Advantages and disadvantages of atypical antipsychotics or valproate in bipolar disorder

2005 ◽  
pp. 199-210
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Advantages And Disadvantages

Typical and atypical antipsychotics in bipolar disorder

2000 ◽  
Vol 12 (3) ◽  
pp. 115-119 ◽  
Author(s):  
R.W. Licht
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Guidelines ◽  
Bipolar Depression ◽  
Term Treatment ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Randomised Controlled ◽  
Typical Antipsychotics

ABSTRACTBackground: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

Database Analysis of Adults with Bipolar Disorder Consuming a Micronutrient Formula

2009 ◽  
Vol 2 ◽  
pp. CMPsy.S2278 ◽  
Author(s):  
Dermot Gately ◽  
Bonnie J. Kaplan
Keyword(s):  
Bipolar Disorder ◽  
Effect Size ◽  
Symptom Severity ◽  
Atypical Antipsychotics ◽  
Self Report ◽  
Expectancy Effects ◽  
Database Analysis ◽  
Treatment Benefit ◽  
Report Data ◽  
Self Report Data

Background Bipolar disorder is a lifelong problem with imperfect available treatments. Recent research has shown potential benefit of nutritional treatment for mood symptoms. The goal of the current study was to determine whether adults with bipolar disorder reported treatment benefit from consuming a micronutrient formula. Methods Self-report data were available from 682 adults who reported a diagnosis of bipolar disorder; 81% were taking psychiatric medications. Those reporting additional diagnoses were excluded, as well as those who provided data <60 times during 180 days of using the micronutrients, leaving 358 for analysis. Results Mean symptom severity was 41% lower than baseline after 3 months (effect size = 0.78), and 45% lower after 6 months (effect size = 0.76) (both paired t-tests significant, p < 0.001). In terms of responder status, 53% experienced ≥50% improvement at 6 months. Half the sample were taking medications approved for bipolar disorder (lithium, anticonvulsants, atypical antipsychotics), and half were either medication-free or taking other medications: the magnitude of treatment benefit did not differ between these two groups. Regression analyses indicated that decreased symptom severity over the 6 months was associated with increasing micronutrient dosage and with reducing medication. Symptom improvements were significant and sustained at 6 months, suggesting that benefits were not attributable to placebo/expectancy effects. Conclusions Further research on this micronutrient formula is warranted.

Correlation between alterations of inflammatory markers and treatment with atypical antipsychotics in patients diagnosed with bipolar affective disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S422-S422 ◽  
Author(s):  
M. Godio ◽  
F. Marino ◽  
M. Preve
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorders ◽  
Inflammatory Markers ◽  
Atypical Antipsychotics ◽  
Rating Scales ◽  
Bipolar Affective Disorder ◽  
Psychiatric Symptomatology ◽  
Inflammatory Processes ◽  
Anti Inflammatory ◽  
Competing Interest

IntroductionClinical evidences suggests that cerebral inflammatory processes are involved in the development of major affective disorders [1].Obvious correlations exist between changes of inflammatory markers such as acute-phase protein C (PCR) and VES, in patients with bipolar spectrum diagnosis [2].ObjectivesOur aim is demonstrating the correlations between changes of PCR and VES and pharmacological treatment with atypical antipsychotics in patients with acute bipolar disorder, highlighting a trend.MethodTwenty patients with bipolar disorder were assessed at the entrance (T0), after three weeks (T1) and after six weeks (T2) of hospitalization using specific rating scales and blood tests routines include PCR and VES.ResultsIs possible to appreciate a correlation between the affective phase of bipolar disorder and inflammatory markers with a proportional trend (Table 1).Discussion and conclusionThe scores obtained seem to confirm the effect of antipsychotic in both sense of psychiatric symptomatology reduction and in anti-inflammatory action.A confirmation of a correlation between the resolution of affective disorders and normalization of inflammatory markers confirm the intrinsic anti-inflammatory activity of such drug compounds [3].Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mania and Depression: What's New?

2017 ◽  
Vol 41 (S1) ◽  
pp. S15-S15
Author(s):  
A. Fagiolini ◽  
G. Amodeo
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Unmet Needs ◽  
Glycogen Synthase ◽  
Treatment Strategies ◽  
Opiate Receptor ◽  
Glycogen Synthase Kinase 3 ◽  
Sustained Effects ◽  
Precise Understanding ◽  
Cellular Apoptosis

