Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T17:14:05.108Z Has data issue: false hasContentIssue false

16 - The use of atypical antipsychotic agents in the treatment of diagnostic subgroups of bipolar disorder: mixed and pure states, psychotic and non-psychotic

Published online by Cambridge University Press:  10 August 2009

By
Robert W. Baker ,
Leslie M. Schuh  and
Mauricio Mauricio Tohen
Edited by
Andreas Marneros  and
Frederick Goodwin
Robert W. Baker
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, USA
Leslie M. Schuh
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, USA
Mauricio Mauricio Tohen
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, and Harvard Medical School, Belmont, MA, USA
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
Get access

Summary

Introduction

There are many challenges in treating bipolar disorder, including confronting marked variability in symptoms between patients, as well as highly differing symptomatic presentations within an individual patient's course of illness. Diversity of presentation and course is potentially quite important to prognosis and treatment selection, though the relevance has not been consistently well defined in empirical research. This chapter reviews controlled findings regarding the impact of variant bipolar presentations to predicting treatment response with atypical antipsychotic agents.

Classic bipolar I disorder consists of euthymic periods punctuated by episodes of mania or major depression. Interindividual variability is manifest in differing severity, length, and frequency of manic and depressive episodes and the degree of symptom relief occurring between acute episodes. There are, of course, many variations on the classic pattern, such as the concurrent dysphoric and manic symptoms of mixed states, subsyndromal presentations, or the markedly frequent episodes of rapid cycling. Bipolar disorder is also commonly complicated by psychiatric comorbidity, such as psychosis, as well as substance abuse or physical disorders. Not surprisingly, patients with bipolar disorder have increased mortality from suicide, accidents, substance-abuse-related causes, and various medical diseases (Baldessarini, 2002).

Variant presentations may be more difficult to treat than classic bipolar depression or mania. First, these presentations often broaden the range of target symptoms requiring treatment, including, for example, psychotic symptoms or the pivotal need to slow cycling in rapid cyclers. Such variant presentations may help to explain the polypharmacy that is typical of bipolar disorder treatment.

