Safety, Efficacy, and Patient Acceptability of Aripiprazole in the Maintenance Treatment of Bipolar Disorder

2012 ◽  
Vol 4 ◽  
pp. CMT.S7388
Author(s):  
Maria Paola Rapagnani
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Early Adulthood ◽  
Similar Efficacy ◽  
Psychotic Symptoms ◽  
Patient Acceptability ◽  
Specific Patient ◽  
Central Nervous System Activity ◽  
The Individual ◽  
Depressive Episodes

Background Bipolar disorder (manic depression) is a serious, long-term mental illness that affects about 1% of adults at some time during their life. It usually develops in late adolescence or early adulthood and affects men and women from all backgrounds. People with bipolar disorder experience wild mood swings that interfere with daily life and damage relationships. They can also have psychotic symptoms: they may see or hear things that are not there. During depressive episodes, affected individuals may feel helpless, worthless, and suicidal. Treatments for bipolar disorder include drugs to stabilize mood swings (for example, lithium and anticonvulsant medications), antide-pressants to treat depressive episodes and antipsychotic drugs to treat manic episodes. The development of second-generation atypical antipsychotics (SGAs) has increased the hopes of psychiatrists. SGAs, however, cannot be considered a unique pharmacological class since each SGA has many complex pharmacologic actions, only some of which are shared with other SGAs. Even though, many antipsychotics have similar efficacy on average, prescribers may be able to achieve better than average results by considering differences in selecting a specific drug for a specific patient. Clinicians know that each patient is unique and in order to achieve best outcomes for the individual patient, the better therapy is the therapy tailored for the single patient. Objectives With this article we provide information on a relatively new antipsychotic aripiprazole released in 2002 by Bristol-Myers Squibb for the treatment of schizophrenia; for acute manic and mixed episodes associated with bipolar disorder in 2004; as an adjunct for major depressive disorder on November 2007; and to treat irritability in children with autism on 2009. Compared with other first line atypical antipsychotics aripiprazole has a unique profile due to partial agonism at dopamine D2 and D3 and serotonin 5-HT1A receptors, and antagonism at 5-HT2A receptors. This paper describes the development of aripiprazole, its unique properties and its metabolically-friendly profile including its receptor binding affinities, pharmacokinetics, central nervous system activity results of clinical efficacy and relevant clinical trials, in particular safety, efficacy and patient acceptability are also examined. The available literature on aripiprazole of the last six years is reviewed.

scholarly journals Ziprasidone Hydrocloride: What Role in the Management of Schizophrenia?

2011 ◽  
Vol 3 ◽  
pp. JCNSD.S4138 ◽  
Author(s):  
Chiara Mattei ◽  
Maria Paola Rapagnani ◽  
Stephen M. Stahl
Keyword(s):  
Atypical Antipsychotics ◽  
Similar Efficacy ◽  
Binding Affinities ◽  
Specific Patient ◽  
Serotonergic Receptors ◽  
Causes Of Disease ◽  
Cns Activity ◽  
The Individual ◽  
Pharmacologic Actions ◽  
Better Than

Background Since schizophrenia is considered one of the top ten causes of disease-related disability in the world, the development of second-generation (atypical) antipsychotics (SGAs) has increased the hopes of psychiatrists. SGAs, however, cannot be considered a unique pharmacological class since each SGA has many complex pharmacologic actions, only some of which are shared with other SGAs. Even though manyantipsychotics have similar efficacy on average, prescribers may be able to achieve better than average results by considering differences in selecting a specific drug for a specific patient. Clinicians know that each patient is unique. In order to achieve best outcomes for the individual patient, the better therapy is the therapy tailored for the single patient. Objectives With this article, we provide information on a relatively new antipsychotic ziprasidone released in 2001 by Pfizer for the treatment of schizophrenia. Compared with other first line atypical antipsychotics ziprasidone has a unique profile due to potent interaction with serotonergic receptors and lesser action upon α1 adrenergic, H1 and M1 antagonist activities. This paper describes the development of ziprasidone, its unique properties and its metabolically-friendly profile including its receptor binding affinities, pharmacokinetics, CNS activity results of clinical efficacy and relevant clinical trials. Safety, efficacy and patient preference are also examined. The available literature on ziprasidone of the last five years is reviewed.

