Treatment Of Bipolar Patients Research Articles

Neurocognitive Impairment and Dementia in Mood Disorders

Neurocognitive Impairment and Dementia in Mood Disorders

Substance use disorders in bipolar disorder: An update

Substance use disorders (SUDs) commonly co-occur during the course of bipolar type I disorder, and they can negatively affect illness outcome. This paper reviews recent research examining SUDs in bipolar disorder. These studies confirmed the high prevalence rate of SUDs but found that they are less common in younger patients (< age 17 years). Two new longitudinal studies suggest that a co-occurring SUD worsens the prognosis of bipolar disorder and leads to more affective symptoms and suicide attempts. Two new studies have examined the treatment of bipolar patients with a comorbid SUD. These studies suggest that valproate (as an adjunct to lithium) and aripiprazole may be useful in the treatment of the affective symptoms of bipolar patients with a comorbid SUD and may also help with the treatment of the SUD.

Use of Long-acting Risperidone in the Treatment of Bipolar Patients

To the Editors:Bipolar illness has a complex clinical presentation and an even more complex treatment. There is more than 1 traditional clinical approach to treatment with a traditional difference between academic authorities in Europe (in favor of the use of antipsychotics and antidepressants) and

The Impact of Lithium Long-Term Medication on Suicidal Behavior and Mortality of Bipolar Patients

ABSTRACT The article reviews the existing evidence and the concept of the anti-suicidal effect of lithium long-term treatment in bipolar patients. The core studies supporting the concept of a suicide preventive effect of lithium in bipolar patients come from the international research group IGSLI, from Sweden, Italy, and recently also from the U.S. Patients on lithium possess an eight- time lower suicide risk than those off lithium. The anti-suicidal effect is not necessarily coupled to lithium's episode suppressing efficacy. The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms. The evidence that lithium can effectively reduce suicide risk has been integrated into modern algorithms in order to select the optimal maintenance therapy for an individual patient.

Add-on topiramate reduces weight in overweight patients with affective disorders: a clinical case series

BackgroundThe weight-gain caused by many psychotropic drugs is a major cause for poor compliance with such medications and could also increase cardio-vascular morbidity among psychiatric patients. Recent reports have shown that the anticonvulsant topiramate causes weight loss in various patient groups. The drug has also shown effectiveness in open trials as a mood stabilizer in patients with affective disorders, but not in controlled trials in the acute treatment of mania. We used topiramate to treat 12 patients with affective disorders who had a body-mass index >30 kg/m2.MethodsTopiramate was prescribed as part of our routine clinical practice, as an add-on medication, or as a replacement of a mood stabilizer. Patients' weight was recorded in 1 to 2 monthly intervals. Patients were followed up for between 6 and 12 months. The final dose of topiramate varied from 200 to 600 mg/day.ResultsTopiramate was effective in reducing the weight in 10 out of the 12 patients. At six months the 12 patients had lost a mean of 7.75 kg (SD = 6.9 kg, p < 0.001) and at 12 months 9 patients had lost a mean of 9.61 kg (SD = 6.7 kg, p = 0.003). Three patients stopped the treatment: one due to side effects, one due to possible side effects, and one suffered a manic relapse and showed no sustained weight loss. There were no other clear changes in the course of illness of the patients.ConclusionThe evidence of a strong weight-reducing potential of topiramate is indisputable and clinically significant. Topiramate could be considered in the treatment of bipolar patients who are overweight, or whose concerns about weight gain compromise their compliance with long-term prophylactic medication. So far there is no evidence that topiramate has anti-manic effect and it should not be used as monotherapy.

P.2.055 Levetiracetam add-on treatment for bipolar patients suffering from subsyndromal symptoms: preliminary data of an open 6-months longitudinal study

P.2.055 Levetiracetam add-on treatment for bipolar patients suffering from subsyndromal symptoms: preliminary data of an open 6-months longitudinal study

Increased inositol-monophosphatase activity by lithium treatment in bipolar patients

Inhibition of inositol monophosphatase (IMPase) enzyme is the target mechanism of action of lithium. However, increased activity of mRNA levels by lithium has been reported. These two diverse effects were shown after relatively short periods of lithium administration. The aim of this study was to observe the effect of prolonged use of lithium on IMPase activity. The authors investigated IMPase activities in fresh erythrocytes and leukocytes in 63 bipolar patients (42 euthymic, 8 depressive, 13 manic episodes) and 16 control subjects. We found that erythrocyte IMPase activity was higher in lithium treated euthymic patients than non-lithium treated patients. The duration of lithium use was positively correlated with leukocyte IMPase activity. Increased IMPase activity by chronic lithium use suggests an up-regulation of the enzyme activity.

