scholarly journals Bipolar depression: a major unsolved challenge

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Ross J. Baldessarini ◽  
Gustavo H. Vázquez ◽  
Leonardo Tondo
Keyword(s):  
General Population ◽  
Psychiatric Disorders ◽  
Suicide Risk ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Short Term ◽  
Term Efficacy ◽  
Medical Disorders ◽  
Mixed Features

AbstractDepression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.

Treating bipolar depression – antidepressants and alternatives: a critical review of the literature

2011 ◽  
Vol 23 (3) ◽  
pp. 94-105 ◽  
Author(s):  
Antonio Tundo ◽  
Paola Cavalieri ◽  
Serena Navari ◽  
Fulvia Marchetti
Keyword(s):  
Electroconvulsive Therapy ◽  
Dopamine Agonists ◽  
Suicide Risk ◽  
Bipolar Depression ◽  
Scientific Evidence ◽  
Unipolar Depression ◽  
Review Of The Literature ◽  
Acute Response ◽  
Drug Classes

Objective: Although depressive symptoms are preponderant in the course of bipolar (BP) disorders, the treatment of BP depression remains a controversial issue with different clinical approaches available. This review addresses the issues of whether antidepressants (ADs) are effective in treating acute and long-term BP depression, risks linked to ADs and what alternatives to ADs are available.Methods: We searched the MEDLINE databases using the following syntax: [bipolar depression AND unipolar depression AND (antidepressants OR anticonvulsants OR lithium OR antipsychotics OR dopamine-agonists OR psychoeducation OR psychotherapy OR electroconvulsive therapy OR transcranial magnetic stimulation)]. The search included studies published up to 31 May 2009 and conducted on adults.Results: In the acute treatment of BP depression ADs are effective with no differences among drug classes. However, neither the switch into (hypo)mania induction rate nor the suicide risk linked to AD use are definitely established. The effectiveness of long-term AD use is limited to highly selected samples of patients with positive acute response. The risk of long-term ADs causing cycle acceleration and rapid cycling induction concerns a subpopulation of patients. Valid alternatives to ADs in treating acute BP depression are quetiapine, an olanzapine–fluoxetine combination, and electroconvulsive therapy for more severe patients. Lamotrigine is effective and safe in preventing depressive relapses. Psychotherapy and psychoeducation represent effective adjunctive treatments.Conclusion: In the treatment of BP depression there is not a specific effective treatment for all the patients. Interventions should therefore be personalised and the scientific evidence should be adapted to each patient's clinical features.

scholarly journals Mycophenolate mofetil for Crohn's disease: short-term efficacy and long-term outcome

2004 ◽  
Vol 19 (4) ◽  
pp. 427-434 ◽  
Author(s):  
H. H. Wenzl ◽  
T. A. Hinterleitner ◽  
B. W. Aichbichler ◽  
P. Fickert ◽  
W. Petritsch
Keyword(s):  
Crohn’S Disease ◽  
Mycophenolate Mofetil ◽  
Crohn's Disease ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Term Efficacy

Introduction

2017 ◽  
Author(s):  
Igor Galynker
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Suicide Risk ◽  
Assessment Methods ◽  
Suicidal Patient ◽  
Clinical Settings ◽  
Short Term ◽  
Imminent Risk ◽  
Intended Use

One of the most difficult determinations a psychiatrist makes is whether the chronically suicidal patient is at risk for imminent suicide. The Introduction presents the challenges of the imminent risk assessment and explains the purpose of The Suicidal Narrative—the first clinical guide to such an assessment. It introduces the distinction between long-term and short-term suicide risk, highlights the lack of structured instruments for imminent risk assessment, and discusses the advantages of multimodal and multi-informant assessment methods. It then describes intended uses of the guide, lists its inherent limitations, and identifies possible areas of unintended misuse. The Introduction concludes by naming the main intended use of The Suicidal Narrative: as a roadmap for a comprehensive assessment of imminent suicide risk in diverse clinical settings.

scholarly journals 160 Lurasidone and Metabolic Syndrome: Results from Short- and Long-Term Clinical Studies in Patients with Bipolar Depression

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 302-303
Author(s):  
Michael Tocco ◽  
John W. Newcomer ◽  
Yongcai Mao ◽  
Andrei Pikalov
Keyword(s):  
Metabolic Syndrome ◽  
Adjunctive Therapy ◽  
Bipolar Depression ◽  
Prevention Study ◽  
Short Term ◽  
Post Hoc Analysis ◽  
Short And Long Term ◽  
Post Hoc ◽  
Therapy Studies

