Disorders - Bipolar Disorders
Hasty, M. K., Conus, P., Cotton, S. M., Macneil, C. A., Berk, M.
Bipolar disorder is a highly recurrent illness, and many young people experience one or more relapses in the years following their initial episode. Understanding the early course of illness and predictors of relapse may help to inform prognosis and improve treatment following recovery from a first episode of mania. Identification of risk factors for recurrence, particularly those that are modifiable, is particularly relevant for psychological interventions aimed at relapse prevention. Therefore, the aim of this study was to examine the course of illness in young people following treatment for first episode psychotic mania and identify factors associated with relapse in this population. Seventy-four patients with first episode mania who were treated at the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia and enrolled in a randomized controlled trial (RCT) comparing acute treatment using either olanzapine or chlorpromazine in combination with lithium were prospectively followed up for 18 months. The design of the RCT allowed us to closely monitor the timing of symptom recurrences and changes to treatment and to examine the association of clinical variables and medication status with relapse. Results from logistic regression and survival analyses will be presented.
Bipolar Disorders, 12 : 26
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Lithium
Goldstein, B. I., Bukstein, O. G.
Objective: The burden of substance use disorders (SUDs) among adults with bipolar disorder is well documented. Comparatively less is known regarding comorbid SUD among youth with bipolar disorder. This article aims to integrate the extant literature on this topic and to suggest strategies for delaying or preventing SUD among youth with bipolar disorder. Data Sources and Study Selection: Relevant studies in English were identified using PubMed and MEDLINE (1950-February 2009). Search terms were bipolar disorder cross-referenced with child, adolescent, or youth, and alcohol, drug, or substance, and abuse, dependence, or disorder. Articles were selected on the basis of containing data regarding both bipolar disorder and SUD. The search was supplemented by manually reviewing reference lists from the identified publications. Data Synthesis: Epidemiologic and clinical studies demonstrate that youth-onset bipolar disorder confers even greater risk of SUD in comparison with adultonset bipolar disorder. Recent studies of youth with bipolar disorder have not identified childhood SUD (0%); however, the prevalence of SUD escalates during adolescence (16%-39%). Substance use disorder among bipolar youth is associated with legal and academic difficulties, pregnancy, and suicidality. Few studies have addressed interventions for this population, although studies are underway. Because bipolar disorder onset most commonly precedes SUD among youth (55%-83%), there is a window of opportunity for prevention. Conclusions: Pending the results of ongoing treatment studies, several strategies are suggested for curtailing the burden of SUD in youth with bipolar disorder. These include screening for substance use among bipolar youth beginning at age 10 irrespective of other risk factors, education and intervention at the family level, and implementation of preventive interventions that have been successful in other populations. (copyright) Copyright 2010 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 71(3) : 348-358
- Year: 2010
- Problem: Bipolar Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Gracious, B. L., Chirieac, M. C., Costescu, S., Finucane, T. L., Youngstrom, E. A., Hibbeln, J. R.
