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-rdxmf Total loading time: 0 Render date: 2024-11-24T17:07:42.610Z Has data issue: false hasContentIssue false

1.07 - Approach to Bipolar Diathesis in Schizophrenia Spectrum Patients

from Part I - Treatment Strategies

Published online by Cambridge University Press:  19 October 2021

Edited by
Michael Cummings  and
Stephen Stahl
Michael Cummings
Affiliation:
University of California, Los Angeles
Stephen Stahl
Affiliation:
University of California, San Diego
Get access

Summary

The mainstay of acute mania treatment for schizoaffective disorder, bipolar type (SAD-BT) patients includes the use of antipsychotic therapy combined with one of the two first-line mood stabilizers lithium or a form of valproic acid (VPA) (e.g. divalproex) [1, 2]. In controled acute mania studies with bipolar I patients, response rates to monotherapy with antipsychotics, lithium or VPA are comparable and roughly 50% [2]. While carbamazepine can be used for maintenance treatment, and has been studied in acute mania, rapid titration is poorly tolerated due to central nervous system (CNS) adverse effects such as sedation, dizziness, ataxia, and nausea, and thus should be avoided unless treatment with lithium or VPA is contraindicated [3]. As an inducer of cytochrome P450 (CYP) enzymes and the drug transporter P-glycoprotein (PGP), carbamazepine may reduce antipsychotic levels by 30–80% and thus presents a source of kinetic interaction than can be problematic during acute and maintenance treatment [4]. Carbamazepine is also associated with hyponatremia [1]. Other anticonvulsants have been studied for acute mania and have been found to be ineffective, including gabapentin, lamotrigine, licarbazepine, oxcarbazepine, and topiramate [2].

Type
Chapter
Information
Management of Complex Treatment-resistant Psychotic Disorders , pp. 42 - 50
Publisher: Cambridge University Press
Print publication year: 2021

