scholarly journals Regional lithium prescription rates and recurrence in bipolar disorder

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Martin Sköld ◽  
Sindre Rolstad ◽  
Erik Joas ◽  
Mathias Kardell ◽  
Erik Pålsson ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Population Level ◽  
Bipolar I Disorder ◽  
Not Otherwise Specified ◽  
Number Of Patients ◽  
Bipolar Ii ◽  
National Quality ◽  
Prescription Rates ◽  
Depressive Episodes

Abstract Background Lithium is the best documented maintenance treatment in bipolar disorder, but its use varies considerably across and within countries. It is not known whether regional differences in lithium prescription rates translate to differing regional outcomes. Aims To estimate associations between county specific lithium prescription rates and county specific recurrence odds of bipolar disorder in Sweden. Method Data from 14,616 patients with bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified were extracted from the Swedish national quality assurance register for bipolar disorders (BipoläR). Lithium prescription frequencies were calculated for 21 counties. Logistic regression analyses were run adjusted for confounders, with any type of recurrence as primary outcome, and incident elated and depressive episodes as secondary outcomes. Subsets of patients with bipolar I, II and not otherwise specified disorder were also analysed separately. Results Lithium prescription rates for populations with all bipolar subtypes ranged across counties from 37.7 to 84.9% (mean 52.4%). Higher regional prescription rates were significantly associated with lower rate of any type of recurrence. The association was stronger when bipolar I disorder was analysed separately. Conclusions The advantages for lithium use long acknowledged for bipolar I disorder are also seen for the rest of the bipolar spectrum. Results suggest that population level outcomes of bipolar disorder could be improved by increasing the number of patients using lithium.

Pharmacological Treatments for Bipolar Disorder

2007 ◽  
pp. 323-350 ◽  
Author(s):  
Paul E. Keck ◽  
Susan L. McElroy
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Bipolar Ii ◽  
Depressive Episodes ◽  
Subsyndromal Symptoms

The vast majority of clinical trials in patients with bipolar disorders have been conducted in groups with bipolar I illness, although a few trials have recently emerged specifically in patients with bipolar II disorder. The pharmacological management of bipolar disorder involves the treatment of acute manic, hypomanic, mixed, and depressive episodes, as well as the prevention of further episodes and subsyndromal symptoms. Lithium, divalproex, carbamazepine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole have demonstrated efficacy in the treatment of acute mania in randomized, controlled (Type 1) trials. Although the pharmacological treatment of acute bipolar depression remains understudied, data from randomized, controlled trials indicate that lithium, olanzapine, olanzapine-fluoxetine, quetiapine, lamotrigine, tricyclics, MAOIs, fluoxetine, and pramipexole have efficacy in this phase of the illness. The optimal duration of antidepressant treatment, in combination with mood stabilizers, is still unknown. Lithium, lamotrigine, olanzapine, and aripiprazole have been shown to have efficacy in relapse prevention. Less extensive data suggest that divalproex and carbamazepine are also efficacious as preventative treatments.

Pharmacological Treatments for Bipolar Disorder

2015 ◽  
Author(s):  
Paul E. Keck ◽  
Susan L. McElroy
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Bipolar Disorders ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Bipolar Ii ◽  
Long Acting ◽  
Depressive Episodes ◽  
Subsyndromal Symptoms

The majority of clinical trials in patients with bipolar disorders have been conducted in groups with bipolar I illness, although a few trials have included patients with bipolar II disorder. Pharmacological management of bipolar disorder involves the treatment of acute manic, hypomanic, mixed, and depressive episodes, as well as the prevention of further episodes and subsyndromal symptoms. Lithium, divalproex, carbamazepine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine have demonstrated efficacy in the treatment of acute mania in randomized controlled (type 1) trials. Although the pharmacological treatment of acute bipolar depression remains understudied, data from randomized controlled trials indicate that lithium, olanzapine, olanzapine-fluoxetine, quetiapine, lurasidone, tricyclics, monoamine oxidase inhibitors, and fluoxetine have efficacy in this phase of the illness. Lithium, lamotrigine, olanzapine, aripiprazole, quetiapine, and risperidone (long-acting, injectable) have been shown to have efficacy in relapse prevention. Less extensive data suggest that divalproex and carbamazepine are also efficacious for prevention.