Objectives: This clinical trial evaluated whether supplementation with flax oil, containing the omega-3 fatty acid (alpha)-linolenic acid ((alpha)-LNA), safely reduced symptom severity in youth with bipolar disorder. Methods: Children and adolescents aged 6-17 years with symptomatic bipolar I or bipolar II disorder (n = 51), manic, hypomanic, mixed, or depressed, were randomized to either flax oil capsules containing 550 mg (alpha)-LNA per 1 gram or an olive oil placebo adjunctively or as monotherapy. Doses were titrated to 12 capsules per day as tolerated over 16 weeks. Primary outcomes included changes in the Young Mania Rating Scale, Child Depression Rating Scale-Revised, and Clinical Global Impressions-Bipolar ratings using Kaplan-Meier survival analyses. Results: There were no significant differences in primary outcome measures when compared by treatment assignment. However, clinician-rated Global Symptom Severity was negatively correlated with final serum omega-3 fatty acid compositions: %(alpha)-LNA (r = -0.45, p < 0.007), % eicosapentaenoic acid (EPA) (r = -0.47, p < 0.005); and positively correlated with final arachidonic acid (AA) (r = 0.36, p < 0.05) and docosapentaenoic acid (DPA) n-6 (r = 0.48, p < 0.004). The mean duration of treatment for (alpha)-LNA was 11.8 weeks versus 8 weeks for placebo; however, the longer treatment duration for (alpha)-LNA was not significant after controlling for baseline variables. Subjects discontinued the study for continued depressive symptoms. Conclusions: Studies of essential fatty acid supplementation are feasible and well tolerated in the pediatric population. Although flax oil may decrease severity of illness in children and adolescents with bipolar disorder who have meaningful increases in serum EPA percent levels and/or decreased AA and DPA n-6 levels, individual variations in conversion of (alpha)-LNA to EPA and docosahexaenoic acid as well as dosing burden favor the use of fish oil both for clinical trials and clinical practice. Additionally, future research should focus on adherence and analysis of outcome based on changes in essential fatty acid tissue compositions, as opposed to group randomization alone. (copyright) 2010 The Authors. Journal compilation (copyright) 2010 John Wiley & Sons A/S.
Bipolar Disorders, 12(2) : 142-154
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Haas, M., Delbello, M. P., Pandina, G., Kushner, S., Van Hove, I., Augustyns, I., Quiroz, J., Kusumakar, V.
Objectives: To evaluate the efficacy, safety, and tolerability of risperidone monotherapy for the treatment of an acute mixed or manic episode in children and adolescents with bipolar I disorder. Methods: This randomized, placebo-controlled, double-blind, 3-arm study (N = 169) included children and adolescents (ages 10-17 years) with a DSM-IV diagnosis of bipolar I disorder, experiencing a manic or mixed episode. Study participants were randomized to placebo (n = 58), risperidone 0.5-2.5 mg/day (n = 50), or risperidone 3-6 mg/day (n = 61) for 3 weeks. The primary efficacy measure was change in Young Mania Rating Scale (YMRS) total score from baseline to end point. Safety assessments included adverse event (AE) monitoring and scores on extrapyramidal symptom rating scales. Results: Improvement in mean YMRS total score was significantly greater in risperidone-treated subjects than in placebo-treated subjects [mean change (SD) -9.1 (11.0) for placebo; -18.5 (9.7) for risperidone 0.5-2.5 mg (p < 0.001); -16.5 (10.3) for risperidone 3-6 mg (p < 0.001)]. The most common risperidone-associated AEs were somnolence, headache, and fatigue. Mean (SD) weight gain was 0.7 (1.9) kg, 1.9 (1.7) kg, and 1.4 (2.4) kg in the placebo, risperidone 0.5-2.5 mg, and risperidone 3-6 mg groups, respectively, during this 3-week study. Conclusions: At daily doses of 0.5-2.5 mg and 3-6 mg, risperidone was effective and well tolerated in children and adolescents experiencing acute manic or mixed episodes of bipolar I disorder. Results indicate that risperidone 0.5-2.5 mg has a better benefit-risk profile than risperidone 3-6 mg. (copyright) 2009 The Authors. Journal compilation (copyright) 2009 John Wiley & Sons A/S.
Bipolar Disorders, 11(7) : 687-700
- Year: 2009
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Grunze, Heinz, Vieta, Eduard, Goodwin, Guy M., Bowden, Charles, Licht, Rasmus W., Moller, Hans-Jurgen, Kasper, Siegfried
These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A-F). As these guidelines are intended for clinical use, the scientific evidence was finally asigned different grades of recommendation to ensure practicability.
World Journal of Biological Psychiatry, 10(2) : 85-116
- Year: 2009
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Hebrani, P., Behdani, F., Manteghi, A. A.
