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Sharpley AL, Williams C, Holder AA, Godlewska BR, Singh N, Shanyinde M, MacDonald O, Cowen PJ. A phase 2a randomised, double-blind, placebo-controlled, parallel-group, add-on clinical trial of ebselen (SPI-1005) as a novel treatment for mania or hypomania. Psychopharmacology (Berl) 2020; 237:3773-3782. [PMID: 32909076 PMCID: PMC7683468 DOI: 10.1007/s00213-020-05654-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE Lithium is an effective prophylactic and anti-manic treatment in bipolar disorder; however, its use is declining through perceived poor tolerance and toxicity. Lithium inhibits inositol monophosphatase (IMPase), a probable key therapeutic mechanism. The anti-inflammatory drug, ebselen, also inhibits IMPase and appears well-tolerated and safe. OBJECTIVES To assess the efficacy of adjunctive ebselen in mania using the Young Mania Rating Scale (YMRS) (primary outcome) and the Altman Self-Rating Mania (ASRM) Scale and Clinical Global Impression-Severity Scale (CGI-S) among the secondary outcomes. METHODS Randomised, double-blind, placebo-controlled, parallel-group trial conducted between October 2017 and June 2019, at Oxford Health NHS Foundation Trust. Pharmacy-controlled randomisation was computer-generated, with full allocation concealment. In/outpatients (n = 68) aged 18-70, experiencing mania or hypomania, were assigned to 3 weeks ebselen (600 mg bd) (n = 33) or placebo (n = 35). Participants received usual clinical care and psychotropic medication. RESULTS Ebselen was numerically, but not statistically, superior to placebo in lowering scores on the YMRS (adjusted mean difference and 95% confidence interval, - 1.71 (- 5.34 to 1.91), p = 0.35) and ASRM (- 1.36 (- 3.75 to 1.17), p = 0.29). However, scores on the CGI-S were significantly lower at week 3 in ebselen-treated participants (adjusted mean difference, - 0.58 (- 1.14 to - 0.03), p = 0.04). A post hoc analysis excluding patients taking concomitant valproate treatment magnified the difference between ebselen and placebo on the YMRS. Adverse events were comparable between groups, and mild. CONCLUSIONS Ebselen merits further investigation where concomitant psychotropic medication is better controlled and participants taking valproate are excluded. If effective, ebselen's superior tolerance and safety could make it a useful alternative to lithium. TRIAL REGISTRATION Trial Registry: www.clinicaltrials.gov , Identifier: NCT03013400.
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Affiliation(s)
- Ann L Sharpley
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Clare Williams
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Adele A Holder
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Beata R Godlewska
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nisha Singh
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Milensu Shanyinde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla MacDonald
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- Neurosciences Building, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Asth L, Tiago PRF, Costa LRF, Holanda VAD, Pacifico S, Zaveri NT, Calo' G, Ruzza C, Gavioli EC. Effects of non-peptide nociceptin/orphanin FQ receptor ligands on methylphenidate-induced hyperactivity in mice: Implications for bipolar disorders. Neuropeptides 2020; 82:102059. [PMID: 32600667 DOI: 10.1016/j.npep.2020.102059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/11/2023]
Abstract
Bipolar disorder is a psychiatric pathology characterized by biphasic mood episodes of mania or hypomania and depression. The pharmacotherapy of bipolar disorder has significant adverse effects impairing treatment adherence and patient quality of life. The N/OFQ-NOP receptor system has been widely implicated with mood disorders. Clinical and preclinical findings suggest antidepressants actions for NOP antagonists. More recently, the administration of NOP agonists has shown to promote depressant states. The present study aimed to investigate the effects of non-peptide NOP ligands in methylphenidate-induced manic-like behavior in mice. The NOP agonist Ro 65-6570 (0.01-1 mg/kg, ip), at the higher dose, did not affect spontaneous locomotion per se, but prevented the methylphenidate (10 mg/kg, sc)-induced hyperlocomotion. The NOP partial agonist AT-090 (0.001-0.03 mg/kg, ip) and the NOP antagonist SB-612111 (1-10 mg/kg, ip) did not significantly affect the psychostimulant-induced hyperactivity. Experiments performed with mice lacking the NOP receptor (NOP(-/-)) demonstrated that the treatment with methylphenidate induced similar hyperlocomotion in NOP(-/-) and NOP(+/+) mice. In conclusion, these findings suggest a potential role for NOP agonists in the prevention of manic states, especially by counteracting the hyperactivity symptom of bipolar patients. However, more studies are necessary in order to evaluate these compounds in other features of bipolar disorder.
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Affiliation(s)
- Laila Asth
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Pamella R F Tiago
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Layse R F Costa
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Victor A D Holanda
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Salvatore Pacifico
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Nurulain T Zaveri
- Astraea Therapeutics, LLC., 320 Logue Avenue, Mountain View, CA 94043, United States
| | - Girolamo Calo'
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, 44121 Ferrara, Italy
| | - Chiara Ruzza
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, 44121 Ferrara, Italy; Technopole of Ferrara, LTTA Laboratory for Advanced Therapies, Ferrara, Italy
| | - Elaine C Gavioli
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil.
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Menegas S, Dal-Pont GC, Cararo JH, Varela RB, Aguiar-Geraldo JM, Possamai-Della T, Andersen ML, Quevedo J, Valvassori SS. Efficacy of folic acid as an adjunct to lithium therapy on manic-like behaviors, oxidative stress and inflammatory parameters in an animal model of mania. Metab Brain Dis 2020; 35:413-425. [PMID: 31840201 DOI: 10.1007/s11011-019-00503-3] [Citation(s) in RCA: 8] [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: 06/12/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
Evaluate the efficacy of folic acid (FA) as a therapeutic adjunct to lithium (Li) on the manic-like behaviors as well as parameters of oxidative stress and inflammation in an animal model of mania induced by m-amphetamine (m-AMPH). Wistar rats first received m-AMPH or saline (NaCl 0.9%, Sal) for 14 days. Between the 8th and 14th day, rats were treated with water, Li, FA or a combination of thereof drugs (Li + FA). Manic-like behaviors were assessed in the open-field test. Oxidative stress and inflammation parameters were assessed in the frontal cortex, striatum, and hippocampus. Administration of m-AMPH in rats significantly enhanced the exploratory and locomotor behaviors, as well as the risk-taking and stereotypic behaviors. Li + FA reversed these behavioral alterations elicited by m-AMPH. Administration of this psychostimulant also increased oxidative damage to lipids and proteins, whereas Li + FA reversed these oxidative damages. m-AMPH also induced an increase in the glutathione peroxidase (GPx) activity and a decrease in the glutathione reductase (GR) activity. Li + FA reversed the alteration in GR activity, but not in GPx activity. In addition, m-AMPH increased the IL-1β and TNF-α levels in the rat brain; Li + FA combined therapy reversed the alterations on these inflammatory parameters. FA administration per se reduced the increased TNF-α content induced by m-AMPH. Present study provides evidence that FA is effective as an adjunct to Li standard therapy on manic-like behaviors, oxidative stress and inflammatory parameters in a model of mania induced by m-AMPH.
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Affiliation(s)
- Samira Menegas
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Gustavo C Dal-Pont
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - José H Cararo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Roger B Varela
- Queensland Brain Institute, The Universty of Queensland, St Lucia, QLD, 4072, Australia
| | - Jorge M Aguiar-Geraldo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Taise Possamai-Della
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Monica L Andersen
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - João Quevedo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Samira S Valvassori
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Taylor RW, Marwood L, Greer B, Strawbridge R, Cleare AJ. Predictors of response to augmentation treatment in patients with treatment-resistant depression: A systematic review. J Psychopharmacol 2019; 33:1323-1339. [PMID: 31526204 DOI: 10.1177/0269881119872194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment-resistant depression is an important contributor to the global burden of depression. Antidepressant augmentation is a recommended treatment strategy for treatment-resistant patients, but outcomes remain poor. Identifying factors that are predictive of response to augmentation treatments may improve outcomes. AIMS This review aimed to synthesise the existing literature examining predictors of response to augmentation treatments in patients who had insufficiently responded to initial treatment. METHODS A systematic search was conducted identifying 2241 unique manuscripts. 24 examining predictors of outcome to pharmacological or psychological augmentation treatment were included in this review. RESULTS Atypical antipsychotics were the most frequently assessed treatment class (nine studies), closely followed by mood stabilisers (eight studies). Only one eligible psychological augmentation study was identified. Early response to treatment (week 2) was the best-supported predictor of subsequent treatment outcome, reported by six studies. Many predictor variables were only assessed by one report and others such as pre-treatment severity yielded contradictory results, both within and across treatment classes. CONCLUSIONS This review highlights the importance of early response as a predictor of pharmacological augmentation outcome, with implications for both the monitoring and treatment of resistant unipolar patients. Further replication is needed across specific interventions to fully assess the generalisability of this finding. However, the clear lack of consistent evidence for other predictive factors both within and across treatments, and the scarce examination of psychological augmentation, demonstrates the need for much more research of a high quality if response prediction is to improve outcomes for patients with treatment-resistant depression.