Report of three cases that received maintenance treatment with risperidone as a mood stabilizer

IntroductionThe current study is a short report of 3 cases of bipolar patients.Material and methodsThree bipolar patients were prospectively followed up. All were partial responders to lithium therapy alone, and unresponsive to other therapies (anticonvulsants, antidepressants, typical antipsychotics, various combinations).ResultsAll manifested complete remission of symptoms after combination therapy with lithium (plasma levels above 0.8 mEq/lt) plus 1–3 mg of risperidone daily. The two of them are still free of symptomatology during the maintenance period for 28 and 38 months respectively. The third patient, after several months during which she was free of symptomatology discontinued lithium against the psychiatrist's advise and received only 3 mg of risperidone daily. For the next 15 months the patient was under risperidone monotherapy and free of symptomatology. She discontinued therapy to become pregnant, the illness recurred several times during pregnancy and after the delivery the patient restarted risperidone therapy. She was free of symptoms for the following 9 months until her last follow-up.DiscussionThe current study provides preliminary evidence concerning the long term efficacy of risperidone in the treatment of bipolar patients

Possible relationship between mitochondrial DNA polymorphisms and lithium response in bipolar disorder.

Although many investigators have been searching for genetic markers to predict lithium response in bipolar disorders, no genetic predictor has been established yet. We previously reported the association of mitochondrial DNA (mtDNA) 5178 and 10398 polymorphisms with bipolar disorder. The objective of this study is to clarify whether these mtDNA polymorphisms can predict response to maintenance lithium treatment in bipolar patients. We examined these polymorphisms and some clinical variables in 54 bipolar patients. A logistic regression analysis was performed and revealed that patients carrying the 10398A polymorphism showed a significantly better response to lithium (p=0.03). Some clinical variables such as sex, age at onset, and rapid cycling also showed a significant association with lithium response in univariate analysis (chi2 test, p&0.05). Our findings suggest that the mtDNA 10398 polymorphism might be related to maintenance lithium treatment response.

Bupropion as Add-On Strategy in Difficult-to-Treat Bipolar Depressive Patients

Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been suggested for the treatment of bipolar depression, not only because of its efficacy, but also because of a probably lower risk of inducing switches to hypomania or mania. Most studies on bupropion treatment in bipolar patients have been performed in moderately ill out-patients. In contrast, we report on a sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic or therapy-refractory bipolar depressive in-patients. In this open and prospective study, 13 patients were treated with bupropion as an add-on strategy mainly to other antidepressants and to various mood stabilizers. Our data support the idea that bupropion is a first-line antidepressant in the treatment of severe bipolar depression. Eight of 13 patients showed a >50% reduction of Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with drugs commonly used in treatment-resistant bipolar disorder including venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our small sample. While adhering to the suggestion of Goren and Levin not to exceed a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we did not observe any switch from depression to hypomania or mania.

The impact of lithium prophylaxis on the course of bipolar disorder: a review of the research evidence

A critical review is provided of the available research evidence concerning the efficacy and effectiveness of lithium prophylaxis in bipolar disorder. It is emphasized that, in spite of the limitations of available placebo-controlled trials and naturalistic studies, lithium is the only drug whose prophylactic activity in bipolar disorder is convincingly proved, and remains the first-choice medication in the long-term treatment of bipolar patients. The impact of lithium prophylaxis is likely to be less significant on atypical and comorbid cases of bipolar disorder than in typical manic depressive illness, but the superiority of other medications over lithium in the long-term treatment of those cases is at present not convincingly proved by research. Currently available research evidence does not seem to support the idea that lithium exerts its prophylactic effect on relapses but not on recurrences of bipolar disorder. Clinicians should be aware of the fact that the drop-out rate in bipolar patients receiving long-term lithium prophylaxis is high even if treatment surveillance is accurate, and that complete suppression of recurrences is a relatively rare outcome of prophylaxis.

Adjunctive antipsychotic use in bipolar patients: an open 6-month prospective study following an acute episode

Background: We examined the use of adjunctive antipsychotics in the treatment of bipolar patients. Methods: A total of 88 bipolar type I patients (DSM-IV diagnosis) were included. The patterns of adjunctive antipsychotic use in the first 6 months after an index episode were examined. Results: A total of 34 patients (39%) received at least one antipsychotic during the follow-up period. At time 0, 23 subjects (26%) were on antipsychotics; at 3 months, 10 subjects (11%); and at the end of the 6 month period, 11 subjects (12%). Prolonged use of antipsychotics (more than 15 weeks) was found in eight patients (9%). No significant differences were found in demographic characteristics or baseline clinical variables between the patients who received or did not receive antipsychotics, except that the use of adjunct antipsychotics in the 6-month period was significantly more common after an index manic than depressive episode (68 versus 17%, respectively, P=0.001; Fisher’s exact test). Limitations: This report presents a secondary analysis of follow-up data from a prospective study, and therefore the hypotheses here examined were not originally part of the primary hypotheses that led to the design of the study. A larger sample size could eventually reveal small differences among the patient sub-groups not presently found. Conclusions: The use of adjunctive antipsychotics among bipolar patients was less extensive than previously reported, and mostly related to an index manic episode. Our findings suggest that in samples of carefully diagnosed bipolar type I patients the group that may need continued antipsychotic treatment is relatively small.