Objective: To study the efficacy and safety of Topiramate versus Sodium Valproate for the Treatment of Bipolar Disorder in Adolescents Methodology: One hundred twenty adolescents (aged 12-18) with an admission diagnosis of bipolar I disorder, manic or mixed episode were enrolled from the Adolescent Ward at Ebn-e-Sina Psychiatric Center of Mashhad University. They were assigned to receive 8 weeks of double-blinded, flexibly dosed treatment with topiramate or sodium valproate. The primary efficacy measure was the mean change from baseline to endpoint in the Young Mania Rating Scale (YMRS). Results: Sodium Valproate was superior to topiramate. The YMRS scores decreased significantly in both groups. However, when efficacy of topiramte was analyzed, only 18.64% of the patients showed YMRS scores decrease more than 50% from baseline. Conclusions: This study does not support the efficacy of topiramate as monotherapy in acute mania or mixed episodes in adolescents with bipolar I disorder and sodium valproate was found superior to topiramate.
Pakistan Journal of Medical Sciences, 25(2) : 247-252
- Year: 2009
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Anticonvulsants/mood stabilisers (excl. lithium)
Findling, R. L., Nyilas, M., Forbes, R. A., McQuade, R. D., Jin, N., Iwamoto, T., Ivanova, S., Carson, W. H., Chang, K.
Objectives: To determine the efficacy and safety of aripiprazole for the treatment of pediatric bipolar I disorder, manic or mixed episode, with or without psychotic features. Method: Subjects were enrolled between March 2005 and February 2007 in a randomized, multicenter, double-blind 4-week study of aripiprazole 10 mg/d, aripiprazole 30 mg/d, and placebo. Subjects (n = 296) were 10 to 17 years old with a DSM-IV diagnosis of bipolar I disorder with current manic or mixed episodes, with or without psychotic features, and a Young Mania Rating Scale (YMRS) score (greater-than or equal to) 20. The primary efficacy variable was change from baseline in the YMRS total score. Results: Both doses of aripiprazole were superior to placebo on the YMRS total score beginning at week 1 and continuing through week 4. Aripiprazole 10 mg and 30 mg were more effective than placebo on global improvement, mania, and overall bipolar illness outcome measures. Response ((greater-than or equal to)50% reduction in YMRS total score) at week 4 was achieved by 44.8%, 63.6%, and 26.1% of subjects in the aripiprazole 10 mg, aripiprazole 30 mg, and placebo groups, respectively (P < .01 both doses vs placebo). Both doses were generally well tolerated. The most common adverse events were extrapyramidal disorder and somnolence; rates were higher for aripiprazole 30 mg compared with aripiprazole 10 mg. Average weight gain was not significantly different between the aripiprazole 10 mg (+0.82 kg) or 30 mg (+1.08 kg) groups compared with the placebo group (+0.56 kg) (P = .35 and P = .13, respectively). Conclusions: Aripiprazole in daily doses of 10 mg or 30 mg is an effective and generally well-tolerated acute treatment for pediatric subjects with bipolar I mania or mixed episodes. Trial Registration: clinicaltrials.gov Identifier: NCT00110461 (copyright) Copyright 2009 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 70(10) : 1441-1451
- Year: 2009
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Delbello, M. P., Chang, K., Welge, J. A., Adler, C. M., Rana, M., Howe, M., Bryan, H., Vogel, D., Sampang, S., mDelgado, S. V., Sorter, M., Strakowski, S. M.
