A Survey of changes in prescription patterns for Bipolar Disorder in a clinical setting and of coherence to therapy guidelines..

We collected data about demographic variables, diagnosis and discharge medication of all patients diagnosed with bipolar disorder admitted to the University Clinic for Psychiatry I, Salzburg, between January 2002 and October 2007.

679 bipolar patients (373 female / 306 male) with a total number of 3217 admissions to our hospital during an observational period of almost 6 years were included in the survey.

Since 2002, a substantial change of prescription patterns in bipolar patients has taken place, with a trend towards valproate and atypical antipsychotics and against lithium and typical antipsychotics. Modern antidepressants are routinely used in the treatment of bipolar depression. Combination strategies of two or more compounds are common. In general, adherence to treatment guidelines was high with the possible exception of very frequent use of antidepressants in bipolar depression.

The purpose of the present study was to examine the relationship between depression and hostility among teacher.

Participants were 531 teachers of education organization of Golestan province in Iran. The mean age of the participants was 37.49 years (SD = 5.58) and ages ranged from 21 to 50 years old. There were 215 men and 316 women. Measures: All participants completed a questionnaire booklet containing one self- report measures: The Symptom Checklist-90-R (SCL-90-R).

The results of the present study demonstrate that: 1) Correlation between depression and teacher's hostility is meaningful and positive (r = 0.714, p<0.001).

The present study revealed that a more depression is associated with a high level of self-reported hostility.

There is limited published data from long-term pediatric bipolar clinical trials with which to guide appropriate treatment decisions. Long-term efficacy and safety of aripiprazole was investigated in this patient population.

296 youths, ages 10-17 year-old with a DSM-IV diagnosis of bipolar I disorder were randomized to receive either placebo or aripiprazole (10mg or 30mg) in a 4-week double-blind trial. Completers continued assigned treatments for an additional 26 weeks (double-blind). Efficacy endpoints included mean change from baseline to week 4 and week 30 on the Young Mania Rating Scale; Children's Global Assessment Scale, Clinical Global Impressions-Bipolar version severity scale, General Behavior Inventory, Attention Deficit Hyperactivity Disorders Rating Scale, and time to discontinuation. Tolerability/safety assessments included incidence and severity of AEs, blood chemistries and metabolic parameters.

Over the 30-week course of double-blind treatment, aripiprazole (10 mg and 30 mg) was superior to placebo as early as week 1 (p< 0.002) and at all scheduled visits from week 2 through week 30 on mean change from baseline in the Y-MRS total score (p<.0001; all visits). Significant improvements were observed on multiple endpoints including the CGAS, GBI, CGI-BP, ADHD-RS-IV total score, time to discontinuation, and response and remission rates. The 3 most common AEs were somnolence, extrapyramidal disorder, and fatigue. Mean change in body weight z-scores over 30 weeks was not clinically significant.

Over 30-weeks of treatment, both doses of aripiprazole were superior to placebo in the long term treatment of pediatric bipolar patients. Aripiprazole was generally well tolerated.

The underlying genetic heterogeneity in Bipolar Disorder (BD) has led to the search of potential markers associated with subtypes of the disorder; as such, age at onset (AAO) could be considered as a factor that defines more genetically homogeneous subgroups.

To analyze the modal distribution of a BD population according to the AAO of the disorder, as well as the clinical characteristics related to the distribution findings.

357 patients with a BD diagnosis were included in the study. AAO was defined as the age when the patient first met DSM-IV criteria for a major mood episode. Using an admixture analysis, patients were distributed among different parameters; and parametric analyses were conducted in order to compare the demographic and clinical characteristics between groups.

The model that best fit the observed distribution was a mixture of three Gaussian distributions (mean ± SD): 17±3.7 years, 26±8.8 years, and 35.5±12.54 years. Statistically significant differences were found with respect to social status, course of illness, suicidal behavior, rapid cycling, medical co-morbidities and lithium response (p<0.05).

