Real-world effectiveness of clozapine in patients with bipolar disorder: results from a 2-year mirror-image study

Background Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups. Aims To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder. Method Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers. Results For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions. Conclusions The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission.

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Switching Bipolar Disorder Patients Treated with Clozapine to Another Antipsychotic Medication: A Mirror Image Study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1906 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S118-S118 ◽

Cited By ~ 1

Author(s):

P. Ifteni ◽

A. Teodorescu

Keyword(s):

Bipolar Disorder ◽

Antipsychotic Medication ◽

Significant Proportion ◽

Manic Episode ◽

Mirror Image ◽

Image Study ◽

Risks And Benefits ◽

Increased Risk ◽

The Mean ◽

Competing Interest

IntroductionBipolar disorder (BD) is associated with periodic symptoms’ exacerbations, leading to functional impairment, substance abuse, and increased risk of suicide and accidents. Clozapine has never been approved for the treatment of BD but it is used in severe episodes.AimsThe aim of the study is to evaluate the risks and benefits of switching remitted BD patients treated with clozapine to another antipsychotic medication.ObjectivesWe assessed the proportion of relapsed patients after switching clozapine, time until relapse, type of relapse and the number of admissions.MethodsThis was an observational, mirror image study of 62 remitted BD outpatients treated with clozapine. Following a change in drug reimbursement rules by which clozapine was no longer reimbursable for patients with BD, 25 patients were switched to another antipsychotic and the rest of 37 continued on clozapine agreeing to pay treatment.ResultsThe mean score of CGI-BP at admission in study was in on both groups almost similar (2.3 vs. 2.4). After switching, a significant proportion of patients relapsed (77%), in 100% cases with a manic episode requiring hospitalisation. The mean YMRS score at relapse was significantly higher compared with the evaluation at the time prior to switching (31.78 (SD = 9.72) vs. 11.99 (SD = 7.29), P < 0.01).ConclusionsDespite the limitations of this naturalistic study, the results suggest that switching from clozapine to another antipsychotic may increase the risk of relapses in remitted patients with BD. The risks, costs and consequences of symptoms exacerbation should be weighed against the quest to control pharmacy costs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320947502 ◽

2020 ◽

Vol 10 ◽

pp. 204512532094750

Author(s):

Louise Öhlund ◽

Michael Ott ◽

Robert Lundqvist ◽

Mikael Sandlund ◽

Ellinor Salander Renberg ◽

...

Keyword(s):

Bipolar Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Dual Diagnosis ◽

Attention Deficit ◽

Retrospective Cohort ◽

Suicide Attempts ◽

Mirror Image ◽

Image Study ◽

Hyperactivity Disorder ◽

Self Injury

Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events ( p = 0.013) and numbers of events experienced ( p = 0.004). These effects were preserved 2 years after CS initiation. Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

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