Objective: To conduct a pilot study comparing the effects of quetiapine and placebo for the treatment of depressive episodes in adolescents with bipolar I disorder. Method: Thirty-two adolescents (ages 12-18 years) with a depressive episode associated with bipolar I disorder were randomized to eight weeks of double-blind treatment with quetiapine, 300-600 mg/day, or placebo. This two-site study was conducted from March 2006 through August 2007. The primary efficacy measure was change in Children's Depression Rating Scale-Revised Version (CDRS-R) scores from baseline to endpoint. Secondary efficacy measures included change in CDRS-R scores over the eight-week study period (PROC MIXED), changes from baseline to endpoint in Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS), and Clinical Global Impression-Bipolar Version Severity (CGI-BP-S) scores, as well as response and remission rates. Safety and tolerability were assessed weekly. Results: There was no statistically significant treatment group difference in change in CDRS-R scores from baseline to endpoint (p = 0.89, effect size = -0.05, 95% confidence interval: -0.77-0.68), nor in the average rate of change over the eight weeks of the study (p = 0.95). Additionally, there were no statistically significant differences in response (placebo = 67% versus quetiapine = 71%) or remission (placebo = 40% versus quetiapine = 35%) rates, or change in HAM-A, YMRS, or CGI-BP-S scores (all p > 0.7) between treatment groups. Dizziness was more commonly reported in the quetiapine (41%) than in the placebo (7%) group (Fisher's exact test, p = 0.04). Conclusions: The results suggest that quetiapine monotherapy is no more effective than placebo for the treatment of depression in adolescents with bipolar disorder. However, limitations of the study, including the high placebo response rate, may have contributed to our findings and should be considered in the design of future investigations of pharmacological interventions for this population. (copyright) 2009 The Authors Journal compilation (copyright) 2009 John Wiley & Sons A/S.
Bipolar Disorders, 11(5) : 483-493
- Year: 2009
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Arbaizar, Beatriz, Dierssen-Sotos, Trinidad, Gomez-Acebo, Ines, Llorca, Javier
Objective: Methods: Results: Conclusion: We performed meta-analyses to obtain pooled estimates from controlled clinical trials on the efficacy of aripiprazole in major depression disorder and manic phase of bipolar disorder.A search was performed in Medline/PubMed using "aripiprazole" AND "depressive disorder" and "aripiprazole" AND "bipolar disorder" as keywords, and "randomized controlled trial" as limit. The last search was performed by April 30, 2009. References in the selected articles were revised to identify other studies. We selected four placebo-controlled clinical trials on aripiprazole's effect on major depression, and three on aripiprazole's effect on bipolar disorder. Studies performed in patients with comorbidity or devoted to measuring the effect of aripiprazole for maintenance therapy were excluded. We extracted, in duplicate, data on number of patients, withdrawals, changes in Montgomery-Asberg Depression Rating Scale and Young Mania Rating Scale (YMRS), response and remission rates, and side effects.Aripripazole is effective in increasing response rates in depressive patients (response rate in the aripiprazole group minus response rate in the placebo group: 7.7%, 95% CI: 1.5-14.2) and manic patients (difference in response rates: 15.7%, 95% CI: 9.7-21.8). It also improves by 3 points the scores in YMRS. Evidence of improving remission rates is unavailable. Some side effects were more frequent in patients taking aripiprazole; this was the case of akathisia, especially in depressive trials (rate difference: 20.3%, 95% CI: 16.9-23.7), and nausea in manic patients (rate difference: 10.5%, 95% CI: 7.4-13.5). Insomnia and restlessness were also more frequent in depressive patients taking aripiprazole.We found evidence suggesting that aripiprazole is effective in both depressive and manic patients, but has relevant side effects. Further research is needed to identify its benefits for comorbid patients and its long-term effect.
General Hospital Psychiatry, 31(5) : 478-483
- Year: 2009
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Azorin, Jean-Michel, Kaladjian, Arthur
Background: Objective: Methods: Results/conclusions: Although depression accounts for a large part of the burden associated with bipolar disorder, its drug treatment has been under-studied.To provide the best available evidence supporting the pharmacotherapy of bipolar depression.A systematic review was conducted, focusing on randomized, controlled trials (RCTs) and meta-analyses.Despite FDA approval of both the olanzapine-fluoxetine combination and quetiapine for the treatment of acute bipolar depression, independent RCTs (i.e., not trials conducted 'under the umbrella' of a drug company) have not found any drug to have antidepressant effects similar to those seen in unipolar depression. A practice-based suggestion, valuable for both short- and long-term treatment, might be to have a background of mood stabilizers and to add drugs, following one of several treatment options, trusting to find a drug with a degree of effectiveness by trial and error. The list of drugs that could be used would include all the current antidepressants, the olanzapine-fluoxetine combination and probably quetiapine too. Special features and situations might also influence treatment options.
