Bipolar Bozukluğun Manik Epizodunda, Maddeye Bağlı Psikoz ve Madde Kullanım Bozukluğu ile Karşılaştırıldığında Serum Valproat Düzeyine Göre Metabolik Farklılaşma

Year 2024, Volume: 26 Issue: 1, 71 - 77, 30.04.2024

Elvan Çiftçi , Emine Cengiz Çavuşoğlu , Merih Altıntaş

https://doi.org/10.18678/dtfd.1373382

Abstract

Amaç: Valproik asit (VPA) öncelikle epilepsi tedavisinde kullanılır, ancak aynı zamanda bipolar bozukluktaki manik atakların ve madde kullanım bozukluklarının tedavisinde de kullanımları vardır. Manik ataklar ve psikoz hepatik klerensi ve ilaç dağıtım hacmini de etkileyebilir. Bu çalışmanın amacı, madde kullanımına kıyasla mani ve psikozun VPA farmakokinetiği, özellikle toplam ve bağlanmamış klerensteki değişiklikler üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Bu geriye dönük çalışmaya bipolar bozukluk manik atağı olan 50 hasta ve 38'i maddeye bağlı psikoz olarak değerlendirilen madde kullanım bozukluğu olan 51 hasta dahil edildi. Tüm hastalara en az beş gün boyunca sabit dozda günlük 1000 mg VPA verildi ve serum VPA konsantrasyonları ölçüldü.
Bulgular: Ortalama serum VPA düzeyi madde kullanım bozukluğu grubunda 59,2±17,4 μg/ml, maddeye bağlı psikoz grubunda 60,9±13,5 μg/ml ve bipolar bozukluğun manik döneminde ise 61,8±13,7 μg/ml idi. Gruplar arasında anlamlı bir fark bulunamadı (p=0,840). Madde kullanım bozukluğu ve maddeye bağlı psikoz tek grup olarak ele alındığında bu grupta ortalama 60,5±14,4 μg/ml olan VPA düzeyi, bipolar bozukluğun manik dönemindeki 61,8±13,7 μg/ml ile karşılaştırıldığında anlamlı bir fark göstermedi (p=0,630).
Sonuç: Kararlı durum plazma seviyelerine ulaştıktan sonra, üç grup arasında serum VPA seviyelerinde anlamlı bir fark gözlenmedi. Bu, mani epizodunun madde kullanım bozukluğu veya maddeye bağlı psikoz ile karşılaştırıldığında VPA metabolizmasında anlamlı bir artışa yol açmadığını düşündürmektedir.

Keywords

Serum valproat düzeyi, bipolar bozukluğun manik dönemi, madde kullanım bozukluğu, maddeye bağlı psikoz

Metabolic Differentiation in Manic Episode of Bipolar Disorder Compared to Substance-Induced Psychosis and Substance Use Disorder Based on Serum Valproate Level

Abstract

Aim: Valproic acid (VPA) is primarily used in the treatment of epilepsy but also has uses in the treatment of manic episodes in bipolar disorder and substance use disorders. Manic episodes and psychosis may also affect hepatic clearance and drug distribution volume. The aim of this study was to assess the effect of mania and psychosis compared to substance use on VPA pharmacokinetics, specifically changes in total and unbound clearance.
Material and Methods: Fifty patients with a manic episode of bipolar disorder, and 51 patients with substance use disorder, 38 of whom were considered as substance-induced psychosis, were included in this retrospective study. All patients received a constant dose of 1000 mg VPA daily for at least five days, and serum VPA concentrations were measured.
Results: The mean serum levels of VPA were 59.2±17.4 μg/ml in the substance use disorder group, 60.9±13.5 μg/ml in the substance-induced psychosis group, and 61.8±13.7 μg/ml in the manic episode of bipolar disorder group. No significant difference was found between the groups (p=0.840). When considering substance use disorder and substance-induced psychosis as one group, the mean VPA level of 60.5±14.4 μg/ml in this group showed no significant difference compared to 61.8±13.7 μg/ml in the manic episode of bipolar disorder (p=0.630).
Conclusion: After reaching steady-state plasma levels, no significant difference in serum VPA levels was observed between the three groups. This suggests that manic episodes do not lead to a significant increase in VPA metabolism compared to substance use disorder or substance-induced psychosis.

Keywords

Serum valproate level, manic episode of bipolar disorder, substance use disorder, substance induced psychosis

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