Long-acting new generation antipsychotics in the maintenance treatment of bipolar disorders

Introduction

Maintaining remission, preventing from future episodes, better treatment adherence and improving the quality of life are main aims of long-term treatment in bipolar disorders (BD). In recent years, new generation long-acting injectable (LAI) antipsychotics have been frequently used in maintenance treatment for bipolar disorders.

Objectives

We aimed to review socio-demographic and clinical characteristics of bipolar patients taking LAI treatment for maintenance treatment.

Methods

Clinical records of 44 bipolar patients who are on LAI treatment and followed in Mazhar Osman Mood Clinic (MOMC) of Selcuk University Medical Faculty were evaluated.

Results

Nearly half of the patients were male (n:24, 54%). 43,2% of the patients were married. The mean age was 36.6±11.9 years and the mean duration of education was 11.5±3.9 years. All of the patients were diagnosed with bipolar 1 disorder. Most of the patients (65.9%) was on aripiprazole LAI while remaining was receiving paliperidone LAI for maintenance treatment. Ten of the patients discontinued the treatment due to the side effects and extrapyramidal side effects was the most common side effect. Relapse was observed in 25% of the patients and there was no difference between aripiprazole and paliperidone in terms of relapse rate.

Conclusions

LAI new generation antipsychotics are taking place in long-term treatment of bipolar disorder via improving treatment adherence. Side effect profile of aripiprazole and paliperidone are different. However, we could not find any difference between two drugs in terms of side effects and relapse rates. Small sample size and shorter duration of follow-up should be considered as limitations.

Disclosure

No significant relationships.

Evaluation of the relationship between lithium treatment response and suicide attempt in bipolar disorder

Introduction

Suicide risk is 20-30 fold higher in bipolar disorder(BD) than general population. A positive family history of suicide, early-onset bipolar disorder, rapid cycling, and drug/alcohol addiction have been identified as risk factors for non-fatal suicidal behavior. Lithium is the only mood stabilizer known to have a suicide-reducing effect in patients with BD. Less than half of the bipolar patients respond lithium well. Even though mechanism of action on suicide behavior is not clearly known, it is thought that lithium significantly reduces “impulsive-aggressive” behavior via serotonergic system which might also be related with treatment response in BD.

Objectives

The aim of this study is to evaluate the relationship between lithium response and history of suicide.

Methods

Those who scored 7 points or more from the Alda total score were considered good responders. Patients were divided into those who responded well to lithium treatment and those who did not. History of suicide attemptbetween these two groups was compared.

Results

65.3% of the patients were female (n:49). The mean age of the patients was 36.82±13.35 years. 25 patients responded well to lithium treatment. Among the good responders, 32% of the patients and 25% of the non-responders had a history of suicide attempts. This difference was not statistically significant. (p=0.46 x²=0.13)

Conclusions

The insufficient number of data in the study was considered as a limitation of this study. In addition, there is a need for more studies as there are many factors that cause suicide attempts.

Disclosure

No significant relationships.

Is there a relationship between clinical stage and cardiovascular disease risk in bipolar disorder?

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in bipolar disorders(BD). The heart age of patients with BD was found to be 8.5 years higher than gender-age matched health controls. Metabolic side effects of antipsychotics, poor diet, insufficient physical activity, smoking and sedentary life style increase the risk of cardiovascular disease in bipolar patients. QRISK-3 is an approved risk classification that calculates the 10-year risk of developing a heart attack or stroke.

Objectives

This study aims to determine whether there is a difference between cardiovascular disease risk scores and clinical stages of bipolar disorder

Methods

35 outpatients that were followed up in Selcuk University Medical Faculty were evaluated. The clinical stages and qrisk3 scores were calculated.

Results

68.6% (n:24) of the patients were female. 42.9% of patients were in stage 3b (recurrent relapses, complete remission between episodes). The mean age was 36.94 ±10.46 years. The mean heart age was 50.54±17.35. The mean Q risk3 score was 5.59±8.18. There was no difference between bipolar patients at stage 2 and stage 3 in terms of age(p=0.36 and gender(p=0.73). When we compared the qrisk3 total socres and heart age of the patients in stage 2 and 3, we could not find any difference between groups (p=0.74, p=0.57 respectively).

Conclusions

Even though we could not find any difference of qrisk scores at different clinical stages of patients with BD, the CVD risk increases with the age. Prospective longitudinal follow-up studies are required to evaluate dual interaction of clinical stages and CVD risk in BD.

Disclosure

No significant relationships.

Evaluation of the Relationship Between Suicide Behavior and SIRT-1 Gene in Patients with Schizophrenia and Other Psychotic Disorders

Introduction

Schizophrenia is a mental disorder with a high risk of suicide, which is one of the leading causes of early death in schizophrenia patients.

Objectives

It was aimed to examine the relationship between the SIRT1 gene and suicidal behavior in patients with schizophrenia, to identify specific polymorphisms and to provide individual protective approaches by predicting suicidal behavior.

Methods

100 patients with schizophrenia were included in our study. The SIRT1 gene was analyzed using the whole exome sequencing method, and 22 SNPs were identified. In addition, participants’ socio-demographic, psychiatric history, and suicidal behavior evaluation form data were recorded. A comparison was made between the two groups according to suicidal behavior.

Results

When sociodemographic and psychiatric history of the participants were compared in terms of suicidal behavior, no significant difference was found. SIRT1 gene SNP; rs2236318; (TT genotype), rs10997870 (GG genotype) was associated about 4 times increased risk in suicidal behavior; rs41299232 (CC genotype) 3.7 times; rs7896005 (AA genotype) with 3.4 times also. Although rs201230502 (TC genotype) and rs36107781 (TC genotype) were more common in the group with suicidal behavior, they lost their significance in regression analysis due to the low number of cases.

Conclusions

Our study showed that schizophrenia has many risks that increase suicidal behavior , but clinical and sociodemographic data are insufficient to predict suicidal behavior. Considering the inheritability of the disease and the effect of genetics on behavior, SIRT1 gene SNP; (rs2236318, rs10997870, rs41299232, rs7896005, rs201230502 and rs36107781) genotypes were found to be associated with suicidal behavior in schizophrenia patients.

Disclosure

No significant relationships.

Relationship between alexithymia and chronic periodontitis

OBJECTIVE

The aim of this study was to investigate the potential relationship between alexithymia and chronic periodontitis.

MATERIALS AND METHODS

A case-control study of 222 male and female subjects aged 21-63 years was conducted. The participants were divided into a chronic periodontitis group (n = 114) and a control group (n = 108) with no history of periodontitis. The Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia status of the subjects. Clinical data were collected on parameters such as the plaque index, bleeding on probing, probing depth, and the clinical attachment level (CAL). Socioeconomic data on the patients were also recorded.

RESULTS

Chronic periodontitis group showed higher frequency in alexithymic patients as compared to control group. The proportion of high dental anxiety did not differ between the groups. The total TAS-20 score was statistically significantly higher in male subjects than in female subjects (P < 0.05). The bivariate analyses of the psychometric measures and the periodontal parameters revealed positive correlations with the severity of periodontal disease/CAL and the total TAS-20 score (P < 0.05).

CONCLUSION

The results of the current study suggest that alexithymia is a possible risk factor for chronic periodontitis. Further research is needed to identify the underlying mechanism.