Z-drug use in the past year, were included...
February 16, 2018: Bipolar Disorders
Miao-Miao Zhu, Hui-Lan Li, Li-Hong Shi, Xiao-Ping Chen, Jia Luo, Zan-Ling Zhang
Valproic acid is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder. Adverse effects of valproic acid are rare, but hepatotoxicity is severe in particular in those younger than 2 years old and polytherapy. During valproic acid treatment, it is difficult for prescribers to predict its individual response. Recent advances in the field of pharmacogenomics have indicated variants of candidate genes that affect valproic acid efficacy and safety. In this review, a large number of candidate genes that influence valproic acid pharmacokinetics and pharmacodynamics are discussed, including metabolic enzymes, drug transporters, neurotransmitters and drug targets...
December 2017: Journal of Human Genetics
Yoonyoung Park, Krista F Huybrechts, Jacqueline M Cohen, Brian T Bateman, Rishi J Desai, Elisabetta Patorno, Helen Mogun, Lee S Cohen, Sonia Hernandez-Diaz
OBJECTIVE: Given the increasing use and broadening of indications for use of antipsychotic medications in the general population, as well as the paucity of information on the safety of this drug class during pregnancy, the study documented patterns of antipsychotic medication use among pregnant women. METHODS: Medicaid Analytic eXtract data (2001-2010) from pregnant women who delivered live-born infants were used. Antipsychotic use at both the class and the individual drug level was defined based on dispensed outpatient prescriptions...
November 1, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
Ayush Patel, Wenyaw Chan, Rajender R Aparasu, Melissa Ochoa-Perez, Jeff T Sherer, Rohan Medhekar, Hua Chen
OBJECTIVE: To assess the long-term effect of all treatment options for pediatric bipolar disorders on body mass index (BMI) and to explore individual characteristics associated with less BMI increase during psychotropic medication exposures. METHODS: A retrospective cohort study was conducted by using the 1995 to 2010 General Electric Electronic Medical Record database. Individuals aged 18 years or younger who had a new bipolar disorder episode were identified. Treatment exposure was defined based on the medication regimens patients received, which include atypical antipsychotic (AT) monotherapy, mood stabilizer (MS) monotherapy, antidepressant (AD) monotherapy, AT+MS polytherapy, AT+AD polytherapy, MS+AD polytherapy, and no treatment...
May 2017: Journal of Child and Adolescent Psychopharmacology
Sara S McMillan, Sara Jacobs, Louise Wilson, Theo Theodoros, Gail Robinson, Claire Anderson, Gabor Mihala, Amanda J Wheeler
BACKGROUND: Antipsychotics are recognised as a critical intervention for schizophrenia and bipolar disorder. Guidelines globally endorse the routine practice of antipsychotic monotherapy, at the minimum effective dose. Even in treatment-resistant schizophrenia, clozapine use is endorsed before combining antipsychotics. This aim of this study was to review antipsychotic polytherapy alone, high-dose therapy alone, polytherapy and high-dose prescribing patterns in adults discharged from an inpatient mental health unit at two time-points, and the alignment of this prescribing with clinical guideline recommendations...
April 13, 2017: BMC Psychiatry
Antonio Tundo, Paola Cavalieri
Evidence from the literature suggests that, on average, 27% of patients with a bipolar disorder (BD) experience a continuous cycling course (CCC) and that this subgroup differs significantly from patients with a noncontinuous cycling course (N-CCC) with respect to sociodemographic characteristics and clinical presentation. The aim of the present paper is to review the studies that evaluated short- and long-term treatment responses in BD patients with CCC. The retrieved studies indicate that CCC is a significant predictor of poor response to long-term treatment with lithium (the odds of a response in the CCC group were 57% less than in the N-CCC group; p<0...
February 2018: CNS Spectrums
Giuseppe Tavormina
Very often clinicians meet great difficulties in making a correct diagnosis of mood disorders which they are assessing, above all when mixed states are present: this because the patients mainly focus on their own symptoms of depressive uneasiness; mixed symptoms can insidiously infiltrate into the mood and life of the patients causing a chronic and worsening clinical state. It is essential not to forget that the depression is only one phase of a broader bipolar mood disorder, and this has to be the illness to be treated by psychiatrists and, generally, by clinicians managing an appropriate polytherapy with mood-stabilisers and antidepressants...
