162 Post-lithium Delirious Mania in Patients with Bipolar Disorder

Abstract:Delirious mania is a life-threatening condition, presenting with symptoms of acute delirium and psychotic mania as a complication of medical or psychiatric condition. It is not recognized as a diagnosis in DSM-V and is under recognized in clinical practice. It was first described by Calmeil (Calmeil, 1832). In 1849 Luther Bell described 40 cases with an associated 75% mortality rate. More recently, Jacobowski et al (2013) compiled a comprehensive review of clinical characteristics, diagnostic work up, and treatment recommendations for delirious mania. In addition to acute onset, clinical course is frequently worsened by psychosis and catatonia. Delirium leads to disequilibrium of neurotransmitters, particularly depletion of acetylcholine and elevation of dopamine.Lithium has been used for the treatment of mania for many decades. Suppes et al performed a meta-analysis of 14 studies including 257 patients with Bipolar I disorder and concluded that patients relapsed 28 times more when stopping lithium compared to those who continued this medication. Baldessarini et al (1999) completed analysis of 227 patients with Bipolar I and II disorders, dividing the sample into “abrupt” (1-14 days) and “gradual” (15-30 days) discontinuation groups and concluded that the frequency of relapse following “abrupt” cessation was four times higher compared to following “gradual” cessation. In a study of 450 bipolar patients, Baldessarini et al (2003) reviewed the long-term treatment of lithium as monotherapy (86 % of the study’s population) in the context of lithium maintenance population morbidity. Greater pretreatment morbidity lead to larger relative reduction in morbidity as a result of treatment with lithium. A subgroup of bipolar patients with “abrupt” discontinuation became refractory when re-challenged with lithium.Describing three clinical cases of delirious mania following conclusions can be derived:•Patients with bipolar disorder and comorbid chronic kidney injury currently or formerly receiving long-term therapy with lithium are at increased risk for delirious mania.•Abrupt lithium discontinuation in patients with bipolar disorder and comorbid chronic medical conditions (especially chronic kidney disease) increases risk for mania refractory to conventional treatment with medications.•In such patients, definitive treatment is ECT.

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Pharmacogenetic association between NAT2 gene polymorphisms and isoniazid induced hepatotoxicity: trial sequence meta-analysis as evidence

Bioscience Reports ◽

10.1042/bsr20180845 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 7

Author(s):

Saif Khan ◽

Raju K. Mandal ◽

Abdulbaset Mohamed Elasbali ◽

Sajad A. Dar ◽

Arshad Jawed ◽

...

Keyword(s):

Gene Polymorphisms ◽

Meta Analysis ◽

Term Treatment ◽

Wild Type ◽

Severe Problem ◽

Trial Sequence ◽

Increased Risk ◽

Long Term Treatment ◽

Nat2 Gene

Abstract Hepatotoxicity is a severe problem generally faced by tuberculosis (TB) patients. It is a well-known adverse reaction due to anti-TB drugs in TB patients undergoing long-term treatment. The studies published previously have explored the connection of N-acetyltransferase 2 (NAT2) gene polymorphisms with isoniazid-induced hepatotoxicity, but the results obtained were inconsistent and inconclusive. A comprehensive trial sequence meta-analysis was conducted employing 12 studies comprising 3613 controls and 933 confirmed TB cases using the databases namely, EMBASE, PubMed (Medline) and Google Scholar till December 2017. A significant association was observed with individuals carrying variant allele at position 481C>T (T vs. C: P = 0.001; OR = 1.278, 95% CI = 1.1100–1.484), at position 590G>A (A vs. G: P = 0.002; OR = 1.421, 95% CI = 1.137–1.776) and at position 857G>A (A vs. G: P = 0.0022; OR = 1.411, 95% CI = 1.052–1.894) to higher risk of hepatotoxicity vis-à-vis wild-type allele. Likewise, the other genetic models of NAT2 gene polymorphisms have also shown increased risk of hepatotoxicity. No evidence of publication bias was observed. These results suggest that genetic variants of NAT2 gene have significant role in isoniazid induced hepatotoxicity. Thus, NAT2 genotyping has the potential to improve the understanding of the drug–enzyme metabolic capacity and help in early predisposition of isoniazid-induced hepatotoxicity.

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The Role of Long Acting Antipsychotics in Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.099 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S15-S15

Author(s):

E. Vieta

Keyword(s):

Bipolar Disorder ◽

Meta Analysis ◽

Term Treatment ◽

Patient Profile ◽

Long Term Treatment ◽

Short And Long Term ◽

Competing Interest ◽

Long Acting

Antipsychotics are widely used for the short and long-term treatment of bipolar disorder. Depot and long-acting injectable formulations (LAIs) can be particularly useful for certain subgroups of patients. This lecture will discuss the available data from randomized controlled trials of LAIs in bipolar disorder. A recently published meta-analysis and individual studies assessing depot medications, as well as modern LAIs such as risperidone, paliperidone and aripiprazole, will be reviewed, looking carefully into the prevention of either pole of illness and tolerability. Potential indications and patient profile, based on data and clinical experience, will be discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Olanzapine in the long-term treatment of bipolar disorder: A systematic review and meta-analysis

Journal of Psychopharmacology ◽

10.1177/0269881109106900 ◽

2009 ◽

Vol 24 (12) ◽

pp. 1729-1738 ◽

Cited By ~ 30

Author(s):

Andrea Cipriani ◽

Jennifer Rendell ◽

John R Geddes

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Meta Analysis ◽

Term Treatment ◽

Long Term Treatment

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Does psychoeducatioanal Approach Could Reach the Target Patients with Bipolar Disorder?