Efficacy and Safety of Lamotrigine for Adults with Bipolar Disorder in a Private Practice Setting

CNS Spectrums ◽  
2006 ◽  
Vol 11 (5) ◽  
pp. 376-382 ◽  
Author(s):  
Lawrence D. Ginsberg
Keyword(s):  
Bipolar Disorder ◽  
Private Practice ◽  
Primary Diagnosis ◽  
Practice Setting ◽  
Efficacy And Safety ◽  
Bipolar Ii Disorder ◽  
Bipolar I Disorder ◽  
Not Otherwise Specified ◽  
Bipolar Ii ◽  
Treatment Support

ABSTRACTIntroductionLamotrigine is approved by the Food and Drug Administration for maintenance therapy in patients with bipolar I disorder. However, several studies of acute-phase and maintenance treatment support the efficacy of lamotrigine for bipolar I and bipolar II disorders. This chart review was performed to assess the efficacy and safety of lamotrigine in the treatment of bipolar disorder in a private psychiatric practice setting and to investigate differences in response among patients with different diagnostic subtypes of bipolar disorder.MethodsThe charts of 587 adult outpatients with a primary diagnosis of bipolar disorder who received treatment with lamotrigine in a private practice setting between July 1998 and May 2004 were reviewed retrospectively. Treatment response was assessed with the Clinical Global Impression-Improvement scale and was defined as achievement of a score of ≤2.ResultsThree hundred forty-nine patients (59.5%) responded to lamotrigine. Response rates were comparable among patients wit h bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified, and among patients with bipolar I disorder who presented with depressive, manic, or mixed episodes. Nonserious rash (12.8%) and headache (2.9%) were the most frequently reported adverse events.ConclusionThese results suggest that lamotrigine is effective and well-tolerated in the treatment of bipolar disorder across the spectrum of sub-types of the illness.

scholarly journals Deficits in explicit emotion regulation in bipolar disorder: a systematic review

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Marcel Kurtz ◽  
Pia Mohring ◽  
Katharina Förster ◽  
Michael Bauer ◽  
Philipp Kanske
Keyword(s):  
At Risk ◽  
Bipolar Disorder ◽  
Emotion Regulation ◽  
Mood State ◽  
Bipolar Disorders ◽  
Protective Measure ◽  
Behavioral Measures ◽  
Increased Risk ◽  
Regulation Strategies ◽  
Depressive Episodes

Abstract Background This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients. Methods To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state. Results In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks. Conclusion We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.

Bipolar Disorders: Antipsychotic Drug Therapy of Aripiprazole an Open Label Study

2018 ◽  
Vol 3 (1) ◽  
pp. 01-02
Author(s):  
Amycus Alecto
Keyword(s):  
Bipolar Disorder ◽  
Early Adulthood ◽  
Indirect Costs ◽  
Bipolar Disorders ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Direct And Indirect Costs ◽  
The Us ◽  
Depressive Episodes

Patients with bipolar disorder are exceptionally challenging to manage because of the dynamic, chronic, and fluctuating nature of their disease. Typically, the symptoms of bipolar disorder first appear in adolescence or early adulthood, and are repeated over the patient's lifetime, expressed as unpredictable recurrences of hypomanic/manic or depressive episodes. The lifetime prevalence of bipolar disorder in adults is reported to be approximately 4%, and its management was estimated to cost the US healthcare system in 2009 $150 billion in combined direct and indirect costs.

scholarly journals A systematic review on neuropsychological function in bipolar disorders type I and II and subthreshold bipolar disorders—something to think about

