Suicide death over the first year of lithium versus valproate treatment in cohorts with and without bipolar disorder

Despite the enormous costs associated to mood disorders’, few studies evaluate potential cost saving from the use of pharmacogenetic tests (PGT). This study compares 12 months before the execution of the PGT versus 12 months after, in terms of number and days of hospitalization and accesses to emergency services, in a sample of 30 patients affected by bipolar disorder. Secondarily, the study gives an economic value to the data based on the diagnosis-related group (DRG). Patients included in the study were required to be aged ≥18 years, sign an informed consent, have a score of Clinical Global Impression item Severity (CGIs) ≥3, and have a discordant therapy compared to the PGT in the 12 months preceding it and a therapy consistent with it for the following 12 months. Cost saving has been evaluated by paired t-tests in a mirror analysis. Statistically significant differences in all the comparisons (p < 0.0001) emerged. Important cost saving emerged after the use of PGT (€148,920 the first year versus €39,048 the following year). Despite the small sample size and lack of a control group in this study, the potential role of PGT in cost saving for the treatment of bipolar disorder treatment emerged. To confirm this result, larger and clinical trials are needed.

Download Full-text

Antiepileptic drugs and suicide-related outcomes in bipolar disorder: A descriptive review of published data

Mental Health Clinician ◽

10.9740/mhc.2018.05.138 ◽

2018 ◽

Vol 8 (3) ◽

pp. 138-147 ◽

Cited By ~ 6

Author(s):

Charles F. Caley ◽

Emily Perriello ◽

Julia Golden

Keyword(s):

Bipolar Disorder ◽

Antiepileptic Drugs ◽

Suicide Attempts ◽

Reference Group ◽

Lithium Treatment ◽

Reporting Rate ◽

Published Data ◽

Suicide Death ◽

Suicidal Thinking ◽

Increased Risk

Abstract Introduction: In January 2008 the US Food and Drug Administration issued a warning to healthcare professionals about the potential for an increased risk of suicidal thinking and behavior associated with antiepileptic drugs (AEDs). Given that AEDs are important for treating bipolar disorder (BD), a better understanding of suicide-related events is necessary. Methods: A PubMed search was performed using the following search terms: anticonvulsant OR valpro* OR carbamazepine OR lamotrigine OR oxcarbazepine OR topiramate AND bipolar AND suicid*. The objective was to identify published investigations reporting rate and/or risk data of suicide-related outcomes in BD patients treated with AED monotherapy. Results: The search identified 323 reviewable citations, with 13 of these studies (4.0%) being reviewed. Valproate was studied most often, and lithium treatment was frequently used as a reference group. Carbamazepine and lamotrigine had small treatment exposure durations. Suicide attempts and suicide deaths were studied the most; a few trials investigated suicidal thinking and/or hospitalizations for suicidal behavior. Suicide attempt rates occurred in the following order: no treatment > carbamazepine > valproate > lithium, while suicide death rates were: no treatment > valproate > lithium > carbamazepine. For valproate, the risk of suicide attempts and suicide death appeared higher than lithium, but lower than no treatment. Discussion: Investigating suicide-related events for AEDs in BD is difficult; more data are necessary for valproate, carbamazepine, and lamotrigine. An improved understanding of AED treatment and suicide-related events in BD may help pharmacists become more effective at supporting their patients with BD.

Download Full-text

Risk of suicide attempt and suicide death in patients treated for bipolar disorder

Bipolar Disorders ◽

10.1111/j.1399-5618.2007.00408.x ◽

2007 ◽

Vol 9 (5) ◽

pp. 526-530 ◽

Cited By ~ 97

Author(s):

Gregory E Simon ◽

Enid Hunkeler ◽

Bruce Fireman ◽

Janelle Y Lee ◽

James Savarino

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Suicide Death

Download Full-text

Prevalence and 5-year trend of incidence for medical illnesses after the diagnosis of bipolar disorder: A nationwide cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211046891 ◽

2021 ◽

pp. 000486742110468

Author(s):

Pao-Huan Chen ◽

Shang-Ying Tsai ◽

Chun-Hung Pan ◽

Yi-Lung Chen ◽

Sheng-Siang Su ◽

...

Keyword(s):

Bipolar Disorder ◽

Human Immunodeficiency Virus ◽

Heart Disease ◽

Incidence Rate ◽

Cerebrovascular Diseases ◽

First Year ◽

Immunodeficiency Virus ◽

Adjusted Incidence Rate ◽

Rate Ratios ◽

Adjusted Incidence

Objective: Medical comorbidities are prevalent in patients with bipolar disorder. Evaluating longitudinal trends of the incidence of medical illnesses enables implementation of early prevention strategies to reduce the high mortality rate in this at-risk population. However, the incidence risks of medical illnesses in the early stages of bipolar disorder remain unclear. This study investigated the incidence and 5-year trend of medical illnesses following bipolar disorder diagnosis. Methods: We identified 11,884 patients aged 13–40 years who were newly diagnosed as having bipolar disorder during 1996–2012 and 47,536 age- and sex-matched controls (1:4 ratio) who represented the general population from Taiwan’s National Health Insurance Research Database. We estimated the prevalence and incidence of individual medical illnesses yearly across the first 5 years after the index date. The adjusted incidence rate ratio was calculated to compare the occurrence of specific medical illnesses each year between the bipolar disorder group and control group using the Poisson regression model. Results: Apart from the prevalence, the adjusted incidence rate ratios of most medical illnesses were >1.00 across the first 5-year period after bipolar disorder diagnosis. Cerebrovascular diseases, ischaemic heart disease, congestive heart failure, other forms of heart disease, renal disease and human immunodeficiency virus infection exhibited the highest adjusted incidence rate ratios during the first year. Except for that of renal disease, the 5-year trends of the adjusted incidence rate ratios decreased for cerebrovascular diseases, cardiovascular diseases (e.g. ischaemic heart disease, other forms of heart disease, and vein and lymphatic disease), gastrointestinal diseases (e.g. chronic hepatic disease and ulcer disease) and communicable diseases (e.g. human immunodeficiency virus infection, upper respiratory tract infection and pneumonia). Conclusion: Incidence risks of medical illnesses are increased in the first year after bipolar disorder diagnosis. Clinicians must carefully evaluate medical illnesses during this period because the mortality rates from medical illnesses are particularly high in people with bipolar disorder.

Download Full-text

"Born Out of Fear": A Grounded Theory Study of the Stigma of Bipolar Disorder for New Mothers

The Qualitative Report ◽

10.46743/2160-3715/2018.3382 ◽

2018 ◽

Author(s):

Walker Ladd

Keyword(s):

Bipolar Disorder ◽

Mental Illness ◽

Grounded Theory ◽

Bipolar Disorders ◽

Future Research ◽

First Year ◽

New Mothers ◽

Grounded Theory Study ◽

Core Category ◽

Stigma Of Mental Illness

Childbirth is an established trigger for the onset of bipolar disorders (BD) in the postpartum period, causing significant pathology and disability. Research has shown that the stigma of mental illness for new mothers is a powerful obstacle to care, preventing women from accessing critical treatment and social support. However, the majority of research has examined the relationship between the stigma and postpartum depression, leaving a gap in knowledge regarding stigma and postpartum bipolar disorder. The problem addressed in this grounded theory study was the lack of knowledge regarding the stigma of a diagnosis of bipolar disorder (BD) in the first year postpartum. A theoretical sample of 15 women given a clinical diagnosis of a BD in the first year postpartum participated in one, 60-90-minute recorded interview using semi-structured questions. I analyzed typed interview transcripts using open, axial, and selective coding according to grounded theory methods. Emergent categories: Diagnosis, Experiencing Stigma, and Lack of Understanding revealed the relief in the initial diagnosis and the subsequent experience of stigma in the form of stigmatizing stereotypes, prejudicial attitudes and discrimination, and the development of the belief that stigma was caused by universal lack of understanding regarding BD. The core category of Born Out of Fear was identified. Selective coding confirmed that the stigma experienced by participants was consistent with existing models of stigma, with the exception that women did not describe their babies or other children as components of the experience of stigma. Increased understanding of the stigma of mental illness for new mothers creates pathways for future research.

Download Full-text

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2012-0048 ◽

2014 ◽

Vol 36 (1) ◽

pp. 16-22 ◽

Cited By ~ 2

Author(s):

Fernanda Novis ◽

Patricia Cirillo ◽

Rafael Assis da Silva ◽

Ana Letícia Santos ◽

Luciana Angélica Silva Silveira ◽

...

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Rating Scale ◽

Depression Scale ◽

First Episode ◽

First Year ◽

International Studies ◽

Hamilton Depression Scale ◽

Adequate Treatment ◽

Depressive Episodes

INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

Download Full-text