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Sepede G, Lorusso M, Spano MC, Di Nanno P, Di Iorio G, Di Giannantonio M. Efficacy and Safety of Atypical Antipsychotics in Bipolar Disorder With Comorbid Substance Dependence: A Systematic Review. Clin Neuropharmacol 2018; 41:181-191. [PMID: 30036197 DOI: 10.1097/wnf.0000000000000297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) patients with a comorbid substance use disorder (SUD) are notoriously difficult to treat. Atypical antipsychotics (AAPs) are widely prescribed in BD, but their efficacy in patients with comorbid SUD is still debated. The aim of the present article is to systematically review the literature findings on the efficacy and safety of AAPs in BD patients with comorbid SUD. METHODS We searched PubMed to identify original studies focused on the treatment of dual diagnosed BD with AAPs. RESULTS Ten articles met our inclusion/exclusion criteria, involving a total of 969 subjects, 906 affected by BD and 793 with comorbid SUD: 4 were randomized controlled trials, 4 were open label trials and 2 were observational studies, published between 2002 and 2017. The most commonly abused substances were alcohol and cocaine. The AAPs used to treat patients were quetiapine (n = 337), asenapine (n = 119), olanzapine (n = 80), risperidone (n = 62), and aripiprazole (n = 48). In terms of safety, AAPs were usually well tolerated. Atypical antipsychotics were usually efficacious on acute mood symptoms, whereas their impact on substance-related issues was reported only in those studies without a placebo comparison. CONCLUSIONS According to our results, even though AAPs are widely used and efficacious in treating the clinical symptoms of BD, there are not enough data to suggest their adjunctive benefit on craving and substance consumption.
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Affiliation(s)
- Gianna Sepede
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti
| | - Marco Lorusso
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti
| | - Maria Chiara Spano
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti
| | - Piero Di Nanno
- Department of Neuroscience, Imaging and Clinical Science, "G. d'Annunzio" University of Chieti
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Fornaro M, De Berardis D, Koshy AS, Perna G, Valchera A, Vancampfort D, Stubbs B. Prevalence and clinical features associated with bipolar disorder polypharmacy: a systematic review. Neuropsychiatr Dis Treat 2016; 12:719-35. [PMID: 27099503 PMCID: PMC4820218 DOI: 10.2147/ndt.s100846] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
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. RESULTS The operative definitions of polypharmacy adopted across varying studies varied, with concomitant use of two or more psychotropic medications or use of four or more psychotropic medications at once being the most common and the most reliable, respectively. Regardless of type or current mood episode polarity of BD, prevalence rates up to 85% and 36% were found using the most permissive (two or more medications at once) and the most conservative (four or more) operative definitions for polypharmacy, respectively. Point prevalence prescription rates of one or more antidepressant or antipsychotic as part of a polypharmacy regimen occurred in up to 45% or 80% of the cases, respectively, according to the most permissive definition of polypharmacy. In contrast, lithium prescription rates ranged from 13% to 33% in BD patients receiving polypharmacy according to conservative and permissive definitions, possibly suggesting a reduced need for augmentation of combination strategies for those cases of BD with a favorable lifetime lithium response and/or long-lasting treatment as well as less likelihood of lithium response over the time most severe cases possibly exposed to a more complex polypharmacy overall. LIMITATIONS "Apples and oranges" bias; publication bias for most recently introduced compounds. CONCLUSION Polypharmacy is common among people with BD across varying type and mood episode phases of illness. Special population, including BD patients at high risk of familial load for suicidal behavior, solicit further research as well as the plausible "protective" role of lithium toward polypharmacy in BD. The PROSPERO registration number is CRD42014015084.
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Affiliation(s)
- Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias - Villa San Benedetto Menni Hospital, FoRiPsi, Italy
| | - Alessandro Valchera
- Hermanas Hospitalarias, FoRiPsi Villa S. Giuseppe Hospital, Ascoli Piceno, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Frieri T, Montemagni C, Crivelli B, Scalese M, Villari V, Rocca P, Scalese M, Mara S, Villari V, Vincenzo V, Rocca P, Paola R. Substance use disorders in hospitalized psychiatric patients: the experience of one psychiatric emergency service in Turin. Compr Psychiatry 2014; 55:1234-43. [PMID: 24791682 DOI: 10.1016/j.comppsych.2014.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/10/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022] Open
Abstract
In the present study we sought: 1) to estimate the frequency of substance use disorders (SUD), and 2) to investigate whether there is a mere association between diagnosis and SUD in a large cohort of patients with severe psychiatric disorders representative of the usual setting and modality of care of a psychiatric emergency service in a geographically well-defined catchment area in Italy, independent of sociodemographic features, anamnestic data and clinical status. The study was conducted between January 2007 and December 2008. The following rating scales were performed: the Clinical Global Impression-Severity (CGI-S), the Global Assessment of Functioning scale (GAF) and the Brief Psychiatric Rating Scale (BPRS). Factors found to be associated (p<0.05) with SUD[+] in the univariate analyses were subjected to multilevel logistic regression model with a backward stepwise procedure. Among 848 inpatients of our sample 29.1% had a SUD codiagnosis. Eleven factors accounted for 30.6% of the variability in SUD[+]: [a] a Personality Disorder diagnosis, [b] a Depressive Disorder diagnosis, [c] male gender, [d] previous outpatient contacts, [e] single marital status, [f] no previous psychiatric treatments, [g] younger age, [h] lower scores for BPRS Anxiety-depression and [i] BPRS Thought Disturbance, [l] higher scores for BPRS Activation and [m] BPRS Hostile-suspiciousness. The findings are important in identifying (1) the complexity of the clinical presentation of SUD in a inpatients sample, (2) the need for collaboration among health care workers, and (3) the need to develop and apply treatment programs that are targeted at particular risk groups.
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Affiliation(s)
| | | | | | | | | | - Paola Rocca
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy.
| | | | - Scalese Mara
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy
| | | | - Villari Vincenzo
- Department of Neuroscience and Mental Health, Psychiatric Emergency Service, A.O. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Paola Rocca
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy.
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Bahorik AL, Newhill CE, Queen CC, Eack SM. Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors. Psychol Med 2014; 44:61-69. [PMID: 23551851 DOI: 10.1017/s0033291713000548] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Illicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia disclose their use of drugs on self-rated assessments, compared to laboratory assays, and to determine the contributors of under-reported drug use in this population. METHOD A total of 1042 individuals with schizophrenia who participated in screening/baseline procedures for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) completed self-rated assessments of substance use and laboratory drug testing. Laboratory tests assayed cannabis, cocaine and methamphetamine use; the procedures included radioimmunoassay (RIA) and urine drug screens. RESULTS A significant proportion of participants tested positive for drug use on laboratory measures (n = 397; 38%), and more than half (n = 229; 58%) did not report using these drugs. Logistic regression models confirmed that patients who were most likely to conceal their use tended to be older, and presented with greater neurocognitive deficits. Patients who accurately reported drug use tended to have greater involvement with the criminal justice system. Illness severity and psychopathology were not associated with whether patients disclosed drug use. CONCLUSIONS Rates of under-reported drug use are considerable among individuals with schizophrenia when compared to laboratory assays, and the exclusive reliance on self-rated assessments should be used with caution. Patients who under-report their drug use are more likely to manifest neurocognitive deficits, which could be improved by interventions attempting to optimize treatment.
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Affiliation(s)
- A L Bahorik
- School of Social Work, University of Pittsburgh, PA, USA
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Bauer M, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, Munoz R, Severus E, Ritter P, Whybrow PC. Drug treatment patterns in bipolar disorder: analysis of long-term self-reported data. Int J Bipolar Disord 2013; 1:5. [PMID: 25505672 PMCID: PMC4230449 DOI: 10.1186/2194-7511-1-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/25/2013] [Indexed: 12/28/2022] Open
Abstract
Background The objective of this study is to investigate drug treatment patterns in bipolar disorder using daily data from patients who received treatment as usual. Methods Patients self-reported the drugs taken daily for about 6 months. Daily drug use and drug combinations were determined for each patient, both by the specific drugs and by medication class. The drug load was calculated for all drugs taken within a medication class. Results and discussion Four hundred fifty patients returned a total of 99,895 days of data (mean 222.0 days). The most frequently taken drugs were mood stabilizers. Of the 450 patients, 353 (78.4%) took a stable drug combination for ≥50% of days. The majority of patients were taking polypharmacy, including 75% of those with a stable combination. Only a small number of drugs were commonly taken within each medication class, but there were a large number of unique drug combinations: 52 by medication class and 231 by specific drugs. Eighty percent of patients with a stable combination were taking three or less drugs daily. Patients without a stable combination took drugs but made frequent changes. Taking more than one drug within a medication class greatly increased the drug load. To summarize, (1) patients were more likely to take a mood stabilizer than any other drug; (2) although most patients were taking polypharmacy, there were no predominant drug regimens even among those taking a stable combination; and (3) most patients with a stable combination take a relatively small number of drugs daily. The wide variation in drug regimens and numerous possible drug combinations suggest that more evidence is needed to optimize treatment of bipolar disorder.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany
| | - Tasha Glenn
- ChronoRecord Association Inc., Fullerton, CA 92834 USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2 Canada
| | - Kemal Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO 64110 USA
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Paul Grof
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1A1 Canada ; Mood Disorders Centre of Ottawa, Ottawa, Ontario K1G 4G3 Canada
| | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093 USA
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Los Angeles, CA 90095 USA
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Van Dorn RA, Desmarais SL, Young MS, Sellers BG, Swartz MS. Assessing illicit drug use among adults with schizophrenia. Psychiatry Res 2012; 200:228-36. [PMID: 22796100 PMCID: PMC3474887 DOI: 10.1016/j.psychres.2012.05.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/21/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
Accurate drug use assessment is vital to understanding the prevalence, course, treatment needs, and outcomes among individuals with schizophrenia because they are thought to remain at long-term risk for negative drug use outcomes, even in the absence of drug use disorder. This study evaluated self-report and biological measures for assessing illicit drug use in the Clinical Antipsychotic Trials of Intervention Effectiveness study (N=1460). Performance was good across assessment methods, but differed as a function of drug type, measure, and race. With the Structured Clinical Interview for DSM-III-R as the criterion, self-report evidenced greater concordance, accuracy and agreement overall, and for marijuana, cocaine, and stimulants specifically, than did urinalysis and hair assays, whereas biological measures outperformed self-report for detection of opiates. Performance of the biological measures was better when self-report was the criterion, but poorer for black compared white participants. Overall, findings suggest that self-report is able to garner accurate information regarding illicit drug use among adults with schizophrenia. Further work is needed to understand the differential performance of assessment approaches by drug type, overall and as a function of race, in this population.
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Affiliation(s)
- Richard A. Van Dorn
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612, USA,Research Triangle Institute International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | - Sarah L. Desmarais
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612, USA,Department of Community & Family Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - M. Scott Young
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Brian G. Sellers
- Department of Criminology, University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620, USA
| | - Marvin S. Swartz
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 238 Civitan Building, Box 3173, Durham, NC 27710, USA
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