Both typical and atypical long-acting injectable antipsychotics in bipolar disorder: a retrospective chart review

Yıl 2014, , 20 - 25, 08.10.2014

Gokay Alpak Bahadir Demir İhsan Aksoy Hilal Kaya Ahmet Unal Feridun Bulbul Haluk A. Savas

https://doi.org/10.5455/jmood.20140311102222

Öz

Objective: Bipolar disorder (BD) is a chronic psychiatric disorder which shows difficulties in the process of diagnosis and treatment. One of the biggest problems in BD maintenance therapy is to ensure medication compliance. Long-acting injectable (LAI) antipsychotic medications have important advantages in such cases. In this study we aimed to include both LAI atypical and typical antipsychotics and to compare the clinical status, number of hospitalization, and side effects of pre and post-treatment periods of one year separately. Methods: Our study sample was constituted of 802 BD patients whom are followed in Mood Disorders Unit of Gaziantep University. Among them 80 patients has been using typical or atypical LAI antipsychotics. In the context of the study criteria only 31 patients included in the study. Efficacy was assessed by the CGI, YMRS, HAMD scores of pre and post-treatment periods of one year (12 months ago, 6 months ago, treatment initiation time, 6 months later and 12 months later), by the rate of hospitalization, and by comparing the average number of mood episodes. Results: LAI antipsychotic usage rate was identified as 9.88% in the study sample. Both of the antipsychotics were shown to decrease the average number of episodes in one year, and effective in preventing manic episodes rather than depressive episodes. Atypical antipsychotics significantly decreased YMRS and CGI scores but a decrease in HAMD scores was not observed, whereas no significant changes were observed in all scale scores with typical antipsychotics. There were not any significant difference when typical and atypical LAI antipsychotics compared according to their side effects in pre and post-treatment periods. Discussion: To the best of our knowledge, this is the first study that atypical and typical LAI antipsychotics were both included. As a result, it was shown that LAI antipsychotics may be effective in the prevention of manic episodes and there were not any differences found in terms of pre and post-treatment side effects. The results of our study are needed to be repeated in new studies with increased number of patients.

Anahtar Kelimeler

long acting antipsychotics, typical, atypical, bipolar disorder

Uzun etkili tipik ve atipik antipiskotiklerin iki uçlu bozukluk hastalarında kullanımı: Geriye dönük dosya taraması

Öz

Amaç: İkiuçlu bozukluk (İUB) tanı ve tedavi sürecinde zorluklar içeren ve kronik seyir gösteren psikiyatrik bir bozukluktur. İUB idame tedavisinde en büyük sorunlardan biri ilaç uyumunun sağlanmasıdır. Uzun etkili enjektabl (UEE) antipsikotikler bu tür hastalarda ciddi avantajlar sağlamaktadır. Biz bu çalışmada, tipik ve atipik UEE antipsikotikleri tedavi öncesi ve sonrasındaki bir yıllık dönemde klinik özellikler, hastane yatış sayıları ve yan etkiler açısından ayrı ayrı karşılaştırmayı amaçladık. Yöntem: Çalışma evreni Gaziantep Üniversitesi Duygudurum Birimi’nde takip edilen 802 İUB hastasından oluşturuldu. Bu hastalardan 80’i tipik ya da atipik UEE antipsikotik kullanıyordu. Çalışma kriterlerini karşılayan sadece 31 hasta çalışmaya dahil edildi. Etkinlik; tedavi öncesi ve sonrası bir yıllık dönem içindeki KGI, YMDÖ, HAMD skorları (12 ay önce, 6 ay önce, tedavi ekleme zamanı, 6 ay sonra ve 12 ay sonra), hastaneye yatış oranları ve ortalama yıllık hecme sayıları karşılaştırılarak değerlendirildi. Bulgular: Çalışma örnekleminde UEE antipsikotik kullanım oranı %9.88 olarak tespit edildi. İdame tedavide UEE antipsikotiklerin yıllık ortalama atak sayısını azalttığı ve depresyondan ziyade manik atağı önlemede etkin olduğu gösterildi. Atipik antipsikotiklerin YMDÖ ve KGI skorlarını anlamlı oranda azalttığı tespit edilirken HAMD skorlarında anlamlı bir değişiklik gözlenmedi. Tipik antipsikotikler ile ise ölçek skorlarının hiçbirinde anlamlı bir