September 2016: Psychiatria Danubina
Chia-Ming Chang, Chi-Shin Wu, Ya-Wen Huang, Yeuk-Lun Chau, Hui-Ju Tsai
OBJECTIVE: The aim of the study was to examine utilization and patterns of psychopharmacological treatment during a 1-year follow-up period among patients with newly diagnosed bipolar disorder from 2001 to 2010. METHODS: Patients with newly diagnosed bipolar disorder from 2001 to 2010 were identified from the National Health Insurance Research Database in Taiwan. We assessed prescription records related to 4 kinds of psychopharmacological medication, including antipsychotics (APs), antidepressants, mood stabilizers, and benzodiazepines, as well as health care utilization in a 1-year follow-up period among the study subjects...
February 2016: Journal of Clinical Psychopharmacology
Jerzy Chudek, Magdalena Olszanecka-Glinianowicz, Agnieszka Almgren-Rachtan, Tomasz Gabryelewicz
INTRODUCTION: Prior to registration, no clinical trial evaluating safety and tolerability of Zolafren® (Adamed Sp. z o.o., Czosnów, Poland), a generic olanzapine formulation, had been performed. Therefore, the aim of this post-authorization safety study (PASS) was to evaluate the safety and tolerability of Zolafren in patients with bipolar disorder (BD). METHODS: Adverse events (AEs) associated with the use of Zolafren were recorded in a PASS, in an open-label, non-randomized, multicenter observational study involving 20,698 outpatients with BD...
May 2015: Advances in Therapy
Natalie N Rohde, Christine B Baca, Anne C Van Cott, Karen L Parko, Megan E Amuan, Mary Jo Pugh
OBJECTIVE: We examined patterns of antiepileptic drug (AED) use in a cohort of Iraq/Afghanistan war veterans (IAVs) who were previously identified as having epilepsy. We hypothesized that clinicians would be more likely to prescribe newer AEDs and would select specific AEDs to treat seizures based on patient characteristics including gender and comorbidities. METHODS: From the cohort of IAVs previously identified with epilepsy between fiscal years 2009 and 2010, we selected those who received AEDs from the Veterans Health Administration in FY2010...
May 2015: Epilepsy & Behavior: E&B
Debajyoti Bhowmik, Rajender R Aparasu, Suja S Rajan, Jeffrey T Sherer, Melissa Ochoa-Perez, Hua Chen
OBJECTIVE: The purpose of this study was to assess the risk of manic switch associated with antidepressants in Medicaid-enrolled pediatric patients with bipolar depression. METHODS: This retrospective cohort study involved 2003-2007 Medicaid Analytic eXtract (MAX) data from four geographically diverse states. The study sample included children and adolescents (ages 6-18 years) who had received a diagnosis of bipolar disorder on two or more separate occasions or during a hospital discharge, followed by a diagnosis of depression...
December 2014: Journal of Child and Adolescent Psychopharmacology
Luca Degli Esposti, Diego Sangiorgi, Claudio Mencacci, Edoardo Spina, Carlotta Pasina, Marianna Alacqua, Flore la Tour
BACKGROUND: Schizophrenia and bipolar disorder (BD) are psychiatric diseases that are commonly managed with antipsychotics. Treatment pathways are highly variable and no universal treatment guidelines are available. The primary objective of the Italian Burden of Illness in Schizophrenia and BD (IBIS) study was to describe pharmaco-utilisation of antipsychotic treatments and characteristics of patients affected by schizophrenia or BD. A secondary objective was to describe costs of illness for patients with schizophrenia or BD...
2014: BMC Psychiatry
A Ventriglio, A Gentile, R J Baldessarini, S Martone, G Vitrani, A La Marca, A Bellomo
PURPOSE: As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients. MATERIALS AND METHODS: During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n=33) or type-I bipolar disorder (n=33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication...
September 2014: European Psychiatry: the Journal of the Association of European Psychiatrists
Debajyoti Bhowmik, Rajender R Aparasu, Suja S Rajan, Jeffrey T Sherer, Melissa Ochoa-Perez, Hua Chen
BACKGROUND: To examine the psychotropic medication utilization and compare adherence to treatment regimens in pediatric bipolar depression patients. METHODS: 2003-2007 MAX data from four geographically diverse states were used. According to the regimen received by the patients (6-18 years) in the first month after the index bipolar depression diagnosis, patients were categorized into six mutually exclusive groups. The month to month change of treatment regimen in each group was then assessed during the 6 month post-index bipolar depression diagnosis...
