The Relationship Between Antipsychotic Use and Functionality in Patients with Bipolar Disorder: A Naturalistic Observational Study

Öz

Aim: The aim of this study is to investigate the impact of antipsychotic use on functioning and medication adherence in patients with bipolar disorder (BD) in remission. Material and Method: The study included 142 patients with BD who were diagnosed with remission according to DSM-5 criteria. The patients were administered various scales, including the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS), Bipolar Disorder Functioning Scale, and Morisky Medication Adherence Scale. Study participants had a HAM-D score of less than 7, a YMRS score of less than 4, and no manic, depressive, or hypomanic symptoms in the past 6 months. Results: 50.7% of study participants were female. The results showed that those not taking antipsychotics were more likely to live with someone, while those taking antipsychotics were more likely to be alone and have lower incomes. No important difference was found when patients and controls were examined in terms of gender, employment status or disease-related parameters. Antipsychotic users had higher scores in emotional functioning, whereas non-users had higher scores in family and friendships, social activities, and general functioning. Medication adherence correlated positively with social relationships but negatively with emotional, intellectual, and sexual functioning. Female gender and antipsychotic use were identified as significant predictors of overall functioning. Conclusion: This study highlights that while antipsychotics are beneficial during the acute phase of BD, their long-term impact on functioning during remission should not be ignored. The results demonstrate the importance of an individualized treatment strategy that balances symptom management with quality of life and regularly reassesses the need for antipsychotic treatment in long-term care.

Anahtar Kelimeler

• Antipsychotic
• bipolar disorder
• functioning
• medication adherence
• treatment

Kaynakça

1. Sachs GS, Thase ME, Otto MW, et al. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2003;53:1028-42.
2. Kessler RC, Akiskal HS, Angst J, et al. Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0. J Affect Disord. 2006;96:259-69.
3. Karanti A, Kardell M, Lundberg U, Landén M. Changes in mood stabilizer prescription patterns in bipolar disorder. J Affect Disord. 2016;195:50-6.
4. Gokcay H, Solmaz M. The association between mood stabilizers, sleep quality, and functioning in patients with remitted bipolar disorder. J Clin Psychopharmacol. 2024;44:258-62.
5. Keskin N, Tamam L, Ozpoyraz N. Assessment of sleep quality in bipolar euthymic patients. Compr Psychiatry. 2018;80:116-25.
6. Berk L, Hallam KT, Colom F, et al. Enhancing medication adherence in patients with bipolar disorder. Hum Psychopharmacol. 2010;25:1-16. Erratum in: Hum Psychopharmacol. 2010;25:192.
7. Lingam R, Scott J. Treatment non-adherence in affective disorders. Acta Psychiatr Scand. 2002;105:164-72.
8. Vieta E. Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry. 2005;66:24-9.