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Affiliation(s)
- Rachael W Taylor
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, UK
| | - Lindsey Marwood
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Greer
- The National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Strawbridge
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, UK
| | - Anthony J Cleare
- The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The National Institute for Health Research Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, UK
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Ibrahim I, Tobar S, Fathi W, ElSayed H, Yassein A, Eissa A, Elsheshtawy E, Elboraei H, Shahda M, Elwasify M, Ibrahim A, Chen K, Wood J, Dickerson F, Yolken RH, El Chennawi F, Gur R, Gur R, El Bahaey W, Nimgaonkar V, Mansour H. Randomized controlled trial of adjunctive Valproate for cognitive remediation in early course schizophrenia. J Psychiatr Res 2019; 118:66-72. [PMID: 31494376 DOI: 10.1016/j.jpsychires.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/07/2019] [Revised: 08/13/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is associated with cognitive impairment that contributes to disability, but the cognitive dysfunction is relatively refractory to pharmacologic intervention. Though Valproate augmentation is reported to improve psychopathology among patients with SZ, its effects on cognitive functions have not been investigated systematically. METHODS Using a randomized double blind placebo controlled design, the effects of Valproate or placebo as adjuncts to risperidone (RISP) treatment were evaluated among patients with early course SZ (N = 109). Domains of cognitive function, estimated using the Arabic version of the Penn Computerized Neurocognitive Battery, were the prime outcomes. Clinical severity and social function were secondary outcomes. We also explored the effects of valproate treatment on serological responses to Toxoplama Gondii (TOXO), a putative risk factor for cognitive dysfunction in SZ. RESULTS There were no significant differences between Valproate and placebo (PLA) treated groups with respect to changes in cognitive functions, positive or negative symptom scores or daily function scores at the beginning and end of the study. No significant Valproate/PLA differences were noted on TOXO serostatus or TOXO-related cognitive dysfunction. CONCLUSION Valproate treatment may not be beneficial for cognitive dysfunction in SZ or for TOXO infection.
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Affiliation(s)
- Ibtihal Ibrahim
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Salwa Tobar
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Warda Fathi
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Hanan ElSayed
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Amal Yassein
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Ahmed Eissa
- Department of Psychiatry, Port-said University School of Medicine, Port-said, Egypt
| | - Eman Elsheshtawy
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Hala Elboraei
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Mohamed Shahda
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Mahmoud Elwasify
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Ahmed Ibrahim
- Clinical pathology department, Mansoura university student Hospital, Egypt
| | - Kehui Chen
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | | | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, USA
| | - Farha El Chennawi
- Department of Clinical Pathology, Mansoura University School of Medicine, Mansoura, Egypt
| | - Raquel Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wafaa El Bahaey
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Vishwajit Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. nimga+@pitt.edu
| | - Hader Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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Mintz M, Hollenberg E. Revisiting Lithium: Utility for Behavioral Stabilization in Adolescents and Adults with Autism Spectrum Disorder. Psychopharmacol Bull 2019; 49:28-40. [PMID: 31308580 PMCID: PMC6598782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To examine the efficacy of lithium as a mood stabilizer for patients with autism spectrum disorder (ASD). EXPERIMENTAL DESIGN A retrospective chart review was performed that examined the use of both extended and immediate release lithium carbonate in patients with ASD that were treated at a single clinical center (CNNH NeuroHealth). Clinical Global Impression (CGI) scales were used to quantify baseline severity of ASD and mood symptoms as well as improvement after treatment with lithium carbonate. PRINCIPLE OBSERVATIONS Our retrospective chart review found that 73.7% (n = 14) of patients with ASD and concomitant maladaptive behaviors experienced "improvement" (CGI-I rating ≤ 3) with the addition of lithium to their treatment regimen. Those with comorbid "ADHD" phenotype were most predictive of an efficacious response (p = 0.038, Odds Ratio 12.2). CONCLUSIONS Lithium carbonate is a viable, efficacious and well tolerated alternative to various neuroleptics and other psychotropic medications for use as a mood stabilizer for patients with ASD.
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Affiliation(s)
- Mark Mintz
- Mintz, MD, Hollenberg, The Center for Neurological and Neurodevelopmental Health (CNNH NeuroHealth)
| | - Emma Hollenberg
- Mintz, MD, Hollenberg, The Center for Neurological and Neurodevelopmental Health (CNNH NeuroHealth)
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Taylor CL, Stewart RJ, Howard LM. Relapse in the first three months postpartum in women with history of serious mental illness. Schizophr Res 2019; 204:46-54. [PMID: 30089534 DOI: 10.1016/j.schres.2018.07.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Received: 10/22/2017] [Revised: 07/03/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relapse of serious mental illness (psychotic and bipolar disorders; SMI) in the postpartum period is potentially devastating for mother and baby. There is limited evidence on whether medication in the perinatal period is protective against postpartum relapse for women with SMI particularly non-affective psychoses. We aimed to investigate risk factors for postpartum relapse, particularly the potential prophylactic effects of medication. METHODS Using an anonymised resource of comprehensive electronic secondary mental health care records linked with maternity data, women with history of SMI who gave birth from 2007 to 2011 were identified. Relapse was defined as admission to acute care in the first 3 months postpartum. Women who were exposed to regular medication were compared with women who were unexposed. Data were analysed by pregnancy using random effects models to account for repeated measures in women who had more than one pregnancy in the study period. RESULTS There were 452 full term pregnancies, of which 128 (28.3%) were associated with relapse in the first 3 months postpartum, with recent relapse an independent predictor (aOR; 95% CI:1.30-2.27). There was no evidence of a prophylactic effect of medication (crude OR = 0.65; 0.34-1.25) (aOR = 0.99; 0.54-1.83), in women with non-affective or affective psychoses (interaction test p = 0.453). CONCLUSIONS Recent relapse increases the risk of relapse in the postpartum period so women with severe illnesses with a recent history of relapse should be warned pre-conception about the high risk of relapse. The lack of evidence of a protective impact of medication prophylaxis may reflect confounding by indication.
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Affiliation(s)
- Clare L Taylor
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Robert J Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Louise M Howard
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
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Fadili A, Attouche N, Charra B, Alami KM, Agoub M. Syndrome de sécrétion inappropriée d’hormone antidiurétique secondaire à la rispéridone et la carbamazépine: à propos d’un cas. Pan Afr Med J 2019; 32:78. [PMID: 31223369 PMCID: PMC6560970 DOI: 10.11604/pamj.2019.32.78.17720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/15/2019] [Indexed: 11/22/2022] Open
Abstract
Le syndrome de sécrétion inappropriée de l'hormone antidiurétique (SIADH) représenterait environ 50% de tous les cas diagnostiqués d'hyponatrémie. Seule une faible proportion de SIADH serait d'origine médicamenteuse. Nous rapportons le cas d'une patiente suivie pour un trouble schizo-affectif qui a développé le SIADH après avoir commencé un traitement à base de la rispéridone et la carbamazépine. Les résultats des tests biochimiques suggéraient un SIADH secondaire à l'utilisation de la rispéridone et la carbamazépine. La patiente a été traitée avec succès par l'arrêt des deux médicaments et une restriction hydrique. Après correction de la natrémie la décision thérapeutique était de mettre la patiente sous clozapine. Elle est actuellement sous 400mg avec des taux de natrémie stables. Les psychiatres doivent être conscients du risque d'hyponatrémie sévère associé aux médicaments psychotropes. Il est donc primordial de surveiller les électrolytes, en particulier le sodium, chez les patients prenant des antipsychotiques et des anticonvulsivants.
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Affiliation(s)
- Assia Fadili
- Centre Psychiatrique Universitaire Ibn Rochd, Casablanca, Maroc
| | - Nadia Attouche
- Centre Psychiatrique Universitaire Ibn Rochd, Casablanca, Maroc
| | | | | | - Mohamed Agoub
- Centre Psychiatrique Universitaire Ibn Rochd, Casablanca, Maroc
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Alvarez P, Papaseit E, Pérez V, Bulbena A, Farré M. Reversible taste and smell dysfunction associated with sodium valproate and quetiapine in bipolar depression: a case report. Actas Esp Psiquiatr 2019; 47:33-36. [PMID: 30724329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Pilar Alvarez
- Hospital del Mar, Departamento de Psiquiatría. Barcelona, España IMIM (Institut Hospital del Mar d'Investigacions Mèdiques). Barcelona, España
| | - Esther Papaseit
- Hospital Universitari Germans Trias i Pujol-IGTP, Unidad de Farmacología Clínica. Badalona, España Universidad Autonóma de Barcelona (UAB). Barcelona, España
| | - Víctor Pérez
- Hospital del Mar, Departamento de Psiquiatría. Barcelona, España IMIM (Institut Hospital del Mar d'Investigacions Mèdiques). Barcelona, España Universidad Autonóma de Barcelona (UAB). Barcelona, España CIBERSAM
| | - Antoni Bulbena
- Hospital del Mar, Departamento de Psiquiatría. Barcelona, España IMIM (Institut Hospital del Mar d'Investigacions Mèdiques). Barcelona, España Universidad Autonóma de Barcelona (UAB). Barcelona, España
| | - Magí Farré
- Hospital Universitari Germans Trias i Pujol-IGTP, Unidad de Farmacología Clínica. Badalona, España Universidad Autonóma de Barcelona (UAB). Barcelona, España
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Goto A, Nakamura Y, Lubna NJ, Chiba K, Hagiwara-Nagasawa M, Izumi-Nakaseko H, Ando K, Naito AT, Sugiyama A. Analysis of Safety Margin of Lithium Carbonate Against Cardiovascular Adverse Events Assessed in the Halothane-Anesthetized Dogs. Cardiovasc Toxicol 2018; 18:530-536. [PMID: 29845450 DOI: 10.1007/s12012-018-9464-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 01/07/2023]
Abstract
Lithium is one of the classical drugs that have been widely used for treating bipolar disorder. However, several cardiac side effects including sick sinus syndrome, bundle branch block, ventricular tachycardia/fibrillation, non-specific T-wave abnormalities in addition to Brugada-type electrocardiographic changes have been noticed in patients who were given antidepressant, anticonvulsant, and/or antipsychotic drugs besides lithium. In this study, we assessed cardiohemodynamic and electrophysiological effects of lithium carbonate by itself to begin to analyze onset mechanisms of its cardiovascular side effects. Lithium carbonate in intravenous doses of 0.1, 1, and 10 mg/kg over 10 min was cumulatively administered with an interval of 20 min to the halothane-anesthetized beagle dogs (n = 4), which provided peak plasma Li+ concentrations of 0.02, 0.18, and 1.79 mEq/L, respectively, reflecting sub-therapeutic to toxic concentrations. The low and middle doses prolonged the ventricular effective refractory period at 30 min and for 5-30 min, respectively. The high dose decreased the heart rate for 45-60 min, delayed the intraventricular conduction for 15-20 min and the ventricular repolarization at 45 min, and prolonged the effective refractory period for 5-60 min. No significant change was detected in the other cardiovascular variables. Thus, lithium alone may have a wide safety margin against hemodynamic adverse events; however, it would directly and/or indirectly inhibit Na+ and K+ channels, which may synergistically increase the ventricular refractoriness from the sub-therapeutic concentration and decrease the heart rate at the supra-therapeutic one. These findings may partly explain its clinically observed various types of arrhythmias as well as electrocardiographic changes.