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

Meyer, J. M. (2018). Pharmacotherapy of psychosis and mania. In Brunton, L. L., Hilal-Dandan, R., and Knollmann, B. C. (eds.). Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th ed. Chicago, IL: McGraw-Hill, pp. 279–302.Google Scholar
Baldessarini, R. J., Tondo, L., Vazquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Mol Psychiatry, 24, 198–217.CrossRefGoogle ScholarPubMed
Post, R. M., Ketter, T. A., Uhde, T., et al. (2007). Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: principles and practice. CNS Drugs, 21, 47–71.CrossRefGoogle ScholarPubMed
Zaccara, G., Perucca, E. (2014). Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord, 16, 409–431.CrossRefGoogle ScholarPubMed
Yatham, L. N., Beaulieu, S., Schaffer, A., et al. (2016). Optimal duration of risperidone or olanzapine adjunctive therapy to mood stabilizer following remission of a manic episode: a CANMAT randomized double-blind trial. Mol Psychiatry, 21, 1050–1056.CrossRefGoogle ScholarPubMed
Leucht, S., Helfer, B., Dold, M., et al. (2015). Lithium for schizophrenia. Cochrane Database Syst Rev, 10, CD003834.Google Scholar
Jochim, J., Rifkin-Zybutz, R. P., Geddes, J., et al. (2019). Valproate for acute mania. Cochrane Database Syst Rev, 10, CD004052.Google ScholarPubMed
Vasudev, A., Macritchie, K., Watson, S., et al. (2008). Oxcarbazepine in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev, 10, CD005171.Google Scholar
Vasudev, A., Macritchie, K., Vasudev, K., et al. (2011). Oxcarbazepine for acute affective episodes in bipolar disorder. Cochrane Database Syst Rev, 10, CD004857.Google Scholar
Kim, Y. S., Kim, D. W., Jung, K. H., et al. (2014). Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia. Seizure, 23, 208–212.CrossRefGoogle ScholarPubMed
Malhi, G. S., Tanious, M. (2011). Optimal frequency of lithium administration in the treatment of bipolar disorder: clinical and dosing considerations. CNS Drugs, 25, 289–298.CrossRefGoogle ScholarPubMed
Castro, V. M., Roberson, A. M., McCoy, T. H., et al. (2016). Stratifying risk for renal insufficiency among lithium-treated patients: an electronic health record study. Neuropsychopharmacology, 41, 1138–1143.CrossRefGoogle ScholarPubMed
Gerhard, T., Devanand, D. P., Huang, C., et al. (2015). Lithium treatment and risk for dementia in adults with bipolar disorder: population-based cohort study. Br J Psychiatry, 207, 46–51.CrossRefGoogle ScholarPubMed
Hayes, J. F., Pitman, A., Marston, L., et al. (2016). Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: a UK population-based electronic health records study. JAMA Psychiatry, 73, 630–637.CrossRefGoogle ScholarPubMed
Song, J., Sjolander, A., Joas, E., et al. (2017). Suicidal behavior during lithium and valproate treatment: a within-individual 8-year prospective study of 50,000 patients with bipolar disorder. Am J Psychiatry, 174, 795–802.CrossRefGoogle Scholar
Van Gestel, H., Franke, K., Petite, J., et al. (2019). Brain age in bipolar disorders: effects of lithium treatment. Aust N Z J Psychiatry, 53(12), 1179–1188.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M., Allen, M. H., McEvoy, J. P., et al. (1999). Safety and tolerability of oral loading divalproex sodium in acutely manic bipolar patients. J Clin Psychiatry, 60, 815–818.CrossRefGoogle ScholarPubMed
Wingard, L., Brandt, L., Boden, R., et al. (2019). Monotherapy vs. combination therapy for post mania maintenance treatment: a population based cohort study. Eur Neuropsychopharmacology, pii, S0924-977X(19)30234-2. doi: 10.1016/j.euroneuro.2019.04.003Google Scholar
Remington, G., Teo, C., Mann, S., et al. (2013). Examining levels of antipsychotic adherence to better understand nonadherence. J Clin Psychopharmacol, 33, 261–263.CrossRefGoogle ScholarPubMed
Murru, A., Pacchiarotti, I., Amann, B. L., et al. (2013). Treatment adherence in bipolar I and schizoaffective disorder, bipolar type. J Affect Disord, 151, 1003–1008.CrossRefGoogle ScholarPubMed
Even, C., Thuile, J., Kalck-Stern, M., et al. (2010). Psychoeducation for patients with bipolar disorder receiving lithium: short and long term impact on locus of control and knowledge about lithium. J Affect Disord, 123, 299–302.CrossRefGoogle Scholar
Butler, M., Urosevic, S., Desai, P., et al. (2018). AHRQ comparative effectiveness reviews. In Treatment for Bipolar Disorder in Adults: A Systematic Review (eds.). Rockville, MD: Agency for Healthcare Research and Quality.CrossRefGoogle ScholarPubMed
Meyer, J. M. (2020). Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs. CNS Spectr, 25, 136–144.Google Scholar
Murru, A., Pacchiarotti, I., Nivoli, A. M., et al. (2011). What we know and what we don’t know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol, 21, 680–690.CrossRefGoogle ScholarPubMed
Vieta, E. (2010). Developing an individualized treatment plan for patients with schizoaffective disorder: from pharmacotherapy to psychoeducation. J Clin Psychiatry, 71 Suppl. 2, 14–19.CrossRefGoogle ScholarPubMed
Koola, M. M., Fawcett, J. A., Kelly, D. L. (2011). Case report on the management of depression in schizoaffective disorder, bipolar type focusing on lithium levels and measurement-based care. J Nerv Ment Dis, 199, 989–990.CrossRefGoogle ScholarPubMed
Bartova, L., Papageorgiou, K., Milenkovic, I., et al. (2018). Rapid antidepressant effect of S-ketamine in schizophrenia. Eur Neuropsychopharmacol, 28, 980–982.CrossRefGoogle ScholarPubMed
Tundo, A., de Filippis, R., De Crescenzo, F. (2019). Pramipexole in the treatment of unipolar and bipolar depression. A systematic review and meta-analysis. Acta Psychiatr Scand, 140, 116–125.CrossRefGoogle ScholarPubMed
Kelleher, J. P., Centorrino, F., Huxley, N. A., et al. (2012). Pilot randomized, controlled trial of pramipexole to augment antipsychotic treatment. Eur Neuropsychopharmacol, 22, 415–418.CrossRefGoogle ScholarPubMed
Eli Lilly and Company (2019). Zyprexa Package Insert. Indianapolis.Google Scholar
Pfizer Inc. (2018). Geodon Package Insert. New York, New York.Google Scholar
Kook, K. A., Stimmel, G. L., Wilkins, J. N., et al. (1985). Accuracy and safety of a priori lithium loading. J Clin Psychiatry, 46, 49–51.Google Scholar
Reed, R. C., Dutta, S. (2006). Does it really matter when a blood sample for valproic acid concentration is taken following once-daily administration of divalproex-ER? Ther Drug Monit, 28, 413–418.CrossRefGoogle ScholarPubMed
Meyer, J. M. (2019). Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs. CNS Spectr, in press. doi: 10.1017/S1092852919000865CrossRefGoogle Scholar
Hard, M. L., Mills, R. J., Sadler, B. M., et al. (2017). Aripiprazole lauroxil: pharmacokinetic profile of this long-acting injectable antipsychotic in persons with schizophrenia. J Clin Psychopharmacol, 37, 289–295.CrossRefGoogle ScholarPubMed
Hard, M. L., Mills, R. J., Sadler, B. M., et al. (2017). Pharmacokinetic profile of a 2-month dose regimen of aripiprazole lauroxil: a phase i study and a population pharmacokinetic model. CNS Drugs, 31, 617–624.CrossRefGoogle 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
×