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 127-143 ◽  
Author(s):  
Sinead King ◽  
James M Stone ◽  
Anthony Cleare ◽  
Allan H Young
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Cochrane Library ◽  
Type I ◽  
Neuropsychological Dysfunction ◽  
Visual Spatial ◽  
Significant Difference ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Disorder Type

Neuropsychological dysfunction is a well-established finding in individuals with bipolar disorder type I (BP-I), even during euthymic periods; however, it is less clear whether this also pertains to bipolar disorder type II (BP-II) or those with subthreshold states (SBP; subthreshold bipolar disorder), such as bipolar not otherwise specified (BP-NOS). Herein, we compare the literature regarding neuropsychological performance in BP-II vs BP-I to determine the extent of relative impairment, and we present and review all related studies on cognition in SBP. After systematically searching PubMed, Medline, PsycINFO, and The Cochrane Library, we found 17 papers that comprise all the published studies relevant for this review. The areas that are consistently found to be impaired in BP are executive function, verbal memory, visual spatial working memory, and attention. More studies than not show no significant difference between BP-I and BP-II, particularly in euthymic samples. Preliminary evidence suggests that patients experiencing major depressive episodes who also meet criteria for SBP show similar profiles to BP-II; however, these results pertain only to a depressed sample. SBP were found to perform significantly better than both MDD and healthy controls in a euthymic sample. A consensus on mood state, patient selection, and neuropsychological testing needs to be agreed on for future research. Furthermore, no studies have used the most recent DSM-5 criteria for SBP; future studies should address this. Finally, the underlying bases of cognitive dysfunction in these diagnostic groups need to be further investigated. We suggest recommendations on all of the above current research challenges.

Magnetic resonance spectroscopic measurement of cerebral gamma-aminobutyric acid concentrations in patients with bipolar disorders

2006 ◽  
Vol 18 (2) ◽  
pp. 120-126 ◽  
Author(s):  
Po W. Wang ◽  
Napapon Sailasuta ◽  
Rebecca A. Chandler ◽  
Terence A. Ketter
Keyword(s):  
Bipolar Disorder ◽  
Magnetic Resonance ◽  
Mood Disorders ◽  
Bipolar Disorders ◽  
Occipital Lobe ◽  
Gabaergic Neurotransmission ◽  
Control Subjects ◽  
Bipolar Ii ◽  
Healthy Control ◽  
Cr Concentration

Background:Animal models of depression and psychopharmacological mechanisms of action suggest the importance of the gamma-amino butyric acid (GABA) system in the pathophysiology of mood disorders. Mood stabilizers have overlapping effects on GABAergic neurotransmission, and antidepressant use has been associated with alterations in GABAB receptor function. Magnetic resonance spectroscopy (MRS) provides an opportunity to noninvasively assess cerebral GABA concentrations in anterior paralimbic circuits that have been implicated in mood disorders.Methods:In bipolar disorder patients and healthy control subjects, we used MRS with a modified GABA-edited point resolved spectroscopy sequence (TE 68 ms, TR 1500 ms, 512 averages, total scan time 26 min) to assess GABA in an 18-cm3 occipital voxel. In addition, in another cohort of bipolar disorder patients and healthy control subjects, we similarly assessed GABA in a 12.5-cm3 medial prefrontal/anterior cingulate (MPF/AC) voxel. The concentration of GABA was referenced to creatine (Cr) from unedited spectra.Results:In bipolar patients and controls, we consistently detected 3.0 p.p.m. GABA peaks in occipital lobe and MPF/AC. In 16 bipolar (nine bipolar I and seven bipolar II) disorder patients, compared with six healthy control subjects, mean occipital GABA/Cr concentration was 61% higher. In addition, in 15 bipolar (five bipolar I, nine bipolar II, and one bipolar not otherwise specified) disorder patients, compared with six healthy control subjects, mean MPF/AC GABA/Cr concentration tended to be 41% higher.Conclusions:Patients with bipolar disorders may have increased cerebral GABA concentrations. Although this was more evident in the occipital lobe, MPC/AC GABA disturbance may be of greater potential interest in view the more established role of MPF/AC in affective processing. Additional studies are warranted to assess changes in GABAergic neurotransmission and the influences of diagnosis, mood state, and medication status in bipolar disorder patients.

Screening for bipolar disorder among outpatients with substance use disorders

2011 ◽  
Vol 28 (3) ◽  
pp. 147-153 ◽  
Author(s):  
A. Nallet ◽  
B. Weber ◽  
S. Favre ◽  
M. Gex-Fabry ◽  
R. Voide ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Bipolar Disorders ◽  
Treatment Compliance ◽  
Opiate Dependence ◽  
Negative Consequences ◽  
Not Otherwise Specified ◽  
Mood Disorder Questionnaire ◽  
Axis I

AbstractBackgroundComorbidity of bipolar disorder and alcohol or substance abuse/dependence is frequent and has marked negative consequences on the course of the illness and treatment compliance. The objective of this study was to compare the validity of two short instruments aimed at screening bipolar disorders among patients treated for substance use disorders.MethodsThe Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32) were tested with reference to the mood section of the Structured Clinical Interview for DSM-IV axis I disorders (SCID) in 152 patients, recruited in two outpatient clinics providing specialized treatment for alcohol and opiate dependence.ResultsAccording to the SCID, 33 patients (21.7%) had a diagnosis within the bipolar spectrum (two bipolar I, 21 bipolar II and 10 bipolar not otherwise specified). The HCL-32 was more sensitive (90.9% vs. 66.7%) and the MDQ more specific (38.7% vs. 77.3%) for the whole sample. The MDQ displayed higher sensitivity and specificity in patients treated for alcohol than for opiate dependence, whereas the HCL-32 was highly sensitive but poorly specific in both samples. Both instruments had a positive predictive value under 50%.ConclusionsCaution is needed when using the MDQ and HCL-32 in patients treated for substance use disorders.

Bipolar Affective Disorders: Diagnostic and Treatment Situation in Lithuania

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Adomaitiene ◽  
A. Kunigeliene ◽  
K. Dambrauskiene ◽  
V. Danileviciute
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Affective Disorders ◽  
Bipolar Disorders ◽  
Male Population ◽  
Female Population ◽  
Bipolar Ii Disorder ◽  
Treatment Situation ◽  
Bipolar Ii ◽  
Bipolar Affective Disorders

Introduction:Bipolar disorder is one of the most important psychiatric diseases. This is a lifelong illness which increases disability, bad social, employment, and functional outcomes. Bipolar disorder causes dramatic mood swings - from overly “high” and irritable to sad and hopeless, often with periods of normal mood between. Bipolar I disorder is characterized by a history of at least one manic episode, with or without depressive symptoms. Bipolar II disorder is characterized by the presence of both depressive symptoms and a less severe form of mania.Objective:To review diagnostic and treatment situation of bipolar affective disorders in Lithuania.Method:A review of bipolar affective disorders in Lithuania: the prevalence of bipolar disorders, the differences between genders, the clinical features between genders.Results:Studies have suggested, that the prevalence of bipolar disorder in Lithuania is 1 % of population. The rates of bipolar disorder: in 2003 was 1131 cases, in 2004 - 1133 cases, in 2005 - 1147 cases, in 2006 - 1255 cases, in 2007 - 1257 cases. Distribution of bipolar disorders between males and females: males - 35,88 %, females - 64,12 %.Conclusion:The rates of Bipolar I disorder are equal between female and male population, but bipolar II disorder is more frequent in female population (bipolar depression, mixed manic disorder). Bipolar disorder with alcohol and drug abuse are very common among male population. Bipolar disorders are very common with somatic disease (thyroid disease, migraine, obesity of medication), anxiety disorders are more frequent in female population.

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