Our results support the existence of a tri-modal distribution in BD defined by AAO, each one with different clinical characteristics; and suggest that early-onset and late-onset BD reflect an underlying genetic heterogeneity in bipolar disorder, being early-onset BD implicitly a more serious subtype of disorder.

To test the prognostic value of suicidal status in depressed patients for responses to antidepressant treatment.

We evaluated treatment response and covariates in depressed patients diagnosed with DSM-IV major depressive (n=50) or bipolar disorders (n=32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment with antidepressants, with or without a mood-stabilizer. Being suicidal was based on an item-3 of the 17-item Hamilton Depression Rating Scale (HDRS17) scored at ≥3 and verified by baseline clinical assessment; morbidity and improvement were based on the total of the remaining 16 nonsuicidal items (HDRS16).

Suicidal (n=31) and nonsuicidal subjects (n=51) were similar in baseline ratings of depressive symptom-severity (HDRS16), but were depressed longer and less likely to be married. Suicidality ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS16) improved (13%) only half as much as in nonsuicidal subjects (25%), independent of diagnosis and treatment. Fewer than half as many suicidal subjects showed ≥20% improvement in HDRS16 scores.

Findings, based on diagnostically complex and relatively treatment-resistant subjects, may not generalize.

Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.

Within a decade, the Repetitive Transcranial Magnetic Stimulation (rTMS) was being used to treat depression and schizophrenia. Antidepressant response has been reported in open and double-blind, sham-controlled studies of depression. Less is known about rTMS efficacy in the obsessive compulsive disorder.

The aim of the randomized, double-blind, sham controlled study was to compare the 2 and 4 week efficacy of the 10 sessions rTMS with sham rTMS in serotonin reuptake inhibitor resistant OCD patient. Thirty seven right-handed patients were randomly assigned to either active rTMS or to sham. Active rTMS with the frequency of 1 Hz at 110% of motor threshold was administered over the left dorso-lateral prefrontal cortex. The same time schedule was used for sham administration. Thirty three patients finished the study, three patients’ dropped out at the beginning. Psychopathology was assessed by CGI, HAMA, Y-BOCS and BAI before the treatment, immediately after the experimental treatment, and 2 weeks after by an independent reviewer.

Both groups improved during the study period but the treatment effect did not differ between them in any of the instruments.

Low frequency rTMS administered over the left dorso-lateral prefrontal cortex during 10 daily sessions did not differ from sham rTMS in facilitating the effect of serotonin reuptake inhibitors in OCD patients.

Supported by the project n. MŠMT ČR 1M0517

Bipolar spectrum disorders often go unrecognised and undiagnosed. One of the underlying reasons is the poor recognition of bipolar disorder among patients presenting depressive episodes. Our goal was to estimate the MDQ rate of positive screens for bipolar disorder in a Spanish sample of outpatients with a current major depressive episode and compare it with their psychiatric diagnosis.

971 consecutively outpatients with a current DSM-IV TR diagnosis of major depressive episode were included. Study measures included socio-demographic and clinical data, Clinical Global Impressions–Severity of Illness Scale (CGI-S), Hamilton Depression Scale (HAMD) and MDQ.

905 patients fulfilled criteria to be included in the analysis. All suffered a current depressive episode. 74.3% (n= 671) of the patients had received previously a diagnosis of unipolar depression and 25.7% (n= 232) of bipolar disorder by a psychiatrist. Using a MDQ of 7-or-more-item threshold, the global positive screen rate for bipolar disorder was 41,3% (n=373). From the 671 patients with previous unipolar depression diagnosis, 161 (24%) screened positive for bipolar disorder with MDQ, whereas in 232 patients diagnosed of bipolar disorder, 212 (91.4%) screened positive.