Expert Opinion on Pharmacotherapy, 10(2) : 161-172
- Year: 2009
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Beynon, S., Soares-Weiser, K., Woolacott, N., Duffy, S., Geddes, J. R.
We conducted a systematic review and meta-analysis of randomised and quasi-randomised controlled trials evaluating all clinically relevant pharmacological interventions for the prevention of relapse in people with bipolar disorder. Thirty-four trials were included in the review. Direct comparisons with placebo and with lithium were available for most drugs. In addition, there were direct comparisons of valproate vs. olanzapine, imipramine vs. lithium plus imipramine, olanzapine plus mood stabilisers vs. mood stabilisers and perphenazine plus mood stabilisers vs. mood stabilisers. Methodological quality varied across studies and the strength of evidence was not equal for all treatments or for all comparisons. There is evidence from placebo-controlled trials for the efficacy of lithium, valproate and lamotrigine as maintenance therapy for the prevention of relapse in bipolar disorder. Three drugs have a significant effect in the prevention of manic relapses (lithium, olanzapine and aripiprazole) and three in the prevention of depressive symptoms (valproate, lamotrigine and imipramine). Imipramine is little used in practice, because of concern about adverse effects. The significant effects of olanzapine and aripiprazole were demonstrated in selected responsive bipolar I patients only. Despite widespread use in clinical practice, there is little evidence to support the efficacy of combination therapy.
Journal of Psychopharmacology, 23(5) : 574-591
- Year: 2009
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Relapse prevention
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Treatment and intervention: Biological Interventions (any)
Fristad, Mary A., Verducci, Joseph S., Walters, Kimberly, Young, Matthew E.
Context: Childhood mood disorders lack sufficient evidence- based treatments. While psychosocial treatments are recommended for both childhood depression and bipolar disorder, empirical support is scarce. Objective: To determine whether adjunctive multifamily psychoeducational psychotherapy would improve outcome for children aged 8 to 12 years with depression or bipolar disorder. Design: One hundred sixty-five children were studied in a randomized controlled trial of multifamily psychoeducational psychotherapy plus treatment as usual (n=78) compared with a wait-list control (WLC) condition plus treatment as usual (n=87). Assessments occurred at baseline and at 6, 12, and 18 months. Intervention occurred between baseline and 6 months for the immediate treatment group and between 12 and 18 months for the WLC group. Setting: University medical center. Participants: Children were recruited from mental health and physical health care providers, media contacts, and word of mouth. All had a major mood disorder (major depressive disorder or dysthymic disorder, 30%; bipolar disorder type I, type II, or not otherwise specified, 70%). Intervention: Children and 1 or more parents participated in eight 90-minute multifamily psychoeducational psychotherapy sessions. Parent and child groups met separately but began and ended sessions together. Main Outcome Measures: The Mood Severity Index (MSI) combines Mania Rating Scale and Children's Depression Rating Scale - Revised scores. Results: Multifamily psychoeducational psychotherapy plus treatment as usual was associated with lower MSI scores at follow-up in intent-to-treat analyses compared with WLC plus treatment as usual. The WLC group showed a similar decrease in MSI scores 1 year later, when also following their treatment. Conclusion: Brief, adjunctive psychoeducational group psychotherapy is associated with improved outcome for children aged 8 to 12 years with major mood disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Archives of General Psychiatry, 66(9) : 1013-1020
- Year: 2009
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation