1
|
Holm M, Tanskanen A, Lähteenvuo M, Tiihonen J, Taipale H. Comparative effectiveness of mood stabilizers and antipsychotics in the prevention of hospitalization after lithium discontinuation in bipolar disorder. Eur Neuropsychopharmacol 2022; 61:36-42. [PMID: 35763976 DOI: 10.1016/j.euroneuro.2022.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
The aim of the study was to compare the real-world effectiveness of mood stabilizers and antipsychotics in the prevention of psychiatric hospitalizations and treatment failure after lithium discontinuation in a nationwide bipolar cohort. Using health-care registers, we identified everyone in Finland diagnosed with bipolar disorder during 1987-2018 who discontinued lithium after using it for at least one year (n = 4 052, median period of lithium use before discontinuation 2.7 years). The risk of psychiatric hospitalization and treatment failure (psychiatric hospitalization, death or change in medication) were investigated with within-individual Cox regression. Of mood stabilizer monotherapies, the periods of valproate use (HR = 0.83, 95% CI = 0.71 - 0.97) had lower risk of hospitalization than nonuse of mood stabilizers. Of antipsychotic monotherapies, the use of long-acting injectable (LAI) antipsychotics (HR = 0.48, 95% CI = 0.26 - 0.88) and chlorprothixene (HR = 0.62, 95% CI = 0.44 - 0.88) were associated with lower risk and the use of quetiapine (HR = 1.26, 95% CI = 1.07 - 1.48) and oral olanzapine (HR = 1.23, 95% CI = 1.01 - 1.49) with higher risk of psychiatric hospitalizations than nonuse of antipsychotics. Of mood stabilizer monotherapies, lithium use was associated with lower risk of treatment failure (HR = 0.82, 95% CI = 0.76 - 0.88) than valproate use. The results suggest that antipsychotic LAIs are especially effective in the prevention of psychiatric hospitalizations after lithium discontinuation. The need to alter used medications may be the lowest when lithium is restarted.
Collapse
Affiliation(s)
- M Holm
- Finnish Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
| | - A Tanskanen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - M Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - J Tiihonen
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden
| | - H Taipale
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden; University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| |
Collapse
|
2
|
Batt MM, Olsavsky AK, Dardar S, St John-Larkin C, Johnson RL, Sammel MD. Course of Illness and Treatment Updates for Bipolar Disorder in the Perinatal Period. Curr Psychiatry Rep 2022; 24:111-120. [PMID: 35166993 DOI: 10.1007/s11920-022-01323-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The perinatal period is a time of increased vulnerability for people with bipolar disorder (BD). The purpose of this review is to provide an update of the literature from the last 3 years regarding course of illness and treatments for BD in the perinatal period to guide clinical care. RECENT FINDINGS Postpartum manic and depressive episodes are emerging as having a unique presentation that may differentiate them from non-perinatal mood episodes. Many important updates regarding medication treatment in the perinatal period have been published recently that have considered the risks of untreated illness versus treatment risks in this population.' Despite significant research, there are still gaps in knowledge regarding safety and efficacy of medications for the mother and child. Crucial future areas of study include improved screening guidelines, randomized controlled trials examining medication safety in pregnancy and lactation, and efficacy of nonpharmacologic treatments.
Collapse
Affiliation(s)
- Melissa M Batt
- Department of Psychiatry, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO, USA.
- Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine - Anschutz Medical Campus, 13199 East Montview Blvd, Suite 330, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, Aurora, CO, USA.
| | - Aviva K Olsavsky
- Departments of Psychiatry and Obstetrics/Gynecology, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Shaleah Dardar
- Department of Psychiatry, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Celeste St John-Larkin
- Department of Psychiatry, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, CO School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Biostatistics & Informatics, CO School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
3
|
Roh D, Chang JG, Yoon S, Kim CH. Antipsychotic Prescribing Patterns in First-episode Schizophrenia: A Five-year Comparison. Clin Psychopharmacol Neurosci 2015; 13:275-82. [PMID: 26598586 PMCID: PMC4662163 DOI: 10.9758/cpn.2015.13.3.275] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. METHODS We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. RESULTS The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic polypharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). CONCLUSION The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.
Collapse
Affiliation(s)
- Daeyoung Roh
- Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jhin-Goo Chang
- Department of Psychiatry, Severance Hospital, Seoul, Korea
| | - Sol Yoon
- Department of Psychiatry, Severance Hospital, Seoul, Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Severance Hospital, Seoul, Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Yun DH, Pae CU, Drago A, Mandelli L, De Ronchi D, Patkar AA, Paik IH, Serretti A, Kim JJ. Effect of the dysbindin gene on antimanic agents in patients with bipolar I disorder. Psychiatry Investig 2008; 5:102-5. [PMID: 20046352 PMCID: PMC2796018 DOI: 10.4306/pi.2008.5.2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We previously reported an association between dysbindin gene (DTNBP1) variants and bipolar I disorder (BID). This paper expands upon previous findings suggesting that DTNBP1 variants may play a role in the response to acute mood stabilizer treatment. METHODS A total of 45 BID patients were treated with antimanic agents (lithium, valproate, or carbamazepine) for an average of 36.52 (+/-19.87) days. After treatment, the patients were evaluated using the Clinical Global Impression (CGI) scale and the Young Mania Rating Scale (YMRS) and genotyped for their DTNBP1 variants (rs3213207 A/G, rs1011313 C/T, rs2005976 G/A, rs760761 C/T and rs2619522 A/C). RESULTS There was no association between the variants investigated and response to mood stabilizer treatment, even after considering possible stratification factors. CONCLUSION Although the small number of subjects is an important limitation in our study, DTNBP1 does not seem to be involved in acute antimanic efficacy.
Collapse
Affiliation(s)
- Dong-Hwan Yun
- Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Antonio Drago
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Laura Mandelli
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Ashwin A. Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - In Ho Paik
- Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | - Jung-Jin Kim
- Department of Psychiatry, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|