MDQ showed a positive screen rate for bipolar disorder in 24% of patients with a previous diagnosis of unipolar disorder and a current depressive episode. Screening tools like MDQ could contribute to increased detection of bipolar disorder in patients with depression. Early diagnosis of bipolar disorder may have, therefore, important clinical and therapeutic implications in order to improve the illness course and the long-term functional prognosis.

The study aimed to evaluate if and how online self-help forums are used by patients with bipolar affective disorders, their relatives and by professionals.

2400 postings in two German language forums for patients with bipolar affective disorders, their relatives and professionals were qualitatively and quantitatively analysed. Interrater-reliability was 0,84 (Cohen's Kappa). Chi-squared tests with Bonferroni correction were performed and exploratory factor analyses were conducted.

94% of all postings were written by patients, 4% were written by relatives, and 2% by professionals. “Disclosure” (44% of all postings), “friendship” (23%), “online-group cohesion” (22%), “empathy and support” (18%), and “provision of information” (15%) were the main self-help mechanisms. The topics most discussed were the “social network” of the patients (27%), the “symptoms of the illness” (22%), “medication” (14%), “professionals” (12%), and “diagnoses” (11%). The item “provision of information” was significantly more often named by professionals (chi(2)=32,30; p<0,001), whereas the item “gratitude” was significantly more often named by relatives (chi(2)=34,91; p<0,001). Factor analysis revealed three factors according to self-help mechanisms: “group cohesion”, “emotional support”, and “exchange of information”. Also according to fields of interest factor analysis yielded three factors: “illness related aspects”, “social aspects”, and “financial and legal issues”.

We infer that the main interest in participating in online forums for patients with bipolar affective disorders and their relatives is to share emotions. Our study also reveals that the social network is very important for patients coping with bipolar affective disorders. Psychoeducative programmes should focus on those aspects.

Depakine crono presents an immediate, longer absorption, with maximum plasmatic concentrations less high than the classic one. It allows a minor number of doses and a better therapeutic fulfillment.

To identify the characteristics and the patients profile treated with depakine crono in a unit of hospitalization. Patients had the diagnosis of bipolar or schizoaffective disorder and they were followed out of the hospital. We stand out the clinical improvement, level of satisfaction, adherence, fulfilment and quality of life obtained.

Patients with a descompensation of their affective disorder admitted in a Acute Unite were studied (N=30). They all needed depakine crono for their stabilization.The information has been obtained by a interview, applying a specific protocol with demographic and clinical data, exploring the reasons and satisfaction with the medication. Four clinical scales were used: DAI, the Scale of Disability of the OMS, EEAG and ICG for the Bipolar Disorder.

The profile showed an 32-48-year-old, married woman, with primary studies who lived in family environment, with a maniac episode, with a development of the disease of more than 20 year. The age of the first episode was of 21 years, with somatic and personality disorders and abuse of substances.

The clinical impression in the admission is serious. The average dose needed of depakine crono was 1.000 mg/día, with a good efficiency in the most of patients. The personal and labour functionality improve from the beginning of the treatment. The level of therapeutic fulfillment is satisfactory.

The impact of depressive symptoms in stability phases on bipolar disorder outpatients’ functional aspects could be important to determine if they are impaired and their treatment requirements. Our aim is to describe functional impact and social adjustment in stable BD, regarding present subclinical depressive symptoms.

Crossectional, prospective, 16-week study of a cohort of 761 BD patients included by 94 investigators. Clinical stability was assessed at baseline and week 16, with the Clinical Global Impression scale for BD (CGI-BP-M), depressive symptoms at baseline with the Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Scale (MADRS) and with the self-applied Center for Epidemiologic Studies-Depression Scale (CES-D). Functional status was evaluated with Social and Occupational Functioning Assessment Scale (SOFAS) and Social Adaptation Self-evaluation Scale (SASS).