September 5, 2013: Journal of Affective Disorders
P-M Llorca, V Camus, P Courtet, D Gourion, M Lukasiewicz, S Coulomb
OBJECTIVES: The objectives were to assess the characteristics of patients with bipolar disorder (BD) and to evaluate the prescribing practices. METHODS: MONTRA is a quantitative survey conducted between December 2010 and February 2011. Data were extracted by the psychiatrists from the medical files of BD patients seen on four consecutive days of consulting. RESULTS: Four hundred and thirty-nine psychiatrists included 2529 patients (inpatients, n=319; outpatients from mental clinics, n=1090; outpatients consulting in private practice, n=1020)...
June 2013: L'Encéphale
Naba Raj Mainali, Leena Jalota, Madan Raj Aryal, Torrey R Schmidt, Madan Badal, Richard Alweis
INTRODUCTION: A laugh-induced seizure is an unrecognized condition and to the best of our knowledge no case has been reported in the medical literature until now. We present an interesting and extremely rare case in which laughing generated the seizure activity that was recorded and confirmed by video electroencephalography. CASE PRESENTATION: A 43-year-old obese Caucasian man with history of bipolar disorder and chronic headache presented with multiple episodes of seizures, all induced by laughter while watching comedy shows...
2013: Journal of Medical Case Reports
Bernardo Dell'osso, Giulia Camuri, Cristina Dobrea, Massimiliano Buoli, Marta Serati, A Carlo Altamura
OBJECTIVE: Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SNRI), is currently approved in many countries for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). The present naturalistic study was aimed to investigate tolerability of Duloxetine in a sample of patients with affective disorders and psychiatric/medical comorbidity, comparing tolerability in monotherapy versus polytherapy and across different age groups. METHODS: The sample included 165 patients, affected by anxiety and/or mood disorders with or without comorbidity, who had been taken Duloxetine for at least 1 month...
2012: Clinical Practice and Epidemiology in Mental Health: CP & EMH
Bogdan J Wlodarczyk, Ana M Palacios, Timothy M George, Richard H Finnell
The treatment of epilepsy in women of reproductive age remains a clinical challenge. While most women with epilepsy (WWE) require anticonvulsant drugs for adequate control of their seizures, the teratogenicity associated with some antiepileptic drugs (AEDs) is a risk that needs to be carefully addressed. Antiepileptic medications are also used to treat an ever broadening range of medical conditions such as bipolar disorder, migraine prophylaxis, cancer, and neuropathic pain. Despite the fact that the majority of pregnancies of WWE who are receiving pharmacological treatment are normal, studies have demonstrated that the risk of having a pregnancy complicated by a major congenital malformation is doubled when comparing the risk of untreated pregnancies...
August 2012: American Journal of Medical Genetics. Part A
Cem Cerit, Meltem Vural, S Ükriye Bos Gelmez, Eylem Ozten, Ahmet Tamer Aker, Mustafa Yıldız
OBJECTIVE: High prevalence of metabolic syndrome (MS) and related metabolic disturbances in patients with schizophrenia and bipolar affective disorder have been in main focus of interest in recent years since the introduction of second-generation antipsychotics. This study aims to examine these questions: 1) Is there a relation between antipsychotic treatment and MS prevalence? 2) Which antipsychotic users have higher MS prevalence? 3) Do patients on antipsychotic polytherapy have higher rates of MS than patients on antipsychotic monotherapy? 4) Which metabolic parameters are considerably disturbed on which antipsychotic users? METHODS: 242 Patients with schizophrenia, schizoaffective disorder and bipolar disorder without any other psychiatric comorbidity according to DSM-IV and using the same antipsychotic(s) and/or mood stabilizers at least for the last 6 months included to the final assessment...
2010: Psychopharmacology Bulletin
David P Soskin, Ari J Kane, Theodore A Stern
BACKGROUND: Polytherapy is common in the management of bipolar disorder, as are the side effects associated with this treatment strategy. OBJECTIVE: The authors review the literature on drug-drug interactions involving oxcarbazepine and identify specific mechanisms that may have clinical importance. METHOD: The authors provide a case report of a patient who developed phenytoin toxicity associated with an oxcarbazepine-phenytoin interaction...
November 2010: Psychosomatics
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