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Prophylactic treatment in bipolar disorder

Year 2014, , 95 - 102, 08.10.2014
https://doi.org/10.5455/jmood.20131216050528

Abstract

Objective: The aim of this study was to determine the prophylactic treatment response and its relationship between clinical variables among the bipolar disorder patient group followed up in the Bipolar Disorder Unit of Psychiatry Department of Cukurova University Faculty of Medicine. Methods: One hundred patients, in euthymic period, diagnosed as bipolar disorder, were included in this study. “Affective Disorders Patient Registry Form” developed by our unit, SCID-I, Young Mani Rating Scale, Hamilton Depression Rating Scale, Prophylactic Treatment Response Scale (PTRS) were used in this study to collect the data. These forms were completed through the interviews with the patients and their relatives, and the evaluation of outpatient files. Results: In this study, 50 of the patients were female, 50 were male. A total of 153 maintenance periods of 100 bipolar patients were examined. In 60.24% of prophylactic treatment periods, mood stabilizers and antipsychotics were used together but only one type of mood stabilizer was used in 30.75% of prophylactic treatment periods. Most frequently preferred mood stabilizer was lithium (43.58%). The prophylactic treatment had an overall positive effect over the course of the illness. The average time to the first period after the prophylactic treatment was 13.32±30.7 (range=0-244) months and a significant decrease was determined in total number of epizodes, epizod frequency and the time with disease periods. When the response to prohylactic treatment was evaluated by PTRS, we determined that the full response rate was 43.8%. As the time with disease periods prolonged and the number of episodes each year got higher the need for antipsychotic use has been increased. Conclusion: Bipolar disorder is a lifelong disorder that disrupts functioning to a large extend. Because of that the consequence of prophylactic treatment is very important. When the prophylactic treatment is continued pregularly and carefully the time with disease periods decreases significantly. Developing scales that evaluate the effects of prophylactic treatment properly will help to determine specific drug treatments for the patients and their disease.