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Affiliation(s)
- Ai Goto
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Yuji Nakamura
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Nur Jaharat Lubna
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Koki Chiba
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Mihoko Hagiwara-Nagasawa
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Hiroko Izumi-Nakaseko
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Kentaro Ando
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Atsuhiko T Naito
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Atsushi Sugiyama
- Department of Pharmacology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan.
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan.
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Martinak B, Bolis RA, Black JR, Fargason RE, Birur B. Dextromethorphan in Cough Syrup: The Poor Man's Psychosis. Psychopharmacol Bull 2017; 47:59-63. [PMID: 28936010 PMCID: PMC5601090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dextromethorphan (3-methoxy-N-methylmorphinan), also known as "DXM" and "the poor man's PCP," is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psychosis characterized by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia. We report a noteworthy case of severe dextromethorphan use disorder with dextromethorphan-induced psychotic disorder in a 40-year-old Caucasian female, whose symptoms remitted only following treatment with a combination of an antipsychotic and mood stabilizer. While some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18-years of age, there is currently no federal ban or restriction on DXM. Abuse of DXM, a readily available and typically inexpensive agent that is not detected on a standard urine drug screen, may be an under-recognized cause of substance-induced psychosis. It is imperative that clinicians are aware of the potential psychiatric sequelae of recreational DXM use.
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Affiliation(s)
- Bridgette Martinak
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Ramy A Bolis
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Jeffrey Ryne Black
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Rachel E Fargason
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Badari Birur
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
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Dehning J, Grunze H, Born C, Hausmann A. [Lithium treatment in patients with impaired kidney function: Between Scylla and Charybdis]. Fortschr Neurol Psychiatr 2017; 85:288-291. [PMID: 28561179 DOI: 10.1055/s-0043-106739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction In quite a few patients with bipolar disorder there is no real alternative to lithium treatment despite impaired kidney function. Is it possible to continue lithium treatment despite kidney malfunction by changing dosage and/or frequency of administration? Case Report We report on a 65-year-old woman suffering from bipolar-I disorder who had been on lithium treatment for many decades. While on lithium, the glomerular filtration rate (GFR) decreased constantly. A decision had to be made whether to switch to a more tolerable o.d. administration or to taper off lithium. Conclusion With a single dose at bedtime, the serum levels remained stable; however, kidney function unfortunately did not improve. A relevant increase of GFR above the level of 60 mL/min/1,73 m2 was only achieved after a 50% dose reduction leading also to a substantial decrease of lithium serum levels. A kidney protective lithium application in patients with reduced renal function is like sailing between Scylla and Charybdis.
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Affiliation(s)
| | - Heinz Grunze
- Paracelsus Medizinische Privatuniversität
- Suchtkrankenhilfe d. Evang. Stadtmission Heidelberg gGmbH
| | - Christoph Born
- Paracelsus Medizinische Privatuniversität
- Christian-Doppler-Klinik
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Westin AA, Brekke M, Molden E, Skogvoll E, Aadal M, Spigset O. Changes in drug disposition of lithium during pregnancy: a retrospective observational study of patient data from two routine therapeutic drug monitoring services in Norway. BMJ Open 2017; 7:e015738. [PMID: 28249852 PMCID: PMC5353288 DOI: 10.1136/bmjopen-2016-015738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Pregnancy may cause changes in drug disposition, dose requirements and clinical response. For lithium, changes in disposition during pregnancy have so far been explored in a single-dose study on 4 participants only. The aim of this study was to determine the effect of pregnancy on serum levels of lithium in a larger patient material in a naturalistic setting. DESIGN A retrospective observational study of patient data from 2 routine therapeutic drug monitoring services in Norway, linked to the Medical Birth Registry of Norway. SETTING Norway, October 1999 to December 2011. MEASUREMENTS Dose-adjusted drug concentrations of lithium during pregnancy were compared with the women's own baseline (non-pregnant) values, using a linear mixed model. RESULTS Overall, coupling 196 726 serum concentration measurements from 54 393 women to the national birth registry identified 25 serum lithium concentration analyses obtained from a total of 14 pregnancies in 13 women, and 63 baseline analyses from the same women. Dose-adjusted serum concentrations in the third trimester were significantly lower than baseline (-34%; CI -44% to -23%, p<0.001). CONCLUSIONS Pregnancy causes a clinically relevant decline in maternal lithium serum concentrations. In order to maintain stable lithium concentrations during the third trimester of pregnancy, doses generally need to be increased by 50%. Individual variability in decline implies that lithium levels should be even more closely monitored throughout pregnancy and in the puerperium than in non-pregnant women to ensure adequate dosing.
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Affiliation(s)
| | - Malin Brekke
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Eirik Skogvoll
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Aadal
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
- Gildheim General Practice, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Amsterdam JD, Lorenzo-Luaces L, DeRubeis RJ. Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder. Bipolar Disord 2017; 19:6-12. [PMID: 28160351 PMCID: PMC5367974 DOI: 10.1111/bdi.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 11/06/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment. METHODS Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. RESULTS These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy. CONCLUSIONS Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.
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Affiliation(s)
- Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lorenzo Lorenzo-Luaces
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J DeRubeis
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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15
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Persson C, Kardell M, Karanti A, Isgren A, Annerbrink K, Landen M. [Prescribed drug use for bipolar disorder type I and II in clinical practice]. Lakartidningen 2017; 114:D77T. [PMID: 28094832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Prescribed drug use for bipolar disorder type I and II in clinical practice Practice guidelines based on available evidence and clinical consensus are available for the treatment of bipolar disorder. We surveyed to which extent those guidelines are implemented in clinical practice in Sweden. We analysed pharmacological treatment in patients with bipolar disorder in 2015 using the national quality register for bipolar disorder (BipoläR). We compared bipolar disorder type I (BDI) with type bipolar disorder type II (BDII). The vast majority of patients were prescribed a mood stabilizer either as monotherapy or as a part of combination therapy (BDI 87%, BDII 83%, p<0.001). Whereas lithium was the most common mood stabilizer in type I (BDI 65%, BDII 40%, p<0.001), lamotrigine was the most common mood stabilizer in type II (BDI 18%, BDII 42%, p<0.001). Antidepressants were less common in BDI than BDII (35% vs. 53%, p<0.001). Antipsychotic drugs (first or second generation) were more frequently used in BDI than BDII (49% vs 35%, p<0.001). Central stimulants were rarely used (BDI 3.1%, BDII 6.6%, p<0.001). Combining a mood stabilizer with an antipsychotic drug was more common in BDI than BDII (27% vs. 12%, p<0.001), whereas combining a mood stabilizer with an antidepressant was less common in BDI than BDII (16% vs 28%, p<0.001). We conclude that most patients are prescribed mood stabilizers and that the differences between BDI and BDII are rational given the differences in clinical manifestations. The use of antidepressants is surprisingly high given the long-standing debate about the risk and effectiveness of this class in bipolar disorder.
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Affiliation(s)
- Charlotte Persson
- Sahlgrenska universitetssjukhuset - Psykiatri Psykos Göteborg, Sweden Sahlgrenska universitetssjukhuset - Psykiatri Psykos Göteborg, Sweden
| | - Mathias Kardell
- BipoläR- Nationella kvalitetsregistret för bipolär affektiv sjukdom - Göteborgs universitet Göteborg, Sweden National Quality Register for bipolar disorder BipoläR - University of Gothenburg Gothenburg, Sweden
| | - Alina Karanti
- Institutionen för neurovetenskap och fysiologi, Göteborgs universitet - Sektionen för psykiatri och neurokemi Göteborg, Sweden Neuroscience and Physiology - Psychiatry and Neurochemistry, University of Gothenburg Gothenburg, Sweden
| | - Anniella Isgren
- Sahlgrenska akademin vid Göteborgs universitet - Institutionen för neurovetenskap och fysiologi Göteborg, Sweden Sahlgrenska akademin vid Göteborgs universitet - Institutionen för neurovetenskap och fysiologi Göteborg, Sweden
| | - Kristina Annerbrink
- Sahlgrenska akademin vid Göteborgs universitet - Institutionen för neurovetenskap och fysiologi Göteborg, Sweden Sahlgrenska akademin vid Göteborgs universitet - Institutionen för neurovetenskap och fysiologi Göteborg, Sweden
| | - Mikael Landen
- Institutionen för neurovetenskap och fysiologi, Göteborgs universitet - Sektionen för psykiatri och neurokemi Göteborg, Sweden Institutionen för neurovetenskap och fysiologi, Göteborgs universitet - Sektionen för psykiatri och neurokemi Göteborg, Sweden
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da Silva Kagy V, Trevisan Bittencourt Muniz L, Michels AC, Luiz ST, Reis Azevedo Alanis L, Brancher JA, Grégio AMT, Ignácio SA, Camargo ES, Machado MÂN, Johann ACBR. Effect of the Chronic Use of Lithium Carbonate on Induced Tooth Movement in Wistar Rats. PLoS One 2016; 11:e0160400. [PMID: 27487121 PMCID: PMC4972349 DOI: 10.1371/journal.pone.0160400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Abstract
Patients who seek dental treatment may have bipolar disorder, and lithium carbonate (LC) is the drug of choice used in the treatment of this disorder. Taking into consideration the controversial results found in the literature, and the possible influence of LC on induced tooth movement, the objective was to evaluate tooth movement induced in rats after administration of lithium carbonate. One hundred and ninety-two rats were divided into 3 groups. In the L group, the animals received daily 60mg/kg of LC, they were not subjected to orthodontic movement, and they were euthanized after 33, 37, 44 or 51 days. In the LM group, the LC was administered for 30 days and during the subsequent 3, 7, 14 and 21 days, corresponding to the period of induced tooth movement, and they received a spring that produced a 30cN force. In the SM group, saline solution was applied. Measurements were made of tooth displacement, the numbers of osteoclasts and serum lithium phosphate (PO4), alkaline phosphatase (ALP) and creatinine levels. The tooth displacement was lower in the LM group compared to the SM group at 44 days. A tendency toward reduction in the number of osteoclasts was observed in the LM group compared to the SM group at 44 days. The average lithium were higher in the L and LM groups compared to the SM group. The opposite was observed for the PO4 group. A higher value for the ALP was found in the L group. The average creatinine level was lower in the LM group. LC inhibited tooth movement for 14 days, possibly due to the reduction in the number of osteoclasts.