Abstract:Background:Among patients with depressive disorders, the prevalence of metabolic syndrome (MetS) is estimated to range from 35-40% and has been associated with increased mortality rates. The aim of this post-hoc analysis was to assess the effect of treatment with lurasidone on the prevalence of MetS in patients with bipolar depression.Method:Lurasidone data (dose range, 20-120 mg/d) used in the current analyses consisted of 3 double-blind (DB), placebo-controlled, 6-week studies in adults with bipolar I depression (total N=1,192), consisting of 1 monotherapy, and 2 adjunctive therapy trials with lithium or valproate. Patients who completed the short-term trials continued into a 6-month open-label (OL) extension study, with 6-month (LOCF-endpoint) data available on 274 patients treated with lurasidone monotherapy, and 436 patients treated with lurasidone adjunctive therapy. Also analyzed was a recurrence prevention study in stabilized bipolar patients who completed up to 20 weeks of OL adjunctive treatment with lurasidone, and then were randomized to 28 weeks of DB adjunctive therapy with lurasidone or placebo (N=497). MetS was defined based on NCEP ATP III criteria (2005 revision).Results:In the short-term monotherapy and adjunctive therapy studies, the proportion of patients at baseline meeting NCEP III criteria for MetS were 27.6% and 23.6%, respectively, for lurasidone, and 23.8% and 25.1%, respectively, for placebo; and at week 6 (LOCF) the proportion with MetS was 27.5% and 26.6%, respectively, for lurasidone and 29.9% and 20.2%, respectively, for placebo. The proportion of patients who did not meet MetS criteria at baseline but developed MetS at week 6 (LOCF) was similar for lurasidone vs. placebo in the monotherapy study (9.9% vs. 11.6%); and in the two adjunctive therapy studies (10.3% vs. 8.3%). During the 6-month OL extension study, the proportion of patients treated with lurasidone monotherapy and adjunctive therapy who did not meet MetS criteria at OL baseline but developed MetS at month 6 (LOCF) was 11.7% and 11.9%, respectively. Conversely, the proportion of patients who met MetS criteria at OL baseline, but no longer met criteria at month 6 (LOCF) was 9.5% and 7.7%, respectively. In the 20-week, OL phase of the recurrence prevention study, the proportion of patients treated with adjunctive lurasidone who did not meet MetS criteria at OL baseline but developed MetS at endpoint was 11.5% (LOCF). After up to 28 weeks of DB treatment, the proportion of patients who did not meet MetS criteria at DB baseline but developed MetS at endpoint was 9.0% in the adjunctive lurasidone group, and 10.5% in the adjunctive placebo group (LOCF).Conclusion:This post-hoc analysis found that short- and long-term treatment with lurasidone was associated with a relatively low risk for the development of metabolic syndrome in patients with bipolar I disorder. These findings are consistent with similar analyses in patients with schizophrenia.Funding Acknowledgements:Supported by funding from Sunovion Pharmaceuticals Inc.

scholarly journals Short-term and Long-term Efficacy of Oropharyngolaryngeal Strengthening Training on Voice Using a Mobile Healthcare Application in Elderly Women

2021 ◽  
Vol 26 (1) ◽  
pp. 219-230
Author(s):  
Nam-Bin Cho ◽  
Sung-Rae Cho ◽  
Seong Hee Choi ◽  
Heecheon You ◽  
Seok In Nam ◽  
...  
Keyword(s):  
Elderly Women ◽  
Short Term ◽  
Mobile Healthcare ◽  
Term Efficacy ◽  
Healthcare Application

Long-term efficacy of deep brain stimulation for essential tremor

Neurology ◽  
2019 ◽  
Vol 92 (12) ◽  
pp. e1378-e1386 ◽  
Author(s):  
Steffen Paschen ◽  
Julia Forstenpointner ◽  
Jos Becktepe ◽  
Sebastian Heinzel ◽  
Helge Hellriegel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Rebound Effect ◽  
Short Term ◽  
Term Efficacy ◽  
Secondary Outcomes ◽  
Deep Brain

ObjectiveDeep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial.MethodsTwenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup.ResultsTremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = −0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation.ConclusionVim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS.Classification of evidenceThis study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years.

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