Problematic definitions of bipolar I disorder and mixed episode in the upcoming ICD-11

IntroductionAripiprazole has demonstrated efficacy for the treatment of paediatric patients (10–17 years) with a manic or mixed episode associated with bipolar I disorder in a clinical trial that utilised the Young Mania Rating Scale (YMRS) Total score as the primary outcome measure.Objectives/aimThis analysis evaluated the profile of discrete symptom response using the YMRS and other measures.MethodsPost-hoc analysis of individual items of the YMRS and the parent or subject version of the General Behaviour Inventory (GBI) Mania and Depression scales using data from a 4-week, double-blind, randomised trial that compared aripiprazole (10 or 30 mg/day, n = 197) with placebo (n = 99).ResultsIn total, 296 patients were randomised; 80% completed the study. Significant decreases at Week 4 (p < 0.05) were seen in eight YMRS items: elevated mood, increased motor activity/energy, need for sleep, irritability, speech (rate and amount), language/thought disorder, abnormal thought content and disruptive/aggressive behaviour. For the GBI, effect sizes for parent-reported mania items were medium to large (for example, 0.41 for ‘depressed but high energy’ to 0.78 for ‘rage combined with unusually happy’) but were consistently small on subject self-reported items of mania and depression and, for the overall scale, had the poorest agreement with clinician ratings.ConclusionsAripiprazole demonstrated improvements in some of the more troublesome symptoms of paediatric patients with bipolar I disorder experiencing an acute manic or mixed episode. Of note, irritability and aggression showed large treatment effects on both clinician and parent-reported measures, but less so for subject-reported measures.

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The safety and effectiveness of open-label extended-release carbamazepine in the treatment of children and adolescents with bipolar I disorder suffering from a manic or mixed episode

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s68951 ◽

2014 ◽

pp. 1589 ◽

Cited By ~ 20

Author(s):

Robert L. Findling ◽

Lawrence Ginsberg

Keyword(s):

Children And Adolescents ◽

Extended Release ◽

Open Label ◽

Mixed Episode ◽

Bipolar I Disorder

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The Role of Divalproex Plus Olanzapine in Outpatient Mixed-Episode Bipolar I Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.09com05470yel ◽

2009 ◽

Vol 70 (11) ◽

pp. 1548-1550

Author(s):

Joseph F. Goldberg

Keyword(s):

Mixed Episode ◽

Bipolar I Disorder

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Change of cliinical features of bipolar i disorder on a year-over-year basis in patients hospitalized in Imam Hossein Hospital during years of 1991 to 2006

European Psychiatry ◽

10.1016/s0924-9338(11)71928-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 218-218

Author(s):

A. Kia ◽

S.M. Samimi Ardestani

Keyword(s):

Manic Episode ◽

Individual Case ◽

Cross Sectional Study ◽

Clinical Feature ◽

Psychiatric Ward ◽

Major Depressive ◽

Cross Sectional ◽

Mixed Episode ◽

Bipolar I Disorder ◽

Dsm Iv

IntroductionBipolar I Disorder (BID) might be diagnosed primarily as schizophrenia or major depressive disorder in children and adolescents due to unstable or vague symptoms. The depressive phase not yet followed by a manic or mixed episode in either adults or adolescents may lead to an early misdiagnosis. The concept of mixed episode as a manic episode intruding on previous depressive traits puts emphasis on early managements that may lead to a mixed episode.ObjectivesAssess of changes in clinical features of BID.AimsTo determine the frequency of mixed and manic phase of BID and assess change in rate of mixed versus manic episode on a year-over-year basis.MethodsStudy is a cross sectional study performed on 322 patients diagnosed with BID hospitalized in the psychiatric ward of Imam Hossein Hospital during the years of 1991 to 2006. Each episode was considered as an individual case. A single psychiatrist used DSM IV-TR criteria to differentiate a mixed episode from a manic one.ResultsAmong 322 patients, 117 were cases of mixed episode and 205 patients were diagnosed as manic episode. Year-over-year comparisons showed an increasing rate of the diagnosis of mixed episode during the course of the study.ConclusionsThe increased rate of the diagnosis of the mixed episode during the period of the study drives attention to all the probable factors that might have a role on the subsequent changes of the clinical feature of BID toward mixed episode.

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A Double-Blind, Placebo-controlled Trial of Divalproex and Olanzapine in Bipolar I Disorder, Mixed Episode

European Psychiatry ◽

10.1016/s0924-9338(09)70809-0 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

J. Houston ◽

M. Tohen ◽

E. Degenhardt ◽

H. Jamal ◽

L. Liu ◽

...

Keyword(s):

Rating Scale ◽

Controlled Trial ◽

Blood Levels ◽

Young Mania ◽

Double Blind ◽

Mixed Episode ◽

Bipolar I Disorder ◽

Double Blind Placebo ◽

Concomitant Medications ◽

Unique Study

Aims:This unique study of treatment of the mixed state of bipolar I disorder using simultaneous depression and mania response criteria compared divalproex monotherapy versus olanzapine augmentation in a 6-week, randomized, double-blind trial.Methods:Patients (age 18-60 years) with 14-28 days of divalproex monotherapy (blood levels of 75-125 μg/mL) were randomized to augmentation with olanzapine 5-20 mg/day or placebo. Data collected included: Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Clinical Global Impression for Bipolar Illness (CGI-BP), hospitalizations, concomitant medications, and adverse events (AEs). Primary co-objectives were comparisons of baseline to endpoint changes in HDRS and YMRS. Secondary objectives included comparisons of times to onset (25% reduction) and response (50% reduction) in both HDRS and YMRS, change in CGI-BP, hospitalizations, and safety.Results:Patients were 59% female, 51% Caucasian, 33% African American, and 14% Hispanic with mean standard deviation (SD) HDRS and YMRS scores of 22.2 (4.5) and 20.9 (4.4). Mean standard error (SE) score changes for the olanzapine (n=100) or placebo (n=101) arms, respectively, were: HDRS, -9.37 (.55) and -7.69 (.54), p=.022; YMRS, -10.15 (.44) and -7.68 (.44), p< .001; and CGI-BP, -1.34 (.11) and -1.06 (.11), p=.056. Times-to-onset (median 7 vs 14 days) and response (median 25 vs 49 days) were significantly shorter for olanzapine augmentation. One olanzapine patient required hospitalization (p=1.0). Treatment-emergent AEs were consistent with previously-published rates.Conclusion:Six-week olanzapine treatment augmentation was associated with greater and earlier reduction of manic and depressive symptoms in mixed episode patients on divalproex treatment.

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