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Affiliation(s)
- Viviane da Silva Kagy
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Arieli Carini Michels
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Suelen Teixeira Luiz
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Luciana Reis Azevedo Alanis
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - João Armando Brancher
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Ana Maria Trindade Grégio
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Sérgio Aparecido Ignácio
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Elisa Souza Camargo
- Department of School of Health and Biosciences of Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Abstract
OBJECTIVE: To review available literature regarding the use of divalproex sodium in the treatment of agitation in elderly patients with dementia. DATA SOURCES: Clinical trials and review articles were identified by MEDLINE search (1966 — March 2002). DATA SYNTHESIS: The literature provides information regarding the potential benefits and tolerability of divalproex sodium in the treatment of dementia-related agitation. This article analyzes 7 studies to better understand the role of divalproex sodium in the treatment of dementia. CONCLUSIONS: Divalproex sodium may offer a slight benefit to elderly patients suffering from dementia-related agitation. Until better-controlled trials demonstrate statistical significance and comparisons with established treatments are performed, practitioners should use divalproex sodium cautiously.
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Affiliation(s)
- Crystal E Pratt
- Campbell University School of Pharmacy, Buies Creek, NC, USA
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Lorenzo-Luaces L, Amsterdam JD, Soeller I, DeRubeis RJ. Rapid versus non-rapid cycling bipolar II depression: response to venlafaxine and lithium and hypomanic risk. Acta Psychiatr Scand 2016; 133:459-69. [PMID: 26803764 PMCID: PMC4879786 DOI: 10.1111/acps.12557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/21/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the safety and effectiveness of antidepressant versus mood stabilizer monotherapy in rapid versus non-rapid cycling bipolar II disorder. METHOD Subjects ≥18 years old with bipolar II depression (n = 129) were randomized to double-blind venlafaxine or lithium carbonate monotherapy for 12 weeks. Responders (n = 59) received continuation monotherapy for six additional months. RESULTS Rapid cycling did not affect frequency of response or change over time in depressive symptoms. Rapid cycling status did not affect frequency of depressive relapse or sustained treatment response. Rapid cyclers were more likely to experience hypomanic symptoms (P = 0.005) during continuation monotherapy; however, rates were similar in venlafaxine (17.6%) and lithium (42.9%) (P = 0.31). CONCLUSION Rapid cycling status may not be associated with an increased risk of diminished response or greater depressive relapse during venlafaxine, relative to lithium monotherapy, in bipolar II subjects. Additional randomized studies are needed to confirm these findings.
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Affiliation(s)
- L Lorenzo-Luaces
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | - J D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - I Soeller
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R J DeRubeis
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
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Souza DN, Mendes FM, Nogueira FN, Simões A, Nicolau J. Lithium Induces Glycogen Accumulation in Salivary Glands of the Rat. Biol Trace Elem Res 2016; 169:271-8. [PMID: 26155966 DOI: 10.1007/s12011-015-0434-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/30/2015] [Indexed: 01/25/2023]
Abstract
Lithium is administered for the treatment of mood and bipolar disorder. The aim of this study was to verify whether treatment with different concentrations of lithium may affect the glycogen metabolism in the salivary glands of the rats when compared with the liver. Mobilization of glycogen in salivary glands is important for the process of secretion. Two sets of experiments were carried out, that is, in the first, the rats received drinking water supplemented with LiCl (38,25 and 12 mM of LiCl for 15 days) and the second experiment was carried out by intraperitoneal injection of LiCl solution (12 mg/kg and 45 mg LiCl/kg body weight) for 3 days. The active form of glycogen phosphorylase was not affected by treatment with LiCl considering the two experiments. The active form of glycogen synthase presented higher activity in the submandibular glands of rats treated with 25 and 38 mM LiCl and in the liver, with 25 mM LiCl. Glycogen level was higher than that of control in the submandibular glands of rats receiving 38 and 12 mM LiCl, in the parotid of rats receiving 25 and 38 mM, and in the liver of rats receiving 12 mM LiCl. The absolute value of glycogen for the submandibular treated with 25 mM LiCl, and the liver treated with 38 mM LiCl, was higher than the control value, although not statistically significant for these tissues. No statistically significant difference was found in the submandibular and parotid salivary glands for protein concentration when comparing experimental and control groups. We concluded that LiCl administered to rats influences the metabolism of glycogen in salivary glands.
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Affiliation(s)
- D N Souza
- Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes, São Paulo, SP, 2227, Brazil
| | - F M Mendes
- Departamento Ortodontia e Odontopediatria, Faculdade de Odontologia, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes, São Paulo, SP, 2227, Brazil
| | - F N Nogueira
- Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes, São Paulo, SP, 2227, Brazil
| | - A Simões
- Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes, São Paulo, SP, 2227, Brazil
| | - J Nicolau
- Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia, Universidade de São Paulo (USP), Av. Prof. Lineu Prestes, São Paulo, SP, 2227, Brazil.
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Maghraoui JE, Kabbali N, Arrayhani M, Houssaini TS. Place de l’hémodialyse dans la prise en charge de l’intoxication aiguë au lithium. Pan Afr Med J 2016; 24:27. [PMID: 27583091 PMCID: PMC4992380 DOI: 10.11604/pamj.2016.24.27.8820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Nous rapportons le cas d'un patient âgé de 47 ans, suivi depuis vingt ans pour une psychose maniaco-dépressive sous lithium admis dans un tableau de trouble de conscience après une tentative de suicide au lithium (30 comprimés de Téralithe® LP 400, forme galénique retard correspondant à 12 g de carbonate de lithium), bien amélioré cliniquement après trois séances d'hémodialyse. Cette observation illustre l'intérêt thérapeutique de l'hémodialyse au cours des intoxications volontaires au lithium sous sa forme retard même après une semaine de la prise et l'insuffisance thérapeutique d'une seule séance d'hémodialyse.
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Affiliation(s)
- Jaouad El Maghraoui
- Service de Néphrologie, CHU Hassan II, Equipe de Recherche REIN, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Nadia Kabbali
- Service de Néphrologie, CHU Hassan II, Equipe de Recherche REIN, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Mohamed Arrayhani
- Service de Néphrologie, CHU Hassan II, Equipe de Recherche REIN, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Tarik Sqalli Houssaini
- Service de Néphrologie, CHU Hassan II, Equipe de Recherche REIN, Faculté de Médecine et de Pharmacie, Fès, Maroc
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21
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Abstract
Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.
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Affiliation(s)
- Andrea Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,
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22
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Kancir ASP, Viftrup JE, Pedersen EB. [Lithium can be given to patients on haemodialysis treatment]. Ugeskr Laeger 2015; 177:60-61. [PMID: 25612969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lithium-induced nephropathy is a known complication of lithium treatment in bipolar disorder. Treatment with lithium should be discontinued, if there is evidence of lithium-induced nephropathy. However, lithium can be given to patients with end-stage-renal-disease on haemodialysis treatment, if there is no other way to control the bipolar disorder. We report one patient who was successfully treated with lithium in parallel with haemodialysis.
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Affiliation(s)
- Anne Sophie Pinholt Kancir
- Medicinsk Forskning og Universitets-klinikken i Nefrologi og Hypertension, Regionshospitalet Holstebro, Lægårdvej 12, 7500 Holstebro.
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23
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Emamghoreishi M, Keshavarz M, Nekooeian AA. Chronic lithium treatment increased intracellular S100ß levels in rat primary neuronal culture. Acta Med Iran 2015; 53:89-96. [PMID: 25725177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 11/11/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023] Open
Abstract
S100ß a neurotrophic factor mainly released by astrocytes, has been implicated in the pathogenesis of bipolar disorder. Thus, lithium may exert its neuroprotective effects to some extent through S100ß. Furthermore, the possible effects of lithium on astrocytes as well as on interactions between neurons and astrocytes as a part of its mechanisms of actions are unknown. This study was undertaken to determine the effect of lithium on S100β in neurons, astrocytes and a mixture of neurons and astrocytes. Rat primary astrocyte, neuronal and mixed neuro-astroglia cultures were prepared from cortices of 18-day's embryos. Cell cultures were exposed to lithium (1mM) or vehicle for 1day (acute) or 7 days (chronic). RT-PCR and ELISA determined S100β mRNA and intra- and extracellular protein levels. Chronic lithium treatment significantly increased intracellular S100β in neuronal and neuro-astroglia cultures in comparison to control cultures (P<0.05). Acute and chronic lithium treatments exerted no significant effects on intracellular S100β protein levels in astrocytes, and extracellular S100β protein levels in three studied cultures as compared to control cultures. Acute and chronic lithium treatments did not significantly alter S100β mRNA levels in three studied cultures, compared to control cultures. Chronic lithium treatment increased intracellular S100ß protein levels in a cell-type specific manner which may favor its neuroprotective action. The findings of this study suggest that lithium may exert its neuroprotective action, at least partly, by increasing neuronal S100ß level, with no effect on astrocytes or interaction between neurons and astrocytes.