References

  • Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord. 1998;50:143-51.
  • Angst J. Comorbidity of mood disorders:a longitudinal prospective study. Br J Psychiatry. 1996;30:31-71.
  • Angst J, Sellaro R. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry. 2000;48:445-57.
  • Wyatt RJ, Henter I. An economic evaluation of manic-depressive illness. Soc Psychiatry Epidemiol. 1995;30:213-9.
  • Simon G.E, Unutzer J. Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatr Serv. 1999;50:1303-8.
  • Coppen A, Noguera R, Bailey J. Prophylactic lithium in affective disorders. Lancet. 1972;275-9.
  • Hullin RP, McDonald R, Allsopp MNE. Prophylactic lithium in recurrent disorders. Lancet. 1972;1:1044-6.
  • Smith LA, Cornelius V, Warnock A, Bell A, Young AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: A systematic review of randomized controlled trials. Bipolar Disorder. 2007;9:394-412.
  • Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: A 12 month randomized double-blind controlled clinical trial. Am J Psychiatry. 2005;162:1281-90.
  • Calabrase JR, Shelton MD, Rapport DJ, Youngstorm EA, Jackson K, Bilali S, Ganocy SJ, Findling RL. A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005;162:2152-61.
  • Tohen M, Calabrase JR, Sachs GS, Banov MD, Dekte HC, Risser R, Baker RW, Chou JC, Bowden CL. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry 2006;163:247-56.
  • Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: A 12 month randomized, double blind controlled clinical trial. Am J Psychiatry. 2005;162:1281-90.
  • Keck Jr. PE, Calabrase JR, McIntyre RS, McQuade RD, Carson WH, Eudicone JM, et al. Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: A 100-week, double-blind study versus placebo. J Clin Psychiatry. 2007;68:1480-91.
  • Keck Jr. PE, Calabrase JR, McQuade RD, Carson WH, Carlson BX, Rollin LM, et al. A randomized double blind placebo controlled 26 week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Psychiatry. 2006;67:626-37.
  • Ketter TA, Houston JP, Adams DH, Risser RC, Meyers AL, Williamson DJ, et al. Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes. J Clin Psychiatry 2006;67:95-101.
  • Tohen M, Chengappa KN, Suppes T, Zarate CA, Calabrase JR, Bowden CL, et al. 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. 2002;59:62-9.
  • Tohen M, Chengappa KN, Suppes T, Baker RW, Zarate CA, Bowden CL, et al. Relaps prevention in bipolar I disorder: 18 month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry. 2004;184:337-45.
  • Houston JP, Ahl J, Meyers AL, Kaiser CJ, Tohen M, Baldessarini RJ. Reduced suicidal ideation in bipolar I disorder mixed-episode patients in a placebo controlled trial of olanzapine combined with lithium or divalproex. J Clin Psychiatry. 2006;67:1246-52.
  • Suppes T, Liu S, Brecher M, Paulsson B, Lazarus A. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex: a placebo controlled randomized multicenter trial (trial 1447C00127). Bipolar Disord. 2008;10(Suppl.1):S18-S24. Vieta E, Eggens I, Persson I, Paulson B, Brecher M. Efficacy and safety of quetiapine in combination with lithium or divalproex as maintenance treatment for patients with bipolar I disorder: results from an international, multicenter, randomized, doubleblind, parellel-group trial. (Trial 126) Presented at the 20 th ECNP Congress Vienna, 2007.
  • Grof P, Duffy A, Cavazzoni P, Grof E, Garnham J, MacDougall M, O’Donovan C, Alda M. Is response to prophylactic lithium a familial trait? J Clin Psychiatry. 2002;63:942-7.
  • Amerikan Psikiyatri Birliği. Mental bozuklukların tanısal ve sayımsal el kitabı, Yeniden Gözden Geçirilmiş Dördüncü Baskı (DSM-IV- TR). Washington D.C, 2000’den çeviri editörü: Köroğlu E, Hekimler Yayın Birliği, Ankara. 2001.
  • Baldessarini RJ, Tondo L, Hennen J. Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord. 2003;5:169-79.
  • Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.
  • Karadağ F, Oral ET, Aran Yalçın F. Young Mani Derecelendirme Ölçeğinin Türkiye’de geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2002;13:107-14.
  • Hamilton M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
  • Akdemir A, Örsel S, Dağ İ. Hamilton Depresyon Derecelendirme Ölçeği: bazı psikometrik ve ICD-10 depresyon tanısı ile karşılaştırılması. 2. Bahar Sempozyumu, Poster Bildiri 1998.
  • First MB, Spitzer RL, Gibbon M, et al. Structred clinical interview for DSM IV clinical version (SCID-I/CV, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 1997.
  • Özkürkçügil A, Aydemir Ö, Yıldız M, Danacı A, Köroğlu. DSMIV Eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe’ye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Dergisi. 1999;12:233-6.
  • Garnham J, Munro A, Slaney C, MacDougall M, Passmore M, Duffy A, O’Donovan C, Teehan A, Alda M. Prophylactic treatment response in bipolar disorder: Results of a naturalistic observation study. J Affect Disord. 2007;104:185-90.
  • Markar HR, Mander AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry. 1989;155:993-1000.
  • Maj M, Pirozzi R, Magliano L. Late non-response to lithium prophylaxis in bipolar patients: prevalence and predictors. J Affect Disord. 1996;39:39-42.
  • Maj M, Pirozzi R, Magliano L, Bartoli L. Long-term outcome of lithium prophylaxis in bipolar disorder:a 5 year prospective study of 402 patients at a lithium clinic. Am J Psychiatry. 1998;155:30-5.
  • Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federationof Societes of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry. 2013;14:154-219.
  • Chen CH, Lin SK. Carbamazepine treatment of bipolar disorder:a retrospective evaluation of naturalistic long-term outcomes. BMC Psychiatry. 2012:12;47.
  • Gitlin M, Frye MA. Maintenance therapies in bipolar disorders. Bipolar Disord. 2012;14:51-65.
  • Bowden CL. The role of ziprasidone in adjunctive use with lithium or valproate in maintenance treatment of bipolar disorder. Neuropsychiatric Disease and Treatment. 2011:7;87-92.