Depressive symptoms were detected: mean scores on the HDRS 3.7 (SD 3.1), MADRS 4.9 (SD 4.5) and CES-D 15.2 (SD 9.9) scales. On EEASL mean was 79.5 (SD 12.7), showing a slight decline in social-labour activity and poor social adjustment; SASS mean was 37.5 (SD 7.9). 3.4% of the sample (95%CI 2.0-4.8) presented mild depression with moderate functional impact. The presence of depressive symptoms is related to social-labour functional impact and social maladjustment. The highest correlation coefficients are seen between EEASL and MADRS (r= -0.54, p<0.0001) and between SASS and CES-D (r=-0.47, p<0.0001).

Depressive symptoms on BD outpatients may result in a decline in social-labour functionality and social maladjustment. Self-applied tests performed during follow-up provide important information about patient's functionality.

To examine the long-term efficacy and safety of quetiapine in combination with lithium (Li) or divalproex (DVP) in the prevention of recurrent mood events (manic, mixed, or depressed).

Patients with bipolar I disorder (DSM-IV, most recent episode manic, mixed or depressed) received open-label quetiapine (400–800 mg/day; flexible, divided doses)+Li/DVP (target serum concentrations 0.5–1.2 mEq/L and 50–125 μg/mL) for up to 36 weeks to achieve ≥12 weeks of clinical stability. Patients were subsequently randomized to double-blind treatment with quetiapine (400–800 mg/day)+Li/DVP or placebo+Li/DVP for up to 104 weeks. Primary endpoint was time to recurrence of any mood event defined by medication initiation, hospitalization, YMRS or MADRS scores ≥20 at two consecutive assessments, or study discontinuation due to a mood event.

1953 patients entered the stabilization phase and 623 were randomized and received ≥1 dose of study medication. Rates of recurrence of a mood event were 20.3% (63/310) vs 52.1% (163/313) for quetiapine and placebo groups, respectively, a risk reduction of 68% (HR 0.32; P<0.0001). Risk reductions were similar for manic and depressed events (HRs 0.30 and 0.33, respectively; P<0.0001). Safety data were consistent with the recognized safety profile of quetiapine. However, a greater incidence of blood glucose ≥126 mg/dL was observed in the quetiapine treatment group.

Maintenance treatment with quetiapine+Li/DVP was significantly more effective than placebo+Li/DVP in increasing the time to recurrence of a mood event in stable patients with bipolar I disorder.

Supported by funding from AstraZeneca Pharmaceuticals LP.

An international, randomized, double-blind, parallel-group study was designed to determine the efficacy and safety of quetiapine+Li/DVP compared with placebo+Li/DVP in the prevention of recurrent mood events (manic, mixed, or depressed) in patients with bipolar I disorder.

Patients with bipolar I disorder (DSM-IV, most recent episode manic, mixed or depressed) received open-label quetiapine (400–800 mg/day; flexible, divided doses) plus Li/DVP (target serum concentrations 0.5–1.2 mEq/L and 50–125 μg/mL, respectively) for up to 36 weeks to achieve at least 12 weeks of clinical stability. Patients were subsequently randomized to double-blind treatment with quetiapine (400–800 mg/day) plus Li/DVP or placebo+Li/DVP for up to 104 weeks. Primary endpoint was time to recurrence of any mood event defined by medication initiation, hospitalization, YMRS or MADRS score ≥20 at two consecutive assessments or at final assessment if the patient discontinued, or study discontinuation due to a mood event.

1461 patients entered the stabilization phase and 703 (48%) were randomized to double-blind treatment receiving at least one dose of study medication (ITT population). A markedly lower proportion of patients had a mood event in the quetiapine+Li/DVP versus placebo+Li/DVP group (18.5% vs 49.0%, respectively), with a risk reduction of 72% (hazard ratio 0.28; P<0.0001). The incidence of adverse events was similar between the two treatment groups.

Maintenance treatment with quetiapine+Li/DVP significantly increased the time to recurrence of any mood event compared with placebo+LI/DVP. Long-term treatment with quetiapine was generally well-tolerated.

Supported by funding from AstraZeneca Pharmaceuticals LP.