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Affiliation(s)
- Masoumeh Emamghoreishi
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Fars, Iran. AND Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Fars, Iran.AND Psychiatric Research Centre, School of Medicine, Shiraz University of Medical Sciences, Fars, Iran.
| | - Mojtaba Keshavarz
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Fars, Iran.
| | - Ali Akbar Nekooeian
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Fars, Iran.
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24
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Abstract
INTRODUCTION Anticonvulsants (AC) are widely used and recommended as a treatment option in different phases of bipolar disorder (BD). In contrast to ample evidence for efficacy in acute mania, there is generally less unambiguous evidence for maintenance treatment or bipolar depression, and data on long-term tolerability in BD are sparse, although this varies greatly between different compounds. This review summarizes the clinically relevant tolerability and safety profile of ACs commonly used for the treatment of BD based on findings from randomized controlled trials (RCT). AREAS COVERED Systematic search of the English literature between January 1991 and May 2015 revealed a total of nine RCTs investigating valproate, five RCTs with carbamazepine and 8 with lamotrigine For these ACs we found information on side effect profiles for both acute and maintenance RCTs, albeit of varying quality, whereas for topiramate (five RCTs), gabapentin and esclicarbazepine acetate (one RCT each) only acute treatment RCTs have been published. Descriptive side effect profiles from open-label studies exist for several other ACs rarely used in BD, and are included in this review as a brief narrative chapter. EXPERT OPINION Whereas both valproate and carbamazepine are associated with, in part, severe adverse events, lamotrigine emerges as a relatively safe and well tolerated treatment option, especially in maintenance treatment and prevention of depressive relapse in BD. Lack of proven efficacy and side effect profile of other, less rigorously studied ACs restricts their use only to very selected BD cases.
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Affiliation(s)
- Eva Maria Pichler
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Georg Hattwich
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Heinz Grunze
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
| | - Moritz Muehlbacher
- a Paracelsus Private Medical University, Department of Psychiatry and Psychotherapy , Ignaz Harrer Strasse 79, 5020 Salzburg, Austria +43 6 62 44 83 43 00 ; +43 6 62 44 83 43 04 ;
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25
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Takahashi M, Suzuki M, Muneoka K, Tsuruoka Y, Sato K, Shirayama Y. Personality traits as predictors for the outcome of lithium augmentation in treatment-resistant depression. Psychiatry Res 2014; 220:1144-6. [PMID: 25453642 DOI: 10.1016/j.psychres.2014.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/27/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022]
Abstract
The NEO Personality Inventory-Revised (NEO) and the Temperament and Character Inventory (TCI) were administered to patients with treatment-resistant depression (n=21) before lithium augmentation. Analysis showed that the poor outcome group (n=11) had lower openness scores on the NEO, and lower cooperativeness scores on the TCI compared with the good outcome group (n=10). These findings may be predictors of poor responsiveness to lithium augmentation in the treatment of antidepressant-resistant depression.
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Kirkham E, Skinner J, Anderson T, Bazire S, Twigg MJ, Desborough JA. One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database. BMJ Open 2014; 4:e006020. [PMID: 25380811 PMCID: PMC4225230 DOI: 10.1136/bmjopen-2014-006020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Lithium is a mainstay of bipolar disorder treatment, however, there are still differences in opinion on the effects of lithium use on renal function. The aim of this analysis was to determine if there is an association between short-term exposure to various elevated lithium levels and estimated-glomerular filtration rate (eGFR) at ≤3 months, 6 months (±3 months) and 1 year (±3 months) follow-up. SETTING Norfolk-wide (UK) lithium register and database. PARTICIPANTS 699 patients from the Norfolk database. PRIMARY OUTCOME MEASURES eGFR change from baseline at ≤3 months, 6 months (±3 months) and 1 year (±3 months) after exposure to a lithium level within these ranges: 0.81-1.0 mmol/L (group 2), 1.01-1.2 mmol/L (group 3) and 1.21-2.0 mmol/L (group 4). The reference group was patients whose lithium levels never exceeded 0.8 mmol/L. RESULTS Compared to the reference group, groups 3 and 4 showed a significant decrease in eGFR in the first 3 months after exposure (p=0.047 and p=0.040). At 6 months (±3 months) postexposure group 4 still showed a decline in eGFR, however, this result was not significant (p=0.298). CONCLUSIONS These results show for the first time that a single incident of a lithium level >1.0 mmol/L is associated with a significant decrease in eGFR in the following 3 months when compared to patients whose lithium levels never exceeded 0.8 mmol/L. It is still not known whether the kidneys can recover this lost function and the impact that more than a single exposure to a level within these ranges can have on renal function. These results suggest that lithium level monitoring should be undertaken at least every 3 months, in line with current UK guidelines and not be reduced further until the impact of more than one exposure to these lithium levels has been fully established.
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Affiliation(s)
- E Kirkham
- School of Pharmacy, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK
| | - J Skinner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - T Anderson
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK
| | - S Bazire
- School of Pharmacy, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK
| | - M J Twigg
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - J A Desborough
- School of Pharmacy, University of East Anglia, Norwich, UK
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27
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Licht RW, Straszek SPV. [Treatment of mania in adults]. Ugeskr Laeger 2014; 176:V01130049. [PMID: 25096351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Around 1% of the population will experience at least one episode of mania. Mania has negative social consequences, may lead to cognitive impairment and may even be lethal. Therefore, prompt and efficient medical action needs to be taken, not only addressing the acute symptoms but also the high risk of recurrence. Many well-documented antimanic drugs are at hand, and the database has been carefully outlined in recent guidelines, also addressing factors of importance in choosing among the options. The real challenge is dealing with non-response, where the database is extremely poor.
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Affiliation(s)
- Rasmus Wentzer Licht
- Enheden for Psykiatrisk Forskning, Aalborg Universitetshospital, Psykiatrien, Mølleparkvej 10, 9000 Aalborg.
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28
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Abstract
Valproate is principally effective in manic aspects of bipolar disorder. Tolerability has been somewhat more favorable for valproate than comparators, with the frequent adverse effects being gastrointestinal disturbances and weight gain. Total cholesterol and low-density lipoproteins are reduced by valproate. Valproate is effective and well tolerated when combined with lithium or antipsychotic drugs. Valproate is efficacious in mixed and euphoric mania. In studies of maintenance versus placebo and active comparators, patients initially treated with divalproex for mania had more robust long-term benefits than in the full sample analyses. In maintenance treatment, patients whose valproate serum levels were between 75 and 99 microg/ml had longer time to discontinuation for any reason or a new mood episode than did patients receiving placebo. The profile of utility in bipolar disorders is principally for core features of manic symptomatology (e.g., impulsivity, hyperactivity and irritability), with little evidence of benefit for anxiety or psychosis. Valproate appears useful in other disorders that have behavioral dimensions inclusive of the domains that valproate benefits in bipolar disorders, such as schizophrenia.
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Affiliation(s)
- Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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29
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Abstract
Goiters and hypothyroidism are well-known patient complications of the use of lithium for treatment of bipolar disease. However, the occurrence of lithium-induced hyperthyroidism is a more rare event. Many times, the condition can be confused with a flare of mania. Monitoring through serial biochemical measurement of thyroid function is critical in patients taking lithium. Hyperthyroidism induced by lithium is a condition that generally can be controlled medically without the patient having to discontinue lithium therapy, although in some circumstances, discontinuation of lithium therapy may be indicated. We report on a patient case of lithium-associated hyperthyroidism that resolved after discontinuation of the medication.
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Affiliation(s)
- Fadi F Siyam
- Division of Endocrinology, Diabetes, and Metabolism.
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30
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Manchia M, Adli M, Akula N, Ardau R, Aubry JM, Backlund L, Banzato CEM, Baune BT, Bellivier F, Bengesser S, Biernacka JM, Brichant-Petitjean C, Bui E, Calkin CV, Cheng ATA, Chillotti C, Cichon S, Clark S, Czerski PM, Dantas C, Zompo MD, DePaulo JR, Detera-Wadleigh SD, Etain B, Falkai P, Frisén L, Frye MA, Fullerton J, Gard S, Garnham J, Goes FS, Grof P, Gruber O, Hashimoto R, Hauser J, Heilbronner U, Hoban R, Hou L, Jamain S, Kahn JP, Kassem L, Kato T, Kelsoe JR, Kittel-Schneider S, Kliwicki S, Kuo PH, Kusumi I, Laje G, Lavebratt C, Leboyer M, Leckband SG, López Jaramillo CA, Maj M, Malafosse A, Martinsson L, Masui T, Mitchell PB, Mondimore F, Monteleone P, Nallet A, Neuner M, Novák T, O’Donovan C, Ösby U, Ozaki N, Perlis RH, Pfennig A, Potash JB, Reich-Erkelenz D, Reif A, Reininghaus E, Richardson S, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schubert OK, Schweizer B, Seemüller F, Grigoroiu-Serbanescu M, Severino G, Seymour LR, Slaney C, Smoller JW, Squassina A, Stamm T, Steele J, Stopkova P, Tighe SK, Tortorella A, Turecki G, Wray NR, Wright A, Zandi PP, Zilles D, Bauer M, Rietschel M, McMahon FJ, Schulze TG, Alda M. Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report. PLoS One 2013; 8:e65636. [PMID: 23840348 PMCID: PMC3686769 DOI: 10.1371/journal.pone.0065636] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/26/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the "Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. MATERIALS AND METHODS Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. RESULTS Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). CONCLUSIONS We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study.