European Psychiatry ◽

10.1016/s0924-9338(09)70800-4 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

S. Cakir ◽

R. Bensusan ◽

Z. Akca ◽

O. Yazici

Keyword(s):

Bipolar Disorder ◽

Participation Rate ◽

Poor Response ◽

Term Treatment ◽

Recruitment Rate ◽

Mood Stabilizers ◽

Blood Levels ◽

Long Term Treatment ◽

Bipolar Patients

The recurrent nature of bipolar disorder needs an optimum compliance with long term pharmacotherapy, however the poor adherence is common. Adjunctive psychoeducation seems favorable effects on adherence during the long term pharmacotherapy. Even strong benefits were showed, setting a psychoeducation in clinical practice is still novel and recruiting the patients with long history of bipolar disorder may not be feasible. In literature, recruitment rate, motivation and attitudes of patients for participation in psychoeducation is not studied. The present study was conducted to clarify the intends of patients with bipolar disorder to participate in psychoeducation and the factors that contribute.The euthymic patients with diagnosis of bipolar disorder I or II, were invited to the 6 week psychoeducation program in prospective study. The demographic and clinical data were obtained from life charts and updated with a clinical interview. The blood levels of mood stabilizers, adherence, response to prophylactic treatment, relapses and hospitalization rates between the participants and non-participants were compared.84 patients were attended the program, 71 patients were considered as unwilling to attend. The motivation of patients to attend a psychoeducation is limited. The participation rate was only 54.2%. The patients who refused attending to this program have fewer adherences to medication and irregular follow up visits, insufficient blood levels of mood stabilizers, poor response to long term treatment, more likely have mood episodes. Education level between attendees and non-attendees were not different.Optimum methods are required for recruitment of bipolar patients to a psychoeducation program.

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Treatment of bipolar depression

CNS Spectrums ◽

10.1017/s1092852912001009 ◽

2013 ◽

Vol 18 (4) ◽

pp. 177-187 ◽

Cited By ~ 4

Author(s):

Laura Musetti ◽

Claudia Del Grande ◽

Donatella Marazziti ◽

Liliana Dell'Osso

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Treatment Options ◽

Mood Stabilizers ◽

Term Outcome ◽

Long Term Outcome ◽

Increased Risk ◽

Long Term Treatment ◽

Antidepressant Use

Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder.

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Outcome of Bipolar Disorder on Long-Term Treatment with Lithium

The British Journal of Psychiatry ◽

10.1192/bjp.159.1.123 ◽

1991 ◽

Vol 159 (1) ◽

pp. 123-129 ◽

Cited By ~ 224

Author(s):

Ralph A. O'Connell ◽

Julia A. Mayo ◽

Leslie Flatow ◽

Beverly Cuthbertson ◽

Barbara E. O'Brien

Keyword(s):

Bipolar Disorder ◽

Treatment Outcome ◽

Lithium Treatment ◽

Term Treatment ◽

Poor Outcome ◽

Psychiatric Admissions ◽

Long Term Treatment ◽

Alcohol And Drug Abuse ◽

Bipolar Patients

The long-term treatment outcome of 248 bipolar patients in an out-patient lithium programme was assessed. Over half of the patients (138 or 56%) had no affective episodes in the year observed. Patients were divided into outcome groups according to GAS scores: the outcome for 40% of patients was good, for 41% fair, and for 19% poor. More frequent psychiatric admissions before starting lithium treatment was the best predictor of poor outcome, followed by a negative affective style in the family and lower social class. Current alcohol and drug abuse was associated with poor outcome. Although familial and psychosocial factors were significantly associated with outcome, the findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.

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Gout – management of a chronic disease: a systematic review

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2020-0011 ◽

2020 ◽

Vol 3 (1) ◽

pp. 70-77

Author(s):

Petruţa Violeta Filip ◽

Sorina Laura Diaconu ◽

Diana Chetroiu ◽

Denisa Cuciureanu ◽

Corina Silvia Pop

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Chronic Phase ◽

Optimal Strategies ◽

Serum Urate ◽

Lifestyle Changes ◽

Term Therapy ◽

Therapeutic Goals ◽

Long Term Treatment

AbstractObjectives: Gout is the most common inflammatory arthritis of the 21 century, but is still frequently misdiagnosed. This review aims to provide guidance for gout management in clinical practice, which includes the diagnosis, treatment of acute episodes, but also long-term therapy to reduce serum urate, as well as lifestyle changes and prevention of recurrent episodes.Design: Systematic review without meta-analysis.Methods: We have systematically searched Google Scholar, PubMed, and all relevant worldwide guidelines to identify and select clinical guidelines for gout. We have included eligible gout articles according to predefined inclusion and exclusion criteria after selecting titles, abstracts and full texts. The characteristics of the recommendations reported in the guidelines included were extracted and analyzed.Results: We selected 27 eligible papers and tried to facilitate the identification of recommendations for the treatment of gout in the acute phase, but also in the chronic phase. The recommendations were detailed and explained during this extensive review.Conclusions: Despite the availability of effective serum urate reduction therapies, overall gout management is poor. Achieving therapeutic goals is often low both at the initiation of therapy and in long-term treatment. Optimal strategies for managing gout are necessary in both acute and chronic gout flames in patients who are prone to the development of this pathology.

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