İki Uçlu Bozuklukta Koruyucu Sağaltım

Year 2014, , 95 - 102, 08.10.2014
https://doi.org/10.5455/jmood.20131216050528

Abstract

Amaç: Bu çalışmada, Çukurova Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı İki Uçlu Bozukluk (İUB) Biriminde düzenli olarak İUB tanısıyla izlenen hastaların koruyucu sağaltıma yanıtları ve sağaltıma yanıtın klinik değişkenlerle ilişkisi araştırıldı. Yöntem: Çalışmaya İki Uçlu Bozukluk tanılı ötimik dönemde olan 100 hasta alındı. Çalışma verileri tarafımızca geliştirilen “Duygudurum Bozuklukları Hasta Kayıt Formu”, SCID-I, Young Mani Derecelendirme Ölçeği (YMDÖ), Hamilton Depresyonu Değerlendirme Ölçeği (HDDÖ) ve Koruyucu Sağaltıma Yanıt Ölçeği (KSYÖ) kullanılarak toplandı. Formlar hasta ve hasta yakınları ile görüşülerek ve poliklinik kayıtları incelenerek dolduruldu. Bulgular: Çalışmaya alınan hastaların 50’si kadın, 50’si erkek’ti. Çalışmamızda 100 İUB hastasının toplam 153 koruma dönemi incelendi. Bu koruma dönemlerinin %30.75’inde tek mizaç dengeleyici ilaç, %60.24’ünde ise mizaç dengeleyiciye ek olarak antipsikotik kullanılıyordu. Mizaç dengeleyici olarak en sık seçilen ilaç lityumdu (%43.58). Koruyucu sağaltımın hastalık seyri üzerinde genel olarak olumlu bir etkisi söz konusuydu. Koruyucu sağaltım sonrası ilk döneme kadar geçen süre ortalama 13.32±30.7 (range=0-244) aydı ve dönem sayısı, sıklığı, hastalıkla geçirilen sürelerde anlamlı bir azalma vardı. Koruma dönemleri KSYÖ ile değerlendirildiğinde %43.8 oranında tam yanıt saptandı. Hastalıkla geçen süre uzadıkça ve yılda geçirilen dönem sayısı arttıkça ek olarak antipsikotik kullanma gereksinimi arttığı görüldü. Sonuç: İUB yaşam boyu süren ve işlevselliği büyük oranda bozan bir hastalıktır. Bu nedenle koruyucu sağaltımın önemi yüksektir. Koruyucu sağaltım düzenli ve özenli bir şekilde sürdürüldüğünde hastalıkla geçen süre önemli oranda azalmaktadır. Koruyucu sağaltımın etkisini doğru değerlendiren ölçeklerin geliştirilmesi hastaya ve hastalığına özgü ilaç tedavisinin belirlenmesine yardımcı olacaktır.