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Affiliation(s)
- Mirko Manchia
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Nirmala Akula
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, University-Hospital of Cagliari, Cagliari, Italy
| | - Jean-Michel Aubry
- Hôpitaux Universitaires de Genève, Department of Mental Health and Psychiatry, Geneva, Switzerland
| | - Lena Backlund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Bernhard T. Baune
- Department of Psychiatry, The University of Adelaide, Adelaide, Australia
| | - Frank Bellivier
- Assistance publique - Hôpitaux de Paris, Groupe Hospitalier Lariboisière-F. Widal, Pôle de Psychiatrie, Paris, France
| | | | - Joanna M. Biernacka
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Clara Brichant-Petitjean
- Assistance publique - Hôpitaux de Paris, Groupe Hospitalier Lariboisière-F. Widal, Pôle de Psychiatrie, Paris, France
| | - Elise Bui
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Cynthia V. Calkin
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Tai Ann Cheng
- Division of Epidemiology and Genetics, Academia Sinica, Institute of Biomedical Sciences, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, University-Hospital of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Department of Genomics, Life and Brain Center and Institute of Human Genetics, Bonn University, Bonn, Germany
| | - Scott Clark
- Department of Psychiatry, The University of Adelaide, Adelaide, Australia
| | - Piotr M. Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Clarissa Dantas
- Department of Psychiatry, University of Campinas, Campinas, Brazil
| | - Maria Del Zompo
- Unit of Clinical Pharmacology, University-Hospital of Cagliari, Cagliari, Italy
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
| | - J. Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sevilla D. Detera-Wadleigh
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Bruno Etain
- Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale, Equipe 15, Faculté de médecine, Créteil, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mark A. Frye
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jan Fullerton
- Neuroscience Research Australia - Genetics of Mental Illness and Brain Function, Sydney, Australia
| | - Sébastien Gard
- Service de psychiatrie, Hôpital Charles Perrens, Bordeaux, France
| | - Julie Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fernando S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, Georg-August-Universität, Göttingen, Germany
| | | | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Urs Heilbronner
- Department of Psychiatry and Psychotherapy, Georg-August-Universität, Göttingen, Germany
| | - Rebecca Hoban
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Liping Hou
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Stéphane Jamain
- Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale, Equipe 15, Faculté de médecine, Créteil, France
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Layla Kassem
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - John R. Kelsoe
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Ichiro Kusumi
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Gonzalo Laje
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale, Equipe 15, Faculté de médecine, Créteil, France
| | - Susan G. Leckband
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
- Department of Pharmacy, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America
| | | | - Mario Maj
- Department of Psychiatry, University of Napoli, Napoli, Italy
| | - Alain Malafosse
- Hôpitaux Universitaires de Genève, Department of Mental Health and Psychiatry, Geneva, Switzerland
| | - Lina Martinsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Takuya Masui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Frank Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | | - Audrey Nallet
- Hôpitaux Universitaires de Genève, Department of Mental Health and Psychiatry, Geneva, Switzerland
| | - Maria Neuner
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Tomás Novák
- Prague Psychiatric Center, University of Prague, Prague, Czech Republic
| | - Claire O’Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Urban Ösby
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Norio Ozaki
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Roy H. Perlis
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany
| | - James B. Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, United States of America
| | - Daniela Reich-Erkelenz
- Department of Psychiatry and Psychotherapy, Georg-August-Universität, Göttingen, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Eva Reininghaus
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Sara Richardson
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Guy A. Rouleau
- Centre of Excellence in Neuroscience of Université de Montréal, Centre Hospitalier de l’Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Canada
| | - Janusz K. Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter R. Schofield
- Neuroscience Research Australia - Genetics of Mental Illness and Brain Function, Sydney, Australia
| | - Oliver K. Schubert
- Department of Psychiatry, The University of Adelaide, Adelaide, Australia
| | - Barbara Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Maria Grigoroiu-Serbanescu
- Alexandru Obregia Psychiatric Hospital, Biometric Psychiatric Genetics Research Unit, Bucharest, Romania
| | - Giovanni Severino
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
| | - Lisa R. Seymour
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Claire Slaney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alessio Squassina
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Jo Steele
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Pavla Stopkova
- Prague Psychiatric Center, University of Prague, Prague, Czech Republic
| | - Sarah K. Tighe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Canada
| | - Naomi R. Wray
- The University of Queensland, Queensland Brain Institute, Brisbane, Australia
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Peter P. Zandi
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland, United States of America
| | - David Zilles
- Department of Psychiatry and Psychotherapy, Georg-August-Universität, Göttingen, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Francis J. McMahon
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Thomas G. Schulze
- Human Genetics Branch, Division of Intramural Research Programs, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Psychiatry and Psychotherapy, Georg-August-Universität, Göttingen, Germany
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- * E-mail: (TS); (M. Alda)
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail: (TS); (M. Alda)
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Taskiran S, Coffey BJ. Unremitting impulsive aggression in a child with childhood onset schizophrenia and pervasive development disorder-not otherwise specified: the role of stimulants, atypical antipsychotics and mood stabilizers. J Child Adolesc Psychopharmacol 2013; 23:363-6. [PMID: 23782130 PMCID: PMC3748417 DOI: 10.1089/cap.2013.2353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sarper Taskiran
- Koc University, Department of Child and Adolescent Psychiatry. Istanbul, Turkey
| | - Barbara J. Coffey
- Icahn School of Medicine at Mount Sinai. Department of Psychiatry. New York, NY
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Amann BL, Wesuls R, Landin Romero R, Grunze H. [De-escalation and atypical antipsychotics in the treatment of acute mania]. Fortschr Neurol Psychiatr 2013; 81 Suppl 1:S9-16. [PMID: 23681717 DOI: 10.1055/s-0033-1335241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Agitation is a severe clinical state which represents a therapeutic challenge and often forms part of manic or mixed episodes. Therapeutic options for acute mania have been limited for many years to lithium and typical antipsychotics. Besides anticonvulsants, atypical antipsychotics have been increasingly introduced in the last decade after proving their efficacy in this indication. To avoid intramuscular administration and excessive sedation, a therapeutic contact to the often agitated patient is required. De-escalation techniques can be helpful in this respect but also reduce aggressive behaviour on the ward, improve compliance, reduce relapse rates and lead to a better outcome in the long-term course of the illness. Therefore, a basic knowledge about de-escalation techniques in acute manic patients is an important clinical tool which will be critically reviewed. Furthermore, the efficacy and tolerability of atypical antipsychotics in acute mania, such as olanzapine, zotepine, risperidone, quetiapine, ziprasidone, aripiprazole, paliperidone and asenapine are discussed.
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Affiliation(s)
- B L Amann
- FIDMAG Research Foundation, Germanes Hospitalàries, Barcelona, Spain.
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Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry 2013; 14:154-219. [PMID: 23480132 DOI: 10.3109/15622975.2013.770551] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES These guidelines are based on a first edition that was published in 2004, and have been edited and updated with the available scientific evidence up to October 2012. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the long-term treatment of bipolar disorder in adults. METHODS Material used for these guidelines are based on a systematic literature search using various data bases. Their scientific rigor was categorised into six levels of evidence (A-F) and different grades of recommendation to ensure practicability were assigned. RESULTS Maintenance trial designs are complex and changed fundamentally over time; thus, it is not possible to give an overall recommendation for long-term treatment. Different scenarios have to be examined separately: Prevention of mania, depression, or an episode of any polarity, both in acute responders and in patients treated de novo. Treatment might differ in Bipolar II patients or Rapid cyclers, as well as in special subpopulations. We identified several medications preventive against new manic episodes, whereas the current state of research into the prevention of new depressive episodes is less satisfactory. Lithium continues to be the substance with the broadest base of evidence across treatment scenarios. CONCLUSIONS Although major advances have been made since the first edition of this guideline in 2004, there are still areas of uncertainty, especially the prevention of depressive episodes and optimal long-term treatment of Bipolar II patients.
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Affiliation(s)
- Heinz Grunze
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.
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34
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Geeraerts I, Sienaert P. [Predictive methods versus clinical titration for the initiation of lithium therapy. A systematic review]. Tijdschr Psychiatr 2013; 55:761-771. [PMID: 24166336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND When lithium is administered, the clinician needs to know when the lithium in the patient’s blood has reached a therapeutic level. At the initiation of treatment the level is usually achieved gradually through the application of the titration method. In order to increase the efficacy of this procedure several methods for dosing lithium and for predicting lithium levels have been developed. AIM To conduct a systematic review of the publications relating to the various methods for dosing lithium or predicting lithium levels at the initiation of therapy. METHOD We searched Medline systematically for articles published in English, French or Dutch between 1966 and April 2012 which described or studied a method for dosing lithium or for predicting the lithium level reached following a specific dosage. We screened the reference lists of relevant articles in order to locate additional papers. RESULTS We found 38 lithium prediction methods, in addition to the clinical titration method. These methods can be divided into two categories: the ‘a priori’ methods and the ‘test-dose’ methods, the latter requiring the administration of a test dose of lithium. CONCLUSION The lithium prediction methods generally achieve a therapeutic blood level faster than the clinical titration method, but none of the methods achieves convincing results. On the basis of our review, we propose that the titration method should be used as the standard method in clinical practice.
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Kulkarni J, Filia S, Berk L, Filia K, Dodd S, de Castella A, Brnabic AJM, Lowry AJ, Kelin K, Montgomery W, Fitzgerald PB, Berk M. Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice. BMC Psychiatry 2012; 12:228. [PMID: 23244301 PMCID: PMC3570370 DOI: 10.1186/1471-244x-12-228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/15/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with 'real-world' treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication. METHODS Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale - Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data. RESULTS On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts. CONCLUSIONS Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Sacha Filia
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Lesley Berk
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, 3010, Australia
- Orygen Research Centre, Parkville, VIC, 3052, Australia
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - Kate Filia
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Seetal Dodd
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, 3010, Australia
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | | | - Amanda J Lowry
- Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde, NSW, 2114, Australia
| | - Katarina Kelin
- Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde, NSW, 2114, Australia
| | - William Montgomery
- Global Health Outcomes, Intercontinental Region, Eli Lilly Australia Pty Ltd, 112 Wharf Road, West Ryde, NSW, 2114, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University, Central Clinical School, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, 3010, Australia
- Orygen Research Centre, Parkville, VIC, 3052, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, 3010, Victoria, Australia
- School of Medicine, Deakin University, Geelong, VIC, 3220, Australia
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Abstract
To review the available data behind the use of lamotrigine in unipolar depression and common comorbid conditions. A PubMed based literature review was conducted using keywords related to lamotrigine, depression, anxiety, post traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and personality disorders. A large number of trials using lamotrigine for unipolar depression and various comorbid conditions were reviewed. A major limitation behind the majority of studies was a limited course of the treatment phase. The most robust data was found among studies that followed patients for over 8 weeks, and used higher dosages. Patients with comorbid anxiety states appeared to benefit. Patients with borderline personality disorder also appeared to benefit. The benefits of lamotrigine in unipolar depression have been inconsistently noted in a number of studies. This is due in part to short treatment phases, atypical domains of benefit and different patient populations across studies. Patients with more treatment-resistance, comorbid anxiety and borderline personality disorder may be more able to benefit from lamotrigine.