Despite the high burden of bipolar disorder and the noticeable progress in its treatment, the disorder still goes frequently misdiagnosed, unrecognized, or not optimally treated. To date, no medication has been specifically developed on the basis of a precise understanding of the pathophysiology of the disorder, or based on the unique characteristics of several subtypes of bipolar disorder or on the medication mechanism of action. Lithium remains on of the gold standard treatments for bipolar disorder. Its mood-stabilizing properties are thought to occur via specific cellular signaling pathways, such as inhibition of glycogen synthase kinase 3, which is considered to regulate cellular apoptosis. Divalproex, carbamazepine and several atypical antipsychotics are also approved for bipolar disease Evidence also suggests that antipsychotics show the ability to treat and prevent mania and/or depression but are often burdened by side effects such as sedation, hortostatic hypotension and weight gain. Hence, while it is clear that there still are several unmet needs especially for what pertains tolerability, efficacy for specific subtypes, and predictability. Novel and more effective treatments are needed and researchers are currently engaging in targeted drug development for bipolar illness, aimed at improving pharmacological strategies with marked and sustained effects. A variety of newer medications are being tested. Some of these drugs target pathways that are similar to those targeted by lithium, while others focus on newer targets, such as opiate receptor and N-methyl-D-aspartate (NMDA) receptors. Newer and older treatment strategies for bipolar disorder will be presented and critically reviewed.Disclosure of interestAndrea Fagiolini is/has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Astra Zeneca, Boehringer Ingelheim, Pfizer, Eli Lilly, Ferrer, Janssen, Lundbeck, Novartis, Otsuka, Roche.

scholarly journals Hospitalization risk in bipolar disorder patients treated with lurasidone versus other atypical antipsychotics

2018 ◽  
Vol 35 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Daisy Ng-Mak ◽  
Rachel Halpern ◽  
Krithika Rajagopalan ◽  
Antony Loebel
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics

The treatment of bipolar disorder in the elderly

2017 ◽  
Author(s):  
Gilberto Sousa Alves ◽  
Felipe Kenji Sudo ◽  
Johannes Pantel
Keyword(s):  
Bipolar Disorder ◽  
Gold Standard ◽  
Atypical Antipsychotics ◽  
Extended Release ◽  
Ethical Issues ◽  
The Elderly ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
First Line ◽  
Evidence Based Guidelines

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.

scholarly journals 62 Predictors of Tardive Dyskinesia in Psychiatric Patients Taking Concomitant Antipsychotics

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 207-208 ◽  
Author(s):  
Oscar Patterson-Lomba ◽  
Rajeev Ayyagari ◽  
Benjamin Carroll
Keyword(s):  
Quality Of Life ◽  
New York ◽  
Bipolar Disorder ◽  
Depressive Disorder ◽  
Prediction Model ◽  
Psychiatric Disorders ◽  
Index Date ◽  
Atypical Antipsychotics ◽  
Increased Risk

AbstractBackgroundTardive dyskinesia (TD) is typically caused by exposure to antipsychotics, is often irreversible, and can be debilitating. TD symptoms can increase the social stigma of patients with comorbid psychiatric disorders, negatively impact quality of life, and potentially increase medical morbidity and mortality. An increased risk of developing TD has been associated with factors such as older age, female sex, underlying mental illness, and long-term use and higher doses of antipsychotics. The association of TD with the use of typical versus atypical antipsychotics has also been evaluated, with mixed results. To date, predictive models assessing the joint effect of clinical characteristics on TD risk have not been developed and validated in the US population.Study ObjectiveTo develop a prediction model to identify patient and treatment characteristics associated with the occurrence of TD among patients with psychiatric disorders taking antipsychotic medications, using a retrospective database analysis.MethodsAdult patients with schizophrenia, major depressive disorder, or bipolar disorder who were taking oral antipsychotics, and who had 6months of data prior to the index date were identified from Medicaid claims from six US states. The index date was defined as the date of the first claim for an antipsychotic drug after a claim for the underlying disorder but before TD diagnosis. A multivariate Cox prediction model was developed using a cross-validated version of the least absolute shrinkage and selection operator (LASSO) regression method to improve prediction accuracy and interpretability of the model. The predictive performance was assessed in a separate validation set via model discrimination (concordance) and calibration.ResultsA total of 189,415 patients were identified: 66,723 with bipolar disorder, 68,573 with depressive disorder, and 54,119 with schizophrenia. The selected prediction model had a clinically meaningful concordance of 70% and was well calibrated (P=0.46 for Hosmer–Leme show goodness-of-fit test). Patient’s age at index date (hazard ratio [HR]: 1.03), diagnosis of schizophrenia (HR: 1.73), dosage of antipsychotic at index date (up to 100mg/day chlorpromazine equivalent; HR: 1.40), and presence of bipolar and related disorders (HR: 1.16) were significantly associated with an increased risk of TD diagnosis. Use of atypical antipsychotics at index date was associated with a modest reduction in the risk of TD (HR=0.94).ConclusionsThis study identified a group of factors associated with the development of TD among patients with psychiatric disorders treated with antipsychotics. This may allow physicians to better monitor their patients receiving antipsychotics, allowing for the prompt identification and treatment of TD to help maintain quality of life.Presented at: American Psychiatric Association Annual Meeting; May 5–9, 2018, New York, New York, USAFunding Acknowledgements: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel.

scholarly journals Suicide attempts in veterans with bipolar disorder during treatment with lithium, divalproex, and atypical antipsychotics

2013 ◽  
Vol 145 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Eileen P. Ahearn ◽  
Peijun Chen ◽  
Michael Hertzberg ◽  
Michelle Cornette ◽  
Lori Suvalsky ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Suicide Attempts
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