Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S332-S332
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
A. De Severac Cano ◽  
I. Tilves Santiago ◽  
F. Moreno De Lara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Oral Treatment ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Community Center ◽  
Psychotic Symptoms ◽  
Competing Interest ◽  
Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Is bipolar over diagnosed in adolescents?

2017 ◽  
Vol 41 (S1) ◽  
pp. S451-S451
Author(s):  
S. Paulino ◽  
N. Santos ◽  
A.C. Almeida ◽  
J. Gonçalves
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Statistical Analysis ◽  
Mood Stabilizers ◽  
Review Of The Literature ◽  
Mood Instability ◽  
Adolescent Population ◽  
Life Threatening ◽  
Competing Interest

IntroductionSince the mid-1990s, the diagnosis of bipolar disorder has increased significantly: two-fold among adults, four-fold among adolescents and 40-fold among children. Mood instability is a hallmark symptom of many psychiatric disorders but does not imply necessarily a diagnosis of bipolar disorder. Misdiagnosis is not just an academic issue: mood stabilizers have significant adverse effects and expose patients to side effects that range from mild to potentially life-threatening.ObjectivesDiscuss the potential overestimation of bipolar diagnosis in the adolescent population through a statistical analysis of a sample from the adolescence's consultation of Centro Hospitalar Lisboa Norte.MethodsAnalysis of 106 patients taking into account the initial diagnosis and the diagnostic stability over 6 months. Non-systematic review of the literature.ResultsFrom this sample, 39.2% of the adolescents have a diagnose of unipolar affective disorder, 0.02% of bipolar disorder and 0.1% of disruptive mood disorder. These diagnoses did not change over the follow-up period.ConclusionIt is important to try to understand the reasons of this potential discrepancy (influence of pharmaceutical company marketing, of parents’ desire, of doctors’ fear) to reduce controversy and confusion and to adjust treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Awkward movements: Extrapyramidal symptoms in a group of patients treated with aripiprazole long acting injectable

2016 ◽  
Vol 33 (S1) ◽  
pp. S552-S553
Author(s):  
C. Victor ◽  
S. Berta ◽  
T. Ivan ◽  
O. Silvia ◽  
C. Sandra ◽  
...  
Keyword(s):  
Side Effects ◽  
Oral Treatment ◽  
Care Center ◽  
Extrapyramidal Symptoms ◽  
Average Score ◽  
Health Care Center ◽  
Normal Limits ◽  
Competing Interest ◽  
Long Acting

IntroductionExtrapyramidal symptoms are well known as side effects in therapy with antipsychotics. Explore this side effects is mandatory because they normally are a cause of treatment discontinuation or assess a change in medication. Some studies notice how long acting injectable antipsychotic cause less extrapyramidal symptoms than oral treatment, others does not find differences.ObjectiveThe aim of this study is to analyze the extrapyramidal symptoms presented on a group of patients treated with aripiprazole long acting injectable (ALAI) follow-up in a mental health care center.MethodsDescriptive study of a group of patients treated with ALAI. To assess the possible extrapyramidal symptoms due to treatment we have used the Simpson-Angus Scale (SAS). The follow up was 3 months after initiation of treatment.ResultsSix patients were included in the study, 2 women (33.3%) and 4 men (66.7%). The mean age of the sample was 37 years old. The different diagnoses of the group were 4 patients with psychotic disorder (66.7%; 2 schizophrenia, 1 schizoaffective disorder and 1 delusional chronic disorder) and the other 2 had an affective disorder (33.3%; both bipolar disorder). The average score for the SAS was 1.2 meaning normal results and therefore no significant extrapyramidal symptoms.ConclusionsIn our sample the average of the results obtained by applying the SAS is considered within normal limits. In our case as to extrapyramidal effects ALAI treatment has been well tolerated. A larger sample would be needed to obtain more reliable results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Potential Misdiagnosis of Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
D. Correia ◽  
L. Correia ◽  
T. Gandra ◽  
F. Silva
Keyword(s):  
Bipolar Disorder ◽  
Seasonal Pattern ◽  
Large Fraction ◽  
Review Literature ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Obsessive Compulsive ◽  
Clinical Indicators ◽  
Compulsive Disorder

Background:Several reports indicate that Bipolar Disorder (BD) is frequently underdiagnosedleading to overuse of antidepressants and underuse of mood stabilizers.Aims and methods:The aim is to review literature concerning this subject published since 2000.Results:BD seems to be frequently underdiagnosed. Several studies, as EPIDEP and NEMESIS, reveal insufficiencies on the diagnosis of this disorder, suggesting that clinicians miss this diagnosis about half of the times, and that about three quarters of these patients are not receiving appropriate treatment, respectively.BD is often misdiagnosed as Major Depression Disorder (MDD), with approximately 40% of BD patients being initially diagnosed as MDD. On the other hand, a large fraction of patients initially diagnosed as MDD will change diagnosis to BD during follow-up, with some authors presenting values as high as 67%. Studies comparing the depressive features of MDD and BD point to some strong clinical indicators of bipolarity in patients presenting with depression, such as family history, seasonal pattern, postpartum onset, psychotic symptoms, younger age, suicidal behaviours, among others.To a lesser extent, BD can also be misdiagnosed as: substance abuse, borderline personality, obsessive-compulsive disorder, among others.It is also important to consider that a large fraction of patients with BD diagnosis will change diagnosis during the follow-up period.Conclusion:BD patients with the diagnosis may represent only a fraction of the subjects with this disorder, and the true epidemiological extent of this problem needs further investigation.

scholarly journals Maintenance Treatment of Bipolar Disorder with Ziprasidone in Adjunctive Use with Lithium or Valproate

2012 ◽  
Vol 4 ◽  
pp. CMT.S7369 ◽  
Author(s):  
Steven L. Dubovsky ◽  
Amelia N. Dubovsky
Keyword(s):  
Bipolar Disorder ◽  
Antipsychotic Drugs ◽  
Mood Stabilizer ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Comorbid Conditions ◽  
Recurrence Rates ◽  
Atypical Antipsychotic Drug ◽  
A Current

Ziprasidone is a second generation (“atypical”) antipsychotic drug that has been used alone and as an adjunct to standard mood stabilizers to reduce recurrence rates in bipolar disorder. Approval of ziprasidone as an adjunct to lithium or valproate in 2009 was based on an industry sponsored study of 584 outpatients with a current or recent manic episode; 240 of these subjects were randomized to adjunctive ziprasidone or placebo and 138 completed a six month trial. Patients enrolled in maintenance studies did not have refractory mood disorders, comorbid conditions or risk of dangerousness. Maintenance ziprasidone augmentation is an option for patients who do not respond to a single mood stabilizer rapidly, and possibly for those with residual psychotic symptoms, but there are insufficient data to prefer this approach to combinations of mood stabilizers or augmentation with other agents. Ziprasidone is generally well tolerated, with less sedation and weight gain than many other antipsychotic drugs; it should be taken with food. Primary interactions of concern are with other serotonergic medications, MAO inhibitors, and other medications that prolong the QT interval.

Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S493-S493
Author(s):  
J. Nogueira ◽  
R. Ribeiro ◽  
J. Vieira ◽  
R. Sousa ◽  
S. Mendes ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Corpus Callosum ◽  
Past History ◽  
Case Reports ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
Major Depressive ◽  
Mixed Features ◽  
Competing Interest ◽  
The Brain

BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evidence-based maintenance treatment of bipolar disorder

2017 ◽  
Author(s):  
Dina Popovic ◽  
Eduard Vieta
Keyword(s):  
Bipolar Disorder ◽  
Randomized Controlled Trials ◽  
Maintenance Treatment ◽  
Mood Stabilizers ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Randomized Controlled ◽  
Second Generation Antipsychotics ◽  
Long Acting

Due to the episodic and chronic nature of bipolar disorder, maintenance therapy represents a critical part of treatment. However, there is a paucity of studies comparing effectiveness of available long-term treatments. In this chapter, the efficacy and safety of pharmacological treatments for maintenance treatment of bipolar disorder, as deriving from the results of randomized controlled trials, will be critically reviewed. These include second-generation antipsychotics aripiprazole, olanzapine, quetiapine, risperidone long-acting injection, ziprasidone, paliperidone, and mood stabilizers lamotrigine, lithium, valproate, carbamazepine, and oxcarbazepine. In general, if a patient has responded satisfactorily to a certain drug during the acute phase, the same treatment should be maintained during maintenance treatment. This was confirmed in two randomized controlled trials. This chapter summarizes the characteristics of the placebo-controlled randomized controlled trials for all the antipsychotics used for maintenance treatment of bipolar disorder.

Use of antidepressants in maintenance phase of patients with bipolar disorder in an outpatient setting

2016 ◽  
Vol 33 (S1) ◽  
pp. S124-S124
Author(s):  
A. Peh ◽  
W.K. Tay
Keyword(s):  
Bipolar Disorder ◽  
Combination Treatment ◽  
Maintenance Treatment ◽  
Maintenance Phase ◽  
Outpatient Setting ◽  
Mood Stabilizers ◽  
Psychiatric Clinic ◽  
Bipolar Ii ◽  
Antidepressant Use ◽  
Competing Interest

IntroductionGuidelines for the maintenance treatment of bipolar disorder discourage the use of antidepressants chiefly on grounds of unproven efficacy and risk if mania for bipolar I. However, for patients stabilised on an antidepressant, naturalistic data support its continued use.AimThe aim is to describe use of antidepressants in patients with bipolar disorder in remission seen at an outpatient clinic in Singapore.MethodsThe case notes of patients with bipolar disorder in remission, seen by psychiatrist in an outpatient psychiatric clinic in a general hospital unit from December 2014 to March 2015 were studied. Data describing the age, sex, type of bipolar disorder and psychotropic medications prescribed, was obtained.ResultsForty-two patients were included, of which 13 (31%) were male and 29 (69%) were female. The age ranged from 23 to 82, with mean age of 47 years. Of these 17 (40%) had bipolar I and 25 (60%) had bipolar II. Antidepressant use for maintenance treatment was present in 19 out of 42 (45%) of these patients; of these 7 out of 17 (41%) were bipolar 1 and 12 out of 25 (48%) were bipolar II. Eighteen out of the 19 (95%) patients who were prescribed antidepressants were on combination treatment with mood stabilizers. Antidepressant type included SSRI (37%), NDRI (37%), SNRI (10.5%), TCA (10.5%), NASSA (5%).ConclusionAlmost half of patients with bipolar disorder managed in an individual practice were on antidepressants together with mood stabilisers. They remained in remission with combination treatment, which did not seem to jeopardise their condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Discontinuation and relapse with paliperidone palmitate three-monthly for maintenance of schizophrenia: Two year follow-up of use in clinical practice

2021 ◽  
pp. 026988112110097
Author(s):  
Phoebe Wallman ◽  
Ivana Clark ◽  
David Taylor
Keyword(s):  
Clinical Practice ◽  
Treatment Duration ◽  
Maintenance Treatment ◽  
Clinical Care ◽  
Paliperidone Palmitate ◽  
Reduce Risk ◽  
Patient Refusal ◽  
Long Acting ◽  
Post Hoc

Background: The use of antipsychotic long-acting injections (LAI) aims to reduce risk of relapse and hospitalisation in patients with schizophrenia compared with oral medication. Paliperidone palmitate is currently the only LAI that can be administered at three-monthly intervals for maintenance treatment of schizophrenia. Aim: This prospective study aimed to evaluate relapse and continuation in licensed use of paliperidone palmitate three-monthly (PP3M) over a 2-year follow-up in clinical practice. Method: Non-interventional, observational study of patients treated in the South London and The Maudsley NHS Foundation Trust. Results: A total of 166 patients initiated on PP3M, 55 were excluded from the study (non-F20 diagnosis ( n = 43); F20 >65 years old ( n = 12)). Of the 111 patients included, 67 (60%) continued PP3M for 2 years. Overall 102 patients received more than one dose of PP3M and 92 (90%) remained on the same dose of PP3M for the whole of their treatment duration. Relapse (defined as a step-up in clinical care) occurred in eight patients (7%) while on PP3M. The most common reason for discontinuation was patient refusal and the most frequent medication prescribed after discontinuation was paliperidone palmitate one-monthly (PP1M). Post hoc, we analysed outcome in those continuing any form of PPLAI (those continuing with PP3M and those switching back to PP1M). Continuation over 2 years with any PPLAI formulation was 73% (81/111) and relapse was recorded in 9% (10/111). Conclusion: Overall, PP3M was an effective maintenance treatment for schizophrenia after stabilisation on PP1M in a clinical setting.

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

2019 ◽  
Vol 53 (5) ◽  
pp. 458-469 ◽  
Author(s):  
YC Janardhan Reddy ◽  
Venugopal Jhanwar ◽  
Rajesh Nagpal ◽  
MS Reddy ◽  
Nilesh Shah ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Self Report ◽  
Mood Stabilizers ◽  
Prescribing Practices ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome

Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists’ practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

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