C.19.01 Treatment adherence and long-term outcomes of bipolar disorder

Offspring of patients with schizophrenia or bipolar disorder have an increased risk of developing these conditions. However, our capacity to predict the long-term outcomes of these at-risk individuals is limited. Now, researchers have investigated whether longitudinal changes in brain structure differ in individuals at high familial risk who develop psychotic spectrum symptoms, compared to those who do not and to low-risk controls.

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A Systematic Review of the Clinical Use of Gabapentin and Pregabalin in Bipolar Disorder

Pharmaceuticals ◽

10.3390/ph14090834 ◽

2021 ◽

Vol 14 (9) ◽

pp. 834

Author(s):

Qin Xiang Ng ◽

Ming Xuan Han ◽

Seth En Teoh ◽

Clyve Yu Leon Yaow ◽

Yu Liang Lim ◽

...

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Significant Proportion ◽

Evidence Base ◽

Small Sample ◽

Long Term Outcomes ◽

Open Label ◽

Related Drug ◽

Small Sample Sizes

Despite its prevalence and disease burden, several chasms still exist with regard to the pharmacotherapy of bipolar disorder (BD). Polypharmacy is commonly encountered as a significant proportion of patients remain symptomatic, and the management of the depressive phase of the illness is a particular challenge. Gabapentin and pregabalin have often been prescribed off-label in spite of a paucity of evidence and clinical practice guidelines to support its use. This systematic review aimed to synthesize the available human clinical trials and inform evidence-based pharmacological approaches to BD management. A total of six randomized, controlled trials (RCTs) and 13 open-label trials involving the use of gabapentin and pregabalin in BD patients were reviewed. Overall, the studies show that gabapentin and its related drug pregabalin do not have significant clinical efficacy as either monotherapy or adjunctive therapy for BD. Gabapentin and pregabalin are probably ineffective for acute mania based on the findings of RCT, with only small open-label trials to support its potential adjunctive role. However, its effects on the long-term outcomes of BD remain to be elucidated. The evidence base was significantly limited by the generally small sample sizes and the trials also had heterogeneous designs and generally high risk of bias.

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Treatment Adherence and Long-Term Outcomes

CNS Spectrums ◽

10.1017/s1092852900026304 ◽

2007 ◽

Vol 12 (S17) ◽

pp. 21-26 ◽

Cited By ~ 56

Author(s):

John M. Kane

Keyword(s):

Public Health ◽

Treatment Adherence ◽

Public Health Issue ◽

Functional Domains ◽

Long Term Outcomes ◽

Successful Management ◽

Antipsychotic Medications ◽

Critical Step ◽

Over Time

AbstractThe successful management of schizophrenia is an enormous public health issue. Although antipsychotic medications can be very helpful in reducing rates of relapse and rehospitalization, nonadherence to medication is a frequent cause of exacerbations in psychopathology, psychotic relapse, and rehospitalization. Relapses can have devastating consequences in a variety of clinical and functional domains. Nonadherence can result from a variety of factors that vary from patient to patient and vary over time in individual patients. A number of strategies have been developed to assess and facilitate adherence. The first critical step is clinician awareness of the scope of the problem and consideration of appropriate strategies to address it.

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Clinical Risk Constellations for the Development of Bipolar Disorders

Medicina ◽

10.3390/medicina57080792 ◽

2021 ◽

Vol 57 (8) ◽

pp. 792

Author(s):

Eva Burkhardt ◽

Andrea Pfennig ◽

Karolina Leopold

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Psychiatric Disorders ◽

Early Recognition ◽

Clinical Care ◽

Bipolar Disorders ◽

Current Evidence ◽

Long Term Outcomes ◽

Affective Psychosis

The early recognition of psychiatric disorders has been a focus of research in the last decades and has led to improvements in clinical care, especially in the area of early psychosis. Like non-affective psychosis, bipolar disorders are often diagnosed with a delay that can lead to long periods of untreated illness and impact long-term outcomes. This article presents the rationale for early recognition in bipolar disorder and presents the current evidence for the identification of risk factors, their assessment and validity in predicting the onset of bipolar disorder.