9. Lama S, Lakshmi KV, Shyangwa PM, Parajuli P. Level of compliance and factors associated with non-compliance to treatment among the mentally ill patients. Health Renaiss. 2012;10:113-7.
10. Sajatovic M, Davies M, Hrouda DR. Enhancement of treatment adherence among patients with bipolar disorder. Psychiatr Serv. 2004;55:264-9.
11. Sajatovic M, Ignacio RV, West JA, et al. Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Compr Psychiatry. 2009;50:100-7.
12. Baldessarini RJ, Tondo L, Hennen J. Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. J Clin Psychiatry. 1999;60:77-116.
13. Eaddy M, Grogg A, Locklear J. Assessment of compliance with antipsychotic treatmentand resource utilization in a medicaid population. Clin Ther. 2005;27:263-72.
14. Levin JB, Aebi ME, Tatsuoka C, et al. Adherence to psychotropic and nonpsychotropic medication among patients with bipolar disorder and general medical conditions. Psychiatr Serv Wash DC. 2016;67:342-5.
15. Bauer M, Glenn T, Alda M, et al. Association between adherence with an atypical antipsychotic and with other psychiatric drugs in patients with bipolar disorder. Pharmacopsychiatry. 2021;54:75-80.
16. Bonnin CM, Torrent C, Vieta E, Martínez-Arán A. Restoring functioning in bipolar disorder: functional remediation. Harv Rev Psychiatry. 2014;22:326-30.
17. Gruber J, Harvey AG, Wang PW, et al. Sleep functioning in relation to mood, function, and quality of life at entry to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Affect Disord. 2009;114:41-9.
18. Nutt DJ. The Hamilton Depression Scale- Accelerator or break on antidepressant drug discovery?. J Neurol Neurosurg Psychiatry. 2014;85:119-20.
19. Akdemir A, Örsel S, Dağ İ, et al. Hamilton depresyon derecelendirme ölçeğinin (HDDÖ) geçerliliği-güvenilirliği ve klinikte kullanımı. 3P Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251-9.
20. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.
21. Karadağ F, Oral T, Yalçin FA, Erten E. Reliability and validity of Turkish translation of Young Mania Rating Scale. Turk Psikiyatri Derg. 2002;13:107-14.
22. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962;10:799-812.
23. Soykan Kahraman Ç. Institutional differences and case typicality as related to-diagnosis symptom severity prognosis and treatment. Master thesis. Middle East Technical University. Ankara, 1990.
24. Aydemir O, Eren I, Savaş H, et al. Development of a questionnaire to assess inter-episode functioning in bipolar disorder: Bipolar Disorder Functioning Questionnaire. Turk Psikiyatri Derg. 2007;18:344-52.
25. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67-74.
26. Bahar G, Savas H, Nal A, et al. Reliability and validity of the Morisky Medication Adherence Scale for bipolar mood disorder. Alpha Psychiatry. 2014;15:141-9.
27. Tiğli Filizer A, Cerit C, Tüzün B, Aker AT. Social aspect of functioning deteriorates more than individual aspect in patients with remitted bipolar disorder. Noro Psikiyatr Ars. 2016;53:158-62.
28. Ringen PA, Reponen EJ, Vedal TSJ, et al. Predictors for antipsychotic dosage change in the first year of treatment in schizophrenia spectrum and bipolar disorders. Front Psychiatry. 2019;10:649.
29. Aguglia A, Fusar-Poli L, Natale A, et al. Factors associated with medication adherence to long-acting injectable antipsychotics: results from the STAR network depot study. Pharmacopsychiatry. 2022;55:281-9.
30. Yen CF, Cheng CP, Huang CF, et al. Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disord. 2008;10:617-24.
31. Zimmerman M, Galione JN, Chelminski I, et al. Sustained unemployment in psychiatric outpatients with bipolar disorder: frequency and association with demographic variables and comorbid disorders. Bipolar Disord. 2010;12:720-6.
32. Comes M, Rosa A, Reinares M, et al. Functional impairment in older adults with bipolar disorder. J Nerv Ment Dis. 2017;205:443-7. Erratum in: J Nerv Ment Dis. 2019;207:522.
33. Rosa AR, Reinares M, Franco C, et al. Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disord. 2009;11:401-9.
34. Berger A, Edelsberg J, Sanders KN, et al. Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: a retrospective cohort study. BMC Psychiatry. 2012;12:99.
35. Sanchez-Moreno J, Martinez-Aran A, Tabarés-Seisdedos R, et al. Functioning and disability in bipolar disorder: an extensive review. Psychother Psychosom. 2009;78:285-97.
36. Cichon GJ, Qadri SF. Risperidone-induced sexual dysfunction case report. Cureus. 2023;15:e35357.
37. Vancampfort D, Stubbs B, Mitchell AJ, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry Off J World Psychiatr Assoc WPA. 2015;14:339-47.
38. Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry. 2014;171:829-43.
39. Rowland DL. Neurobiology of sexual response in men and women. CNS Spectr. 2006;11:6-12.
40. Luca M, Prossimo G, Messina V, et al. Epidemiology and treatment of mood disorders in a day hospital setting from 1996 to 2007: an Italian study. Neuropsychiatr Dis Treat. 2013;9:169-76.