Kidney functioning during short and long-term lithium treatment in bipolar patients

Kidney functioning during short and long-term lithium treatment in bipolar patients

Anticonvulsant drugs in bipolar disorder

Although much progress has been made in successfully treating bipolar disorder, there is increasing awareness of the limitations of traditional treatment regimens such as lithium and neuroleptics. The large family of anticonvulsant drugs, however, appears to be capable of providing new treatment options, not only as medication of second choice in patients refractory to treatment, but often as a treatment standard with high efficacy and low incidence of side effects. Besides established mood stabilizers such as carbamazepine and valproate, new antiepileptic drugs are entering the field with promising initial results in the treatment of bipolar patients. Furthermore, bringing to light the mechanisms of action of anticonvulsants and the similarities between anticonvulsants effective in bipolar disorder may also deepen our understanding of the pathophysiological basis of the disorder.

Strategies for managing depression complicated by bipolar disorder, suicidal ideation, or psychotic features.

Major depression, a common clinical problem that, if recognized early and treated vigorously, is often highly responsive to antidepressants and can be complicated by such features as mania, suicidal thoughts and actions, and psychosis. Suicide is one of the most serious complications of major depression. An online search of the medical literature was used to select English-language articles addressing depression using, but not limited to, the following specific terms: "primary care," "depressive disorders," "bipolar disorder," "suicide," "psychosis," and "antidepressants." Treatment of the manic phases of bipolar disorder includes lithium or anticonvulsants. Breakthrough depression can be particularly resistant to treatment in bipolar patients, and the tricyclic antidepressants can cause patients to cycle more rapidly into the manic phase. The selective serotonin reuptake inhibitors (SSRIs) and bupropion are less likely to cause rapid cycling in bipolar disorder. Depressed patients with suicidal tendencies should be closely monitored and given full doses of antidepressant medications. The SSRIs lessen suicidal tendencies and, importantly, are markedly safer than the tricyclic antidepressants when taken in an overdose. Depressed patients can also become psychotic, exhibiting mood-congruent delusions. Combination therapy with antidepressant and antipsychotic medications is often necessary. Some physicians prefer to hospitalize patients with psychotic depression. Depression can be a complex and multifaceted disorder that requires careful diagnosis and treatment plans.

Suicidality in patients with pure and depressive mania

A previous comprehensive literature review indicated that suicide accounted for 18.9% of the deaths of 9,389 individuals with manic-depressive illness. The literature associates these deaths with the depressed phase of the disease. This study was designed to determine the rate and severity of suicidality among patients with pure and depressive mania. The patients were 93 persons who met the Research Diagnostic Criteria (RDC) for bipolar I disorder (N = 75) or schizoaffective disorder (N = 18). All met the RDC for primary mania and the DSM-III-R criteria for bipolar disorder, manic or mixed. Patients with depressive mania met the RDC for mania and major depressive disorder concurrently. Severity of current suicidality was measured by using the Schedule for Affective Disorders and Schizophrenia suicide subscale. Differences in the mean suicidality scores between any two groups were assessed with the Kruskal-Wallis test. Relationships of age, gender, type of affective illness (bipolar I versus schizoaffective disorder), psychosis, race, and mania subtype to suicidality were assessed by using multivariate logistic regression analysis. One (2.0%) of the 49 patients with pure mania was suicidal. In contrast, 24 (54.5%) of the 44 patients with depressive mania were suicidal. This difference was highly significant. Gender and psychosis were not related to suicidality. African-Americans were less likely to be suicidal than Caucasians. Subtype of mania had the strongest relationship to suicidality. A subgroup of manic patients are severely suicidal. Presentation in the manic state is an indication for careful assessment of depressive symptoms and suicidality.

Effects of lithium treatment on hypothalamic-pituitary-thyroid axis: A longitudinal study

Lithium carbonate, widely used in the treatment of bipolar patients, is well known to induce thyroid alterations. In this longitudinal study the thyroid function was investigated during lithium treatment over a period of 12 months in 12 euthymic bipolar patients with a normal thyroid function and absence of thyroid antibodies. Nine of the 12 patients were further studied on the 15th month, 5 of these 9 on the 18th month and 4 of the last-mentioned 5 on the 24th month. The mean basal and TRH-stimulated TSH values during lithium therapy were significantly higher as compared to those at the beginning of the treatment. More particularly, during lithium therapy, a significant increase of basal TSH over the normal range was found in 10 out of the 12 patients. A rise of TRH-stimulated TSH was found in 11 out of the 12 patients. The impairment of the hypothalamic-pituitary-thyroid (HPT) axis was transitory in the majority of cases. Two patients developed a nodular goiter during the treatment. Plasma T3, T4, FT3 and FT4 levels did not change during the treatment. Thyroid antibodies remained undetectable. The conclusions of the study are twofold: 1) Subclinical hypothyroidism during lithium therapy is much more frequent than previous cross-sectional studies suggest; 2) Thyroxine replacement in lithium-treated patients is advisable in order to prevent subclinical hypothyroidism and the risk of a subsequent goiter.