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Affiliation(s)
- Adam Daniel Zavodnick
- Department of Psychiatry and Behavioral Medicine, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
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Lu RB, Chen SL, Lee SY, Chang YH, Chen SH, Chu CH, Tzeng NS, Lee IH, Chen PS, Yeh TL, Huang SY, Yang YK, Hong JS. Neuroprotective and neurogenesis agent for treating bipolar II disorder: add-on memantine to mood stabilizer works. Med Hypotheses 2012; 79:280-3. [PMID: 22677298 PMCID: PMC3622707 DOI: 10.1016/j.mehy.2012.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/18/2012] [Accepted: 04/27/2012] [Indexed: 12/29/2022]
Abstract
Bipolar disorder, characterized by a dysregulation of mood, impulsivity, risky behavior and interpersonal problems, is a recurrent and often becomes chronic psychiatric illness. However, bipolar subtypes are not often recognized in psychiatric settings, especially bipolar II subtype, until Akiskal and Angst made clear definition to bipolar I (BP-I) and bipolar II (BP-II) disorder in 1999. More and more studies, not only on family inheritance, diagnosis, but also on disease process have been reported that BP-I and BP-II are two different disorders with distinct pathological mechanisms. In general, patients with BP-II express less symptoms and have shorter hypomania stages than BP-I. According to a longitudinal research, patients with BP-II have poor recovery than do BP-I patients. Memantine used to be recognized as a noncompetitive N-methyl-d-aspartate receptor antagonist. However, it was found to have neuroprotective and neurogenesis effect in several neurodegenerative diseases in the past years. We found that memantine could inhibit brain inflammatory response through its action on neuroglial cells and provide neurotrophic effect. The above evidences of benefit on auto-immune system with memantine would support that memantine as add-on therapy to valproate might be more effective than valproate alone on improvement of the neuron degeneration in bipolar disorders. Review articles indicate that not only the mood stabilizers provide with good neuroprotection, but the memantine also have conspicuous anti-autoimmune and neurogenesis effect. Therefore, we propose that drugs with neuroprotective effect and neurotrophic effect may treat neurodegenerative diseases including BP-II. The combination treatment of mood stabilizers memantine may not only augment and improve the remedy for bipolar disorders, but also repair the damaged neurons and neurogenesis through activation of astroglial cell and release of neurotrophic factors.
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Affiliation(s)
- Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
- Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Sheng-Yu Lee
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Yun-Hsuan Chang
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
| | - Shih-Heng Chen
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Chun-Hsieh Chu
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | | | - I Hui Lee
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Po See Chen
- Institute of Behavioral Medicine, National Cheng Kung University
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, NIEHS/NIH, USA
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital & College of Medicine, National Cheng Kung University
- Institute of Behavioral Medicine, National Cheng Kung University
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Post RM, Leverich GS, Altshuler LL, Frye MA, Suppes T, McElroy SL, Keck PE, Nolen WA, Rowe M, Kupka RW, Grunze H, Goodwin FK. Relationship of prior antidepressant exposure to long-term prospective outcome in bipolar I disorder outpatients. J Clin Psychiatry 2012; 73:924-30. [PMID: 22480597 DOI: 10.4088/jcp.11m07396] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 01/23/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The long-term impact of prior antidepressant exposure on the subsequent course of bipolar illness remains controversial. METHOD 139 outpatients (mean age, 42 years) with bipolar I disorder diagnosed by DSM-IV criteria had a detailed retrospective examination of their prior course of illness on the National Institute of Mental Health Life Chart Method. Number of prior antidepressant trials and total duration of antidepressant exposure were assessed. Prospective long-term response (for at least 6 months) to naturalistic treatment in the network from 1996 through 2002 was the primary outcome measure as it related to prior antidepressant exposure (and other illness variables) by logistic regression, with P < .05 used for statistical significance in this post hoc analysis. RESULTS Greater number of antidepressant trials, but not duration of antidepressant exposure, was related to prospective nonresponse (P = .0051) whether or not antidepressants were covered by concurrent treatment with a mood stabilizer or atypical antipsychotic. Poor prospective response was also independently related to having had an anxiety disorder and 20 or more prior affective episodes. CONCLUSIONS That the number of antidepressant trials, but not duration of antidepressant treatment, was associated with prospective nonresponse suggests that it is the repeated use of antidepressants to treat episodes of depression that is related to poor prospective response to naturalistic treatment. The direction of causality is unclear as to whether more antidepressant trials led to this increased treatment resistance or whether a difficult course of illness with more episodes and anxiety comorbidity engendered more attempts at antidepressant treatment.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda, Maryland, USA.
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McKean A, Vella-Brincat J. Is it NICE to monitor lithium routinely? N Z Med J 2012; 125:50-54. [PMID: 22722215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Lithium has a narrow and well described therapeutic range. AIM The aim of this study was to evaluate lithium blood concentration monitoring in Canterbury District Health Board (CDHB) and consider whether it meets the UK National Institute for Health and Clinical Excellence (NICE) standard (in lieu of more local standards). METHODS Lithium dispensing data for patients within the CDHB boundaries was combined with lithium blood concentrations for the period of 1 July 2009 to 30 June 2010 and the results analysed. RESULTS Lithium was prescribed for 1416 patients with a mean daily dose of 507 mg per day. 92% of patients in CDHB had had a lithium blood concentration performed at least once during the year. Twenty percent had had four or more lithium blood concentrations analysed. The mean (plus or minus 95% CI) lithium blood concentration was 0.63 (0.62 to 0.64) mmol/L; the median (interquartile range) was 0.6 (0.43 to 0.80) mmol/L and the range was 0 to 2.8 mmol/L. The median (interquartile range) sampling interval was 35 (13-93) days. Sampling was performed approximately every 3 months (80 to 100 days) in 11 patients (<1%). Of those 56 patients that had a lithium blood concentrations >1.2 mmol/L only 7 patients had this repeated within 3 weeks. DISCUSSION In conclusion, lithium blood monitoring at CDHB did not achieve the NICE standard. This is in keeping with a number of other audits conducted of lithium blood monitoring.
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Affiliation(s)
- Andrew McKean
- Hillmorton Hospital, Private Bag 4733, Christchurch, New Zealand.
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Katagiri H, Takita Y, Tohen M, Higuchi T, Kanba S, Takahashi M. Safety and efficacy of olanzapine monotherapy and olanzapine with a mood stabilizer in 18-week treatment of manic/mixed episodes for Japanese patients with bipolar I disorder. Curr Med Res Opin 2012; 28:701-13. [PMID: 22356118 DOI: 10.1185/03007995.2012.666961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of 18-week olanzapine monotherapy in Japanese patients with bipolar mania, following a 6-week, placebo- and haloperidol-controlled double-blind study (acute study). For those who discontinued the acute study due to lack of efficacy, safety and efficacy was assessed with a combination therapy of olanzapine and a mood stabilizer. RESEARCH DESIGN AND METHODS In this open-label, multicenter extension study, patients who completed the acute study received olanzapine (5-20 mg/day) as monotherapy, and patients who discontinued the acute study due to lack of efficacy with greater Young Mania Rating Scale (YMRS) total score than the acute study baseline, received olanzapine in combination with one of three mood stabilizers: lithium, carbamazepine, or valproate. Safety was assessed by treatment-emergent adverse events (TEAEs), vital signs, weight, and extrapyramidal symptoms (EPSs). Efficacy measures included YMRS total score, and response and remission rates of manic symptoms. MAIN OUTCOME AND MEASURES There were no deaths or serious adverse events considered potentially related to olanzapine in the monotherapy group (N = 100) or the combination-therapy group (N = 39). TEAEs occurred in 59.0% and 79.5% of patients in the monotherapy and combination-therapy groups, respectively, and their severities were mostly mild or moderate. Regarding the efficacy measures, in the monotherapy group, mean YMRS change from extension study baseline to endpoint was -3.0, and the response and remission rates at endpoint were 97.0% and 93.0%, respectively. In the combination-therapy group, mean YMRS change from extension-study baseline was -19.8; response and remission rates increased from the extension-study baseline (both 0.0%) to 64.1% and 61.5% respectively by endpoint. CONCLUSION Olanzapine was generally well tolerated during the 18-week extension period in Japanese patients with bipolar mania. Results of both groups were also generally consistent with US and European studies. Monitoring of metabolic parameters is recommended.
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Affiliation(s)
- Hideaki Katagiri
- Lilly Research Laboratories Japan, Eli Lilly Japan K.K., Kobe, Japan.
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Abstract
The aim of this study was to provide data to aid decision making regarding lithium use during lactation. Three women treated with lithium for bipolar disorder during pregnancy and lactation and their four infants provided lithium levels at 1 month postpartum. Infant levels ranged from 10% to 17% of maternal levels. Two infants experienced early feeding problems which were overcome with breastfeeding education and support. Women taking lithium can be supported to breastfeed, and their infants should be followed closely until breastfeeding is well established.
