scholarly journals Timing of onset of lithium relapse prevention in bipolar disorder: evidence from randomised trials

2018 ◽  
Vol 213 (5) ◽  
pp. 664-666 ◽  
Author(s):  
Matthew J. Taylor
Keyword(s):  
Bipolar Disorder ◽  
Relapse Prevention ◽  
Early Onset ◽  
Hazard Ratio ◽  
Randomised Trials ◽  
Mood Episode ◽  
Early Effects ◽  
Timing Of Onset

SummaryLithium is widely prescribed, but the timing of key effects remains uncertain. The timing of onset of its relapse prevention effects is clarified by placebo-controlled randomised trials (3 studies, n = 1120). Lithium reduced relapse into any mood episode over the first 2 weeks of treatment (hazard ratio 0.40, 95% CI 0.16–0.97). Fewer manic relapses were evident within the first 4 weeks, however, early effects on depressive relapse were not demonstrated. There is an early onset of lithium relapse prevention effects in bipolar disorder, particularly against manic relapse. Full effects against depressive relapse may develop over a longer period.Declaration of interestM.J.T. reports personal fees from Sunovion, Otsuka, Lundbeck, outside the submitted work.

Early and Late Onset Bipolar Disorders in Older Adults

2017 ◽  
Vol 41 (S1) ◽  
pp. S211-S211
Author(s):  
N. Smaoui ◽  
L. Zouari ◽  
N. Charfi ◽  
M. Maâlej-Bouali ◽  
N. Zouari ◽  
...  
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Medical Diagnoses ◽  
The Mean ◽  
Bipolar Patients

IntroductionAge of onset of illness may be useful in explaining the heterogeneity among older bipolar patients.ObjectiveTo examine the relationship of age of onset with clinical, demographic and behavioral variables, in older patients with bipolar disorder.MethodsThis was a cross-sectional, descriptive and analytical study, including 24 patients suffering from bipolar disorders, aged 65 years or more and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic, behavioral and clinical data. Age of onset was split at age 40 years into early-onset (< 40 years; n = 12) and late-onset (≥ 40 years; n = 12) groups.ResultsThe mean age for the entire sample was 68.95 years. The mean age of onset was 39.95 years. The majority (60%) of patients were diagnosed with bipolar I. Few meaningful differences emerged between early-onset and late-onset groups, except that tobacco use was significantly higher in the late-onset group (66.6% vs. 16.6%; P = 0.027). No significant differences between the early-onset and late-onset groups were seen on demographic variables, family history and number of medical diagnoses or presence of psychotic features.ConclusionOur study found few meaningful behavioral differences between early versus late age at onset in older adults with bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early-Onset Bipolar Disorder: Characteristics and Outcomes in the Clinic

2017 ◽  
Vol 27 (10) ◽  
pp. 875-883 ◽  
Author(s):  
Daniel F. Connor ◽  
Julian D. Ford ◽  
Geraldine S. Pearson ◽  
Victoria L. Scranton ◽  
Asha Dusad
Keyword(s):  
Bipolar Disorder ◽  
Early Onset

scholarly journals Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study

2011 ◽  
Vol 199 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Lars Vedel Kessing ◽  
Gunnar Hellmund ◽  
John R. Geddes ◽  
Guy M. Goodwin ◽  
Per Kragh Andersen
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Clinical Practice ◽  
Hospital Admission ◽  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Observational Cohort Study ◽  
Hazard Ratio ◽  
Daily Clinical Practice ◽  
Observational Cohort

BackgroundValproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse.AimsTo compare the effect of valproate v. lithium for treatment of bipolar disorder in clinical practice.MethodAn observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.ResultsA total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder. The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59–2.16). The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed). Similarly, for participants with a depressive index episode (HR = 1.87, 95% CI 1.40–2.48), a manic index episode (HR = 1.24, 95% CI 1.01–1.51) and a mixed index episode (HR = 1.44, 95% CI 1.04–2.01), the overall rate of hospital admissions was significantly increased for valproate compared with lithium.ConclusionsIn daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.

Differential Recovery in Early- and Late-Onset Delayed Facial Palsy Following Vestibular Schwannoma Resection

2019 ◽  
Vol 18 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Stephano Chang ◽  
Serge Makarenko ◽  
Ivan Despot ◽  
Charles Dong ◽  
Brian D Westerberg ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Early Onset ◽  
Late Onset ◽  
Motor Evoked Potentials ◽  
Historical Analysis ◽  
Study Cohort ◽  
Postoperative Result ◽  
Nerve Recovery ◽  
Timing Of Onset

AbstractBACKGROUNDDelayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result.OBJECTIVETo characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS.METHODSBetween 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions.RESULTSMean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P &lt; .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11).CONCLUSIONGiven the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.

Age at onset in bipolar disorder: Investigation of the role of TaqIA polymorphism of DRD2 gene in a Sardinian sample

2011 ◽  
Vol 26 (3) ◽  
pp. 141-143 ◽  
Author(s):  
A. Squassina ◽  
M. Manchia ◽  
M. Costa ◽  
C. Chillotti ◽  
R. Ardau ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Association Study ◽  
Early Onset ◽  
Psychiatric Illness ◽  
Age At Onset ◽  
Drd2 Gene ◽  
Genetic Complexity

AbstractBipolar disorder (BD) is a highly heterogeneous and heritable psychiatric illness. Age at onset has been shown to be a powerful tool for dissecting both the phenotypic and genetic complexity of BD. In this article, we present findings from an association study between the DRD2 TaqIA polymorphism and age at onset, showing that both alleles and genotypes at this locus associate with early onset BD.

The treatment of bipolar disorder in children and adolescents

2017 ◽  
Author(s):  
Philip Hazell
Keyword(s):  
Clinical Trial ◽  
Bipolar Disorder ◽  
Young People ◽  
Relapse Prevention ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Acute Mania ◽  
Clinical Trial Evidence ◽  
Second Generation Antipsychotic ◽  
Trial Evidence

The presentation of bipolar disorder in young people can be different from that of adults; therefore, the approach to treatment differs slightly. Treatment is described for early intervention, acute mania, bipolar depression, relapse prevention, and refractory bipolar disorder. A strong therapeutic alliance with the patient and engagement and involvement of the patient’s family is critical to successful intervention. The evidence informing treatment is limited, but there is emerging research focused on the management of acute mania favouring monotherapy with a second-generation antipsychotic (SGA) over a mood stabilizer. Preliminary data favour a combination of an SGA and antidepressant over monotherapy with an SGA for the treatment of bipolar depression. Guidelines endorse electroconvulsive therapy for refractory mania and bipolar depression but there is no clinical trial evidence to support this practice. The development of algorithms to guide the management of all phases of bipolar disorder is a work in progress.

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