References

  • Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord. 1998;50:143-51.
  • Angst J. Comorbidity of mood disorders:a longitudinal prospective study. Br J Psychiatry. 1996;30:31-71.
  • Angst J, Sellaro R. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry. 2000;48:445-57.
  • Wyatt RJ, Henter I. An economic evaluation of manic-depressive illness. Soc Psychiatry Epidemiol. 1995;30:213-9.
  • Simon G.E, Unutzer J. Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatr Serv. 1999;50:1303-8.
  • Coppen A, Noguera R, Bailey J. Prophylactic lithium in affective disorders. Lancet. 1972;275-9.
  • Hullin RP, McDonald R, Allsopp MNE. Prophylactic lithium in recurrent disorders. Lancet. 1972;1:1044-6.
  • Smith LA, Cornelius V, Warnock A, Bell A, Young AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: A systematic review of randomized controlled trials. Bipolar Disorder. 2007;9:394-412.
  • Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: A 12 month randomized double-blind controlled clinical trial. Am J Psychiatry. 2005;162:1281-90.
  • Calabrase JR, Shelton MD, Rapport DJ, Youngstorm EA, Jackson K, Bilali S, Ganocy SJ, Findling RL. A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005;162:2152-61.
  • Tohen M, Calabrase JR, Sachs GS, Banov MD, Dekte HC, Risser R, Baker RW, Chou JC, Bowden CL. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry 2006;163:247-56.
  • Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: A 12 month randomized, double blind controlled clinical trial. Am J Psychiatry. 2005;162:1281-90.
  • Keck Jr. PE, Calabrase JR, McIntyre RS, McQuade RD, Carson WH, Eudicone JM, et al. Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: A 100-week, double-blind study versus placebo. J Clin Psychiatry. 2007;68:1480-91.
  • Keck Jr. PE, Calabrase JR, McQuade RD, Carson WH, Carlson BX, Rollin LM, et al. A randomized double blind placebo controlled 26 week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Psychiatry. 2006;67:626-37.
  • Ketter TA, Houston JP, Adams DH, Risser RC, Meyers AL, Williamson DJ, et al. Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes. J Clin Psychiatry 2006;67:95-101.
  • Tohen M, Chengappa KN, Suppes T, Zarate CA, Calabrase JR, Bowden CL, et al. 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. 2002;59:62-9.
  • Tohen M, Chengappa KN, Suppes T, Baker RW, Zarate CA, Bowden CL, et al. Relaps prevention in bipolar I disorder: 18 month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry. 2004;184:337-45.
  • Houston JP, Ahl J, Meyers AL, Kaiser CJ, Tohen M, Baldessarini RJ. Reduced suicidal ideation in bipolar I disorder mixed-episode patients in a placebo controlled trial of olanzapine combined with lithium or divalproex. J Clin Psychiatry. 2006;67:1246-52.
  • Suppes T, Liu S, Brecher M, Paulsson B, Lazarus A. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex: a placebo controlled randomized multicenter trial (trial 1447C00127). Bipolar Disord. 2008;10(Suppl.1):S18-S24. Vieta E, Eggens I, Persson I, Paulson B, Brecher M. Efficacy and safety of quetiapine in combination with lithium or divalproex as maintenance treatment for patients with bipolar I disorder: results from an international, multicenter, randomized, doubleblind, parellel-group trial. (Trial 126) Presented at the 20 th ECNP Congress Vienna, 2007.
  • Grof P, Duffy A, Cavazzoni P, Grof E, Garnham J, MacDougall M, O’Donovan C, Alda M. Is response to prophylactic lithium a familial trait? J Clin Psychiatry. 2002;63:942-7.
  • Amerikan Psikiyatri Birliği. Mental bozuklukların tanısal ve sayımsal el kitabı, Yeniden Gözden Geçirilmiş Dördüncü Baskı (DSM-IV- TR). Washington D.C, 2000’den çeviri editörü: Köroğlu E, Hekimler Yayın Birliği, Ankara. 2001.
  • Baldessarini RJ, Tondo L, Hennen J. Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord. 2003;5:169-79.
  • Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.
  • Karadağ F, Oral ET, Aran Yalçın F. Young Mani Derecelendirme Ölçeğinin Türkiye’de geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2002;13:107-14.
  • Hamilton M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
  • Akdemir A, Örsel S, Dağ İ. Hamilton Depresyon Derecelendirme Ölçeği: bazı psikometrik ve ICD-10 depresyon tanısı ile karşılaştırılması. 2. Bahar Sempozyumu, Poster Bildiri 1998.
  • First MB, Spitzer RL, Gibbon M, et al. Structred clinical interview for DSM IV clinical version (SCID-I/CV, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 1997.
  • Özkürkçügil A, Aydemir Ö, Yıldız M, Danacı A, Köroğlu. DSMIV Eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe’ye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Dergisi. 1999;12:233-6.
  • Garnham J, Munro A, Slaney C, MacDougall M, Passmore M, Duffy A, O’Donovan C, Teehan A, Alda M. Prophylactic treatment response in bipolar disorder: Results of a naturalistic observation study. J Affect Disord. 2007;104:185-90.
  • Markar HR, Mander AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry. 1989;155:993-1000.
  • Maj M, Pirozzi R, Magliano L. Late non-response to lithium prophylaxis in bipolar patients: prevalence and predictors. J Affect Disord. 1996;39:39-42.
  • Maj M, Pirozzi R, Magliano L, Bartoli L. Long-term outcome of lithium prophylaxis in bipolar disorder:a 5 year prospective study of 402 patients at a lithium clinic. Am J Psychiatry. 1998;155:30-5.
  • Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federationof Societes of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry. 2013;14:154-219.
  • Chen CH, Lin SK. Carbamazepine treatment of bipolar disorder:a retrospective evaluation of naturalistic long-term outcomes. BMC Psychiatry. 2012:12;47.
  • Gitlin M, Frye MA. Maintenance therapies in bipolar disorders. Bipolar Disord. 2012;14:51-65.
  • Bowden CL. The role of ziprasidone in adjunctive use with lithium or valproate in maintenance treatment of bipolar disorder. Neuropsychiatric Disease and Treatment. 2011:7;87-92.
There are 36 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Meliha Zengin Eroğlu This is me