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Affiliation(s)
- Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Mickley GA, Remus JL, Ramos L, Wilson GN, Biesan OR, Ketchesin KD. Acute, but not chronic, exposure to d-cycloserine facilitates extinction and modulates spontaneous recovery of a conditioned taste aversion. Physiol Behav 2012; 105:417-27. [PMID: 21925192 PMCID: PMC3225641 DOI: 10.1016/j.physbeh.2011.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
D-cycloserine, the glutamate N-methyl-D-aspartate receptor partial agonist, has been reported to facilitate the extinction of learned fears acquired in both naturalistic and laboratory settings. The current study extended this literature by evaluating the ability of either chronic or acute administrations of DCS to modulate the extinction and spontaneous recovery of a conditioned taste aversion (CTA). Twenty-three hour fluid-deprived Sprague-Dawley rats acquired a strong CTA following 3 pairings of a conditioned stimulus (CS; 0.3% oral saccharin)+unconditioned stimulus [US; 81 mg/kg (i.p.) lithium chloride (LiCl)]. In separate groups of rats, we then employed 2 different extinction paradigms: (1) CS-only (CSO-EXT) in which saccharin was presented every-other day, or (2) Explicitly Unpaired (EU-EXT) in which both saccharin and LiCl were presented but on alternate days. Previous studies have indicated that the EU-EXT procedure speeds up the extinction process. Further, spontaneous recovery of a CTA emerges following CSO-EXT but the EU-EXT paradigm causes a suppression of spontaneous recovery. DCS (15 mg/kg, i.p.) was administered immediately after daily liquid presentations (saccharin or water, alternate days) during the extinction period. In an acute drug manipulation, DCS (15 mg/kg, i.p.) or saline control injections were administered for 4 days only. This was done during one of 3 different phases of extinction [i.e., static (2-5%), early dynamic (8-16%), or middle dynamic (20-40%) saccharin reacceptance]. Other animals assigned to the chronic DCS condition received daily DCS (15 mg/kg, i.p.) throughout extinction. Changes in saccharin drinking in these animals were compared to the data from rats that received no drug (saline controls). Once rats met our criterion for asymptotic extinction (90% reacceptance of the CS) they entered a 30-day latency period during which they received water for 1 h/day. The day after the completion of the latency period, a final opportunity to drink saccharin was provided (spontaneous recovery test). Saline-treated control rats that went through the EU-EXT procedure achieved asymptotic extinction more quickly than did the CSO-EXT rats and did not exhibit a spontaneous recovery of the CTA. Chronic DCS treatments did not significantly reduce the time to achieve asymptotic CTA extinction in rats exposed to either CSO or EU extinction methods. Further, animals treated with DCS throughout EU-EXT exhibited a spontaneous recovery of the CTA whereas the saline-treated, EU-EXT rats did not. Thus, chronic DCS treatment did not shorten the time to extinguish a CTA and this treatment eliminated the ability of EU-EXT to block spontaneous recovery of the CTA. Acute DCS treatments were more effective in reducing the time required to extinguish a CTA than were chronic drug treatments. Moreover, the timing of these acute DCS treatments affected spontaneous recovery of the CTA depending on the extinction method employed. Acute DCS administrations later in extinction were more effective in reducing spontaneous recovery than were early administrations if the rats went through the CSO-EXT procedure. However, late-in-extinction administrations of DCS facilitated spontaneous recovery of the CTA in rats that experienced the EU-EXT method. These data agree with other findings suggesting that DCS treatments are more effective when administered a limited number of times. Our data extend these findings to the CTA paradigm and further suggest that, depending on the extinction paradigm employed, acute exposure to DCS can speed up CTA extinction and reduce spontaneous recovery of the aversion. The timing of the acute DCS treatment during extinction is generally less important than its duration in predicting the rate of CTA extinction. However, the timing of acute DCS treatments during extinction and the method of extinction employed can interact to affect spontaneous recovery of a CTA.
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Affiliation(s)
- G. Andrew Mickley
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
| | - Jennifer L. Remus
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
| | - Linnet Ramos
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
| | - Gina N. Wilson
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
| | - Orion R. Biesan
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
| | - Kyle D. Ketchesin
- The Neuroscience Program, Baldwin-Wallace College, 275 Eastland Rd., Berea, OH, 44017, USA
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Wada K. [Mood stabilizers]. Nihon Rinsho 2012; 70:58-62. [PMID: 22413493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mood stabilizers available in Japan include lithium, valproate, carbamazepine, and lamotrigine. These are prescribed for manic or hypomanic episodes of bipolar disorder, organic mania, and drug-induced mania. Careful dose titration is needed in consideration for serum drug level and clinical symptoms. Lithium frequently develops neurological toxicity because of its narrow therapeutic serum level. Valproate has the most favorable adverse effect profile among mood stabilizers, but gastrointestinal symptoms and weight gain can appear with a dose dependent fashion. Hyperammonemia is occasionally induced early after initiation of valproate and tends to be overlooked. Carbamazepine sometimes develops liver dysfunction and skin disorders associated with allergic mechanisms. Lamotrigine should be slowly titrated to avoid severe skin disorders such as Stevens-Johnson syndrome.
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Affiliation(s)
- Ken Wada
- Department of Psychiatry, Hiroshima City Hospital
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Krępuła K, Bidzińska-Speichert B, Lenarcik A, Tworowska-Bardzińska U. Psychiatric disorders related to polycystic ovary syndrome. Endokrynol Pol 2012; 63:488-491. [PMID: 23339008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The psychiatric disorders accompanying the clinical symptoms and hormonal abnormalities are important, but underestimated, aspects in PCOS. Obesity, hirsutism, acne, menstrual disturbances and infertility play important roles in lowering the quality of life in women with PCOS. Depression and anxiety are more often observed in patients with PCOS than in healthy women. Some authors consider that there is a relationship between valproic acid treatment of bipolar disease and PCOS. There have been reports that in women with PCOS anorexia nervosa, bulimia nervosa and other unspecified eating disorders are found more often than in the general population.
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Johnston S. Mind over matter? Ment Health Today 2012:14-15. [PMID: 22479943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Hoegberg LCG, Jürgens G, Zederkof VW, Holgersson B, Andersson JE, Dalhoff KP, Larsen EB, Angelo HR. A Computerised Sampling Strategy for Therapeutic Drug Monitoring of Lithium Provides Precise Estimates and Significantly Reduces Dose-Finding Time. Basic Clin Pharmacol Toxicol 2011; 110:259-63. [PMID: 21933347 DOI: 10.1111/j.1742-7843.2011.00800.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Valproic acid is associated with a variety of hematologic abnormalities, most commonly thrombocytopenia. Pancytopenia is much less common and potentially much more serious. Little is known about the natural course of valproate-induced pancytopenia. CASE SUMMARY We present a patient who developed pancytopenia while taking valproic acid for bipolar illness. After failing to respond to several other mood stabilizers, valproic acid was cautiously reintroduced with close hematologic monitoring. The pancytopenia has not recurred in the past 6 months. CONCLUSIONS Pancytopenia may not represent an absolute contraindication to continuing valproate therapy, although caution is warranted.
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Navarro R, Llamas M, Gallo E, Sánchez-Pérez J, Fraga J, García-Diez A. Follicular mucinosis in a mycosis fungoides-like hypersensitivity syndrome induced by oxcarbamazepine. J Cutan Pathol 2011; 38:1009-11. [PMID: 21899590 DOI: 10.1111/j.1600-0560.2011.01791.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lysen C, Hendriksen C, Faxholm MS, Reuther LØ. [Medication errors after hospitalisation due to multi-dose drug dispensing in the primary sector]. Ugeskr Laeger 2011; 173:1944-1945. [PMID: 21849131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Multi-dose drug dispensing (MDDD) was introduced in Denmark in 2001 in order to minimize medication errors. In May 2010 44.500 Danish citizens received MDDD. We report two cases where MDDD in the primary sector led to medication errors after hospitalisation, the reason partly being difficulties in getting information on MDDD on admission, lack of knowledge on handling MDDD in hospital and inadequate communication between the primary and the secondary sector. These problems has until now been underestimated.
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Affiliation(s)
- Charlotte Lysen
- Klinisk Farmakologisk Afdeling, Bispebjerg Hospital, 2400 København NV, Denmark
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Amrollahi Z, Rezaei F, Salehi B, Modabbernia AH, Maroufi A, Esfandiari GR, Naderi M, Ghebleh F, Ahmadi-Abhari SA, Sadeghi M, Tabrizi M, Akhondzadeh S. Double-blind, randomized, placebo-controlled 6-week study on the efficacy and safety of the tamoxifen adjunctive to lithium in acute bipolar mania. J Affect Disord 2011; 129:327-31. [PMID: 20843556 DOI: 10.1016/j.jad.2010.08.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Considerable amount of biochemical data supports the potential involvement of protein kinase C in the pathophysiology and treatment of bipolar disorder. The aim of this double-blind, placebo-controlled study was to investigate the efficacy and tolerability of tamoxifen as an adjunct to lithium for the treatment of acute mania in hospitalized bipolar patients. METHODS Eligible participants were 40 inpatients, between the ages of 19 and 49 years with current manic episode. Patients were randomly allocated to lithium (1-1.2 mEq/L) + tamoxifen 80 mg/day (group A) or lithium (1-1.2 mEq/L) + placebo (group B) for a 6-week, double-blind, placebo-controlled study. The principal measure of outcome was the Young Mania Rating Scale. The raters used standardized instructions for Young Mania Rating Scale. RESULTS Young Mania Rating Scale scores improved with tamoxifen. The difference between the two protocols was significant as indicated by the effect of the group, the between-subjects factor (F=5.41, df=1, p=0.02). A significant difference was observed on the Positive and Negative Syndrome Scale total score at week 6 in the two groups. The difference between the two groups in the frequency of side effects was not significant except for fatigue that occurred more often in the tamoxifen group. LIMITATIONS Tamoxifen is an antagonist of estrogen receptor as well. CONCLUSION The results demonstrate that the combination of tamoxifen with lithium was superior to lithium alone for the rapid reduction of manic symptoms. The combined use of tamoxifen with lithium was well tolerated in these acutely manic patients.
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Affiliation(s)
- Zohreh Amrollahi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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