Keywords

acute maniaantipsychotic agentsaripiprazolebipolar disordernon-psychotic patientsolanzapineclozapinelithiumquetiapinerisperidone
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 353 - 368
Publisher: Cambridge University Press
Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). Am. J. Psychiatry, 159 (suppl. 4), 1–50.
Baldessarini, R. J. (2002). Treatment research in bipolar disorder: issues and recommendations. CNS Drugs., 16, 721–9.Google Scholar
Berk, M., Ichim, L., and Brook, S. (1999). Olanzapine compared to lithium in mania: a double–blind randomized controlled trial. Int. Clin. Psychopharmacol., 14, 339–43.Google Scholar
Brotman, M. A., Post, R. M., Fergus, E. L., and Leverich, G. S. (2000). High exposure to neuroleptics in bipolar patients: a retrospective review. J. Clin. Psychiatry, 61, 68–72.Google Scholar
Calabrese, J. R., Kimmel, S. E., Woyshville, M. J., et al. (1996). Clozapine for treatment-refractory mania. Am. J. Psychiatry, 153, 759–64.Google Scholar
DelBello, M. P., Schwiers, M. L., Rosenberg, H. L., et al. (2002). A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J. Am. Acad. Child Adolesc. Psychiatry, 41, 1216–23.Google Scholar
Garfinkel, P. E., Stancer, H. C., and Persad, E. (1980). A comparison of haloperidol, lithium carbonate and their combination in the treatment of mania. J. Affect. Disord., 2, 279–88.Google Scholar
Glazer, W. (2000a). Review of incidence studies of tardive dyskinesia associated with typical antipsychotics. J. Clin. Psychiatry, 61, 15–20.Google Scholar
Glazer, W. (2000b). Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality. J. Clin. Psychiatry, 61, 16–21.Google Scholar
Glazer, W. M. (2000c). Expected incidence of tardive dyskinesia associated with atypical antipsychotics. J. Clin. Psychiatry, 61, 21–6.Google Scholar
Goodwin, F. K. and Jamison, K. R. (1990). Manic–Depressive Illness. New York, NY: Oxford University Press.
Green, A. I., Tohen, M., Patel, J. K., et al. (2000). Clozapine in the treatment of refractory psychotic mania. Am. J. Psychiatry, 157, 982–6.Google Scholar
Hirschfeld, R., Keck, P. E., Karcher, K., Kramer, M., and Grossman, F. (2004). Rapid antimanic effect of risperidone monotherapy: a 3-week multicenter, double-blind, placebo-controlled trial. Am. J. Psychiatry, 161, 1057–65.Google Scholar
Kapur, S., and Seeman, P. (2001). Does fast dissociation from dopamine d(2) receptors explain the action of atypical antipsychotics? A new hypothesis. Am. J. Psychiatry, 158, 360–9.Google Scholar
Keck, P. E. Jr., Versiani, M., Ptkin, S.et al. (2003a). Ziprasidone in the treatment of acute bipolar mania. A 3-week, placebo-controlled, double-blind, randomized trial. Am. J. Psychiatry, 160, 741–8.Google Scholar
Keck, P. E. Jr., Marcus, R., Tourkodimitris, S., et al. (2003b). Aripiprazole versus placebo in acute mania. Am. J. Psychiatry, 160, 1651–8.Google Scholar
Khanna, R., Das, A., and Damodaran, S. S. (1992). Prospective study of neuroleptic-induced dystonia in mania and schizophrenia. Am. J. Psychiatry, 149, 511–13.Google Scholar
Koukopoulos, A., Reginaldi, D., Laddomada, P., et al. (1980). Course of the manic depressive cycle and changes caused by treatment. Pharmacopsychiatria, 13, 156–67.Google Scholar
Krakowski, M., Czobor, P., and Volavka, J. (1997). Effect of neuroleptic treatment on depressive symptoms in acute schizophrenic episodes. Psychiatry Res., 71, 19–26.Google Scholar
Morgan, H. G. (1972). The incidence of depressive symptoms during recovery from hypomania. Br. J. Psychiatry, 120, 537–9.Google Scholar
Nasrallah, H. A., Churchill, C. M., and Hamdan-Allan, G. A. (1988). Higher frequency of neuroleptic-induced dystonia in mania than in schizophrenia. Am. J. Psychiatry, 145, 1455–6.Google Scholar
Sachs, G. S., Printz, D. J., Kahn, D. A., Carpenter, D., and Docherty, J. P. (2000). The Expert Consensus Guideline Series. Medication treatment of bipolar disorder. Postgrad. Med., April, 1–104.Google Scholar
Sachs, G., Grossman, F., Ghaemi, N., Okamoto, A., and Bowden, C. (2002a). Combination of a mood stabilizer with risperidone or haloperidol for the treatment of acute mania: a double-blind placebo controlled comparison of efficacy and safety. Am. J. Psychiatry, 159, 1146–54.Google Scholar
Sachs, G., Grossman, F., Ghaemi, S. N., Okamoto, A., and Bowden, C. L. (2002b). Combination of a mood stabilizer with risperidone or haloperidol for treatement of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am. J. Psychiatry, 159, 1146–54.Google Scholar
Sachs, G., Chengappa, K. N., Suppes, T.et al. (2004). Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study. Bipolar Disord., 6, 213–23.Google Scholar
Seeman, P. and Trallerico, T. (1999). Rapid release of antipsychotic drugs from dopamine 2 receptors: an explanation for low receptor occupancy and early clinical relapse upon withdrawal of clozapine or quetiapine. Am. J. Psychiatry, 156, 876–84.Google Scholar
Segal, J., Berk, M., and Brook, S. (1998). Risperidone compared with both lithium and haloperidol in mania: a double-blind randomized controlled trial. Clin. Neuropharmacol., 121, 176–80.Google Scholar
Stanniland, C. and Taylor, D. (2000). Tolerability of atypical antipsychotics. Drug Safety, 22, 195–214.Google Scholar
Suppes, T., Webb, A., Paul, B., et al. (1999). Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am. J. Psychiatry, 156, 1164–9.Google Scholar
Swann, A. C., Bowden, C. L., Morris, D., et al. (1997). Depression during mania: treatment response to lithium or divalproex. Arch. Gen. Psychiatry, 54, 37–42.Google Scholar
Tohen, M. and Zarate, C. Jr. (1998). Antipsychotic agents and bipolar disorder. J. Clin. Psychiatry, 59 (suppl. 1), 38–48.Google Scholar
Tohen, M., Sanger, T. M., McElroy, S. L., et al. (1999). Olanzapine versus placebo in the treatment of acute mania. Am. J. Psychiatry, 156, 702–9.Google Scholar
Tohen, M., Jacobs, T. G., Grundy, S. L., et al. (2000). Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. Arch. Gen. Psychiatry, 57, 841–9.Google Scholar
Tohen, M., Baker, R. W., Altshuler, L., et al. (2002a). Olanzapine versus divalproex for the treatment of acute mania. Am. J. Psychiatry, 159, 1011–17.Google Scholar
Tohen, M., Chengappa, K. N. R., Suppes, T. R., et al. (2002b). Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Arch. Gen. Psychiatry, 59, 62–9.Google Scholar
Tohen, M., Goldberg, J. F., Arrillaga, Gonzalez-Pinto A. M., et al. (2003a). Efficacy of olanzapine and olanzapine/fluoxetine combination in the treatment of bipolar I depression. Arch. Gen. Psychiatry, 60, 1079–88.Google Scholar
Tohen, M., Vieta, E., Calabrese, J., et al. (2003b). Efficacy of olanzapine and olanzapine fluoxetine combination in the treatment of bipolar I depression. Arch. Gen. Psychiatry, 60, 1079–88.Google Scholar
Tohen, M., Bowden, C. L., Risser, R., Detke, H. C., and Calabrese, J. R. (2004). Olanzapine versus placebo in the prevention of relapse for mixed index versus manic episode patients. Eur. Psychiatry, 19 (suppl. 1), 205s.Google Scholar
Vieta, E., Khanna, S., Lyons, B., et al. (2002). Risperidone in the treatment of manic or mixed episodes of bipolar disorder. American College of Neuropsychopharmacology 41st annual meeting, San Juan, PR (conference proceedings).
Yatham, L. (2000). Safety and efficacy of risperidone as combination therapy for the manic phase of bipolar disorder: preliminary findings of a randomised, double-blind study (RIS-INT-46). Int. J. Neuropsychopharmacol., 3, S142.Google Scholar
Zajecka, J., Weisler, R., Sachs, G., et al. (2002). A comparison of the efficacy, safety, and tolerability of divalproex sodium and olanzapine in the treatment of bipolar disorder. J. Clin. Psychiatry, 63, 1148–55.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×