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Long-term outcomes of youth who manifested the CBCL-Pediatric Bipolar Disorder phenotype during childhood and/or adolescence

Journal of Affective Disorders ◽

10.1016/j.jad.2008.05.024 ◽

2009 ◽

Vol 113 (3) ◽

pp. 227-235 ◽

Cited By ~ 96

Author(s):

Stephanie E. Meyer ◽

Gabrielle A. Carlson ◽

Eric Youngstrom ◽

Donna S. Ronsaville ◽

Pedro E. Martinez ◽

...

Keyword(s):

Bipolar Disorder ◽

Pediatric Bipolar Disorder ◽

Long Term Outcomes

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Olanzapine as Maintenance Therapy in Patients with Bipolar I Disorder

Progress in Neurotherapeutics and Neuropsychopharmacology ◽

10.1017/s1748232106000164 ◽

2006 ◽

Vol 2 (1) ◽

pp. 225-238

Author(s):

Mauricio Tohen ◽

Daniel Yen Lin

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Treatment Options ◽

Additional Treatment ◽

Long Term Outcomes ◽

Double Blind ◽

Randomized Controlled ◽

Depressive Episodes ◽

Prevention Of Relapse

ABSTRACTEffective treatments for the prevention of relapse and recurrence of mood episodes in patients with bipolar disorder are essential to reduce the high mortality associated with this condition, and to improve long-term outcomes. While lithium is considered to be effective as a first line maintenance treatment, additional treatment options would provide clinicians with tools to address the needs of individual patients. The efficacy of olanzapine, an atypical antipsychotic, for the prevention of relapse in bipolar disorder has been demonstrated in several randomized controlled double-blind clinical trials, both as monotherapy and in combination with other agents. The data reviewed herein suggest a more robust efficacy of treatment with olanzapine in the prevention of relapse into manic episodes than into depressive episodes. The adverse events observed most frequently in patients treated with olanzapine relative to comparators were related to somnolence (somnolence, fatigue, or hypersomnia) and weight gain (weight gain, or increased appetite). Moreover, a larger proportion of olanzapine-treated patients than comparator-treated patients experienced clinically important weight gain.

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Mood stabilizer: a concept analysis and operationalization of a model

10.1101/2021.11.13.21266303 ◽

2021 ◽

Author(s):

Lauro Estivalete Marchionatti ◽

Paula Blaya Rocha ◽

Pedro Vieira da Silva Magalhaes

Keyword(s):

Bipolar Disorder ◽

Qualitative Methodology ◽

Mood Stabilizer ◽

Concept Analysis ◽

Qualitative Inquiry ◽

Acute Effects ◽

Long Term Outcomes ◽

The Core ◽

Proposed Model

Background. The term 'mood stabilizer' is controversial in literature. As there is no consensual meaning, its retirement has been suggested to avoid confusion and misuse. On the other hand, it remains largely employed, and some advocate it carries an important meaning. This issue has not been previously approached using a validated qualitative inquiry. Methods. We employed document analysis for reviewing proposed definitions for mood stabilizer. Then, we used concept analysis as a qualitative methodology to clarify meanings associated with the term. Based on its results, we built a theoretical model for mood stabilizer, matching it with evidence for drugs used in the treatment of bipolar disorder. Results. Concept analysis of documents defining the term unearthed four attributes of a mood stabilizer that could be usefully nested into the following ascending hierarchy: 'not worsening', 'acute effects', 'prophylactic effects', and 'advanced effects'. To be considered a mood stabilizer, a drug had to reach the 'prophylactic effects' tier, as this was discussed by authors as the core aspect of the class. After arranging drugs according to this scheme, lithium and quetiapine received the label, but only the former fulfilled all four attributes, as evidence indicates it has neuroprotective action. Conclusion. The proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. This could modify long-term outcomes and illness trajectory.

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