Nurgül Özpoyraz This is me

Lut Tamam This is me

Publication Date October 8, 2014
Published in Issue Year 2014

Cite

APA Eroğlu, M. Z., Özpoyraz, N., & Tamam, L. (2014). İki Uçlu Bozuklukta Koruyucu Sağaltım. Journal of Mood Disorders, 4(3), 95-102. https://doi.org/10.5455/jmood.20131216050528
AMA Eroğlu MZ, Özpoyraz N, Tamam L. İki Uçlu Bozuklukta Koruyucu Sağaltım. Journal of Mood Disorders. March 2014;4(3):95-102. doi:10.5455/jmood.20131216050528
Chicago Eroğlu, Meliha Zengin, Nurgül Özpoyraz, and Lut Tamam. “İki Uçlu Bozuklukta Koruyucu Sağaltım”. Journal of Mood Disorders 4, no. 3 (March 2014): 95-102. https://doi.org/10.5455/jmood.20131216050528.
EndNote Eroğlu MZ, Özpoyraz N, Tamam L (March 1, 2014) İki Uçlu Bozuklukta Koruyucu Sağaltım. Journal of Mood Disorders 4 3 95–102.
IEEE M. Z. Eroğlu, N. Özpoyraz, and L. Tamam, “İki Uçlu Bozuklukta Koruyucu Sağaltım”, Journal of Mood Disorders, vol. 4, no. 3, pp. 95–102, 2014, doi: 10.5455/jmood.20131216050528.
ISNAD Eroğlu, Meliha Zengin et al. “İki Uçlu Bozuklukta Koruyucu Sağaltım”. Journal of Mood Disorders 4/3 (March 2014), 95-102. https://doi.org/10.5455/jmood.20131216050528.
JAMA Eroğlu MZ, Özpoyraz N, Tamam L. İki Uçlu Bozuklukta Koruyucu Sağaltım. Journal of Mood Disorders. 2014;4:95–102.
MLA Eroğlu, Meliha Zengin et al. “İki Uçlu Bozuklukta Koruyucu Sağaltım”. Journal of Mood Disorders, vol. 4, no. 3, 2014, pp. 95-102, doi:10.5455/jmood.20131216050528.
Vancouver Eroğlu MZ, Özpoyraz N, Tamam L. İki Uçlu Bozuklukta Koruyucu Sağaltım. Journal of Mood Disorders. 2014;4(3):95-102.