scholarly journals Pola Penggunaan Obat Mood Stabilizer Pada Pasien Bipolar di Rumah Sakit Jiwa Daerah Atma Husada Mahakam

2019 ◽  
Vol 10 ◽  
pp. 86-93
Author(s):  
Annida Rifaya ◽  
Risna Agustina ◽  
Rolan Rusli
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Early Adulthood ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
School Level ◽  
Research Subjects ◽  
High School Level ◽  
Bipolar Patients ◽  
Depressive Episodes

Bipolar disorder is a chronic mood disorder characterized by episodes of mania or hypomania that occur alternately or mixed with depressive episodes. This study aims to determine the characteristics of bipolar patients and patterns of drug use inpatient and outpatient bipolar patients at Atma Husada Mahakam Hospital. The type of this research is non experimental (descriptive) and done retrospectively. Data are collected from medical record. Research subjects were 84 inpatients and 137 outpatients with bipolar disorder diagnosis. Data are analyzed by describing research's objects. The results were obtained from inpatient and outpatient data showing 63% and 60% female sex, showing 26-35 years (early adulthood), not working, not married, and high school level education. The most usage pattern of drugs is a combination of 2 and 3 drugs, namely 74.99% for inpatient care and 73.71% for outpatient treatment. The drugs most commonly used are mood stabilizers (valproate acid) and atypical antipsychotics (risperidone).

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.

Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression

2014 ◽  
Vol 27 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Kimiya Nakamura ◽  
Junichi Iga ◽  
Naoki Matsumoto ◽  
Tetsuro Ohmori
Keyword(s):  
Bipolar Disorder ◽  
Severe Depression ◽  
Psychotic Symptoms ◽  
Primary Disorder ◽  
Icd 10 ◽  
History Of ◽  
Physical Diseases ◽  
The Stability ◽  
Psychotic Features ◽  
Depressive Episodes

ObjectiveSevere depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).MethodsPatients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.ResultsBy the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.ConclusionSub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more ‘primary’ disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.

Managing bipolar disorder during pregnancy and lactation: is there a safe and effective option?

2003 ◽  
Vol 18 (S1) ◽  
pp. 3s-8s ◽  
Author(s):  
Pierre Thomas ◽  
W. Emanuel Severus
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Options ◽  
Treatment Success ◽  
Early Adulthood ◽  
Bipolar Ii ◽  
Effective Option ◽  
Pregnancy And Lactation ◽  
Disease Subtypes ◽  
Typical And Atypical Antipsychotics

Bipolar disorder is a serious psychiatric illness that usually emerges during adolescence or early adulthood, and patients are likely to experience recurrent episodes throughout their lives. The treatment of bipolar disorder is complicated by the difficulty in distinguishing between subtly different disease subtypes (bipolar I, bipolar II, rapid cycling and mixed episodes), each of which is associated with a different probability of treatment success. Furthermore, physicians are faced with an array of treatment options that includes mood stabilisers, antidepressants, and typical and atypical antipsychotics.

Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study

2019 ◽  
Vol 53 (8) ◽  
pp. 772-781 ◽  
Author(s):  
Alfredo Carlo Altamura ◽  
Massimiliano Buoli ◽  
Bruno Mario Cesana ◽  
Andrea Fagiolini ◽  
Andrea de Bartolomeis ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Confidence Interval ◽  
Clinical Features ◽  
Odds Ratio ◽  
Age At Onset ◽  
Psychotic Symptoms ◽  
Bipolar Type ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
First Diagnosis

Objective: Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. Methods: A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student’s t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. Results: Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed ( p < 0.01) and never married/partnered ( p < 0.01); have an earlier age at onset ( p < 0.01); more frequently receive a first diagnosis different from a mood disorder ( p < 0.01); have a shorter duration of untreated illness ( p < 0.01); have a more frequently hypomanic/manic prevalent polarity ( p < 0.01) and a prevalent manic–depressive type of cycling ( p < 0.01); present a lower lifetime number of depressive episodes ( p < 0.01), but have more manic episodes ( p < 0.01); and less insight ( p < 0.01) and more hospitalizations in the last year ( p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). Conclusion: Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.

scholarly journals 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.

Prodromal Symptoms to Relapse in Bipolar Disorder

2007 ◽  
Vol 41 (5) ◽  
pp. 385-391 ◽  
Author(s):  
Pilar Sierra ◽  
Lorenzo Livianos ◽  
Sergio Arques ◽  
Javier Castelló ◽  
Luis Rojo
Keyword(s):  
Bipolar Disorder ◽  
Coping Strategies ◽  
Sleep Disturbances ◽  
Psychotic Symptoms ◽  
Prodromal Symptoms ◽  
Hand Search ◽  
Mood Changes ◽  
The Individual ◽  
Bipolar Patients ◽  
Psychomotor Symptoms

In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients’ coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965–May 2006). ‘Bipolar disorder’, ‘prodromes’, ‘early symptoms’, ‘coping’, ‘manic’ and ‘depression’ were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients.

Mood Stabilizers

2008 ◽  
Author(s):  
Susan W. Lehmann
Keyword(s):  
Bipolar Disorder ◽  
Late Onset ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Behavioral Disturbances ◽  
Seizure Disorders ◽  
Immunodeficiency Virus ◽  
Atypical Antipsychotic Medications ◽  
Depressive Episodes

The term ‘‘mood stabilizers’’ refers to a heterogeneous group of medications that are effective in the treatment of bipolar disorder, an illness characterized by recurrent episodes of mania and major depression. The list of mood stabilizers includes lithium, several anticonvulsant medications, and atypical antipsychotic medications. For some of these medications, there have been randomized, placebo-controlled studies demonstrating efficacy in reducing the severity and frequency of illness episodes (Kahn et al., 2000). For other medications, the evidence supporting therapeutic use in mood disorders is more anecdotal or preliminary. Late-onset bipolar disorder beginning after 50 years of age is more likely to be associated with comorbid medical or neurologic condition, or their treatments (McDonald, 2000; Depp and Jeste, 2004). A number of medications have been known to precipitate manic episodes. These include antiparkinsonian medications, corticosteroids, anticholinergic agents, and antidepressants. In addition, manic episodes may develop in patients with Huntington’s disease, multiple sclerosis, brain tumors, seizure disorders, dementia, neurosyphilis, human immunodeficiency virus (HIV), and some poststroke syndromes. The goal of long-term psychiatric management is to minimize affective upheaval and to diminish frequency of mood cycling. Psychotic symptoms are common in bipolar disorder, and severe behavioral disturbances such as physical aggression can occur as well during manic episodes. Depressive episodes are accompanied by a risk of suicide. Given the potential for these severe complications, and the need for continual medication reassessment and adjustment, the long-term pharmacologic and psychologic treatment of bipolar disorder is best managed by a psychiatrist. Lithium, the oldest of the mood-stabilizing medications, is also considered to be the ‘‘gold standard’’ of treatment against which all other potentially mood-stabilizing medications are compared. It is still the treatment of choice for many patients with bipolar disorder, and it has been approved by the U.S. Food and Drug Administration for treatment of manic episodes and for maintenance therapy. At least eight placebo-controlled, randomized trials have shown lithium to have efficacy in maintenance treatment of bipolar disorder (Goodwin, 2002). Lithium is effective in reducing risk of recurrent episodes of both mania and depression, although studies have suggested greater superiority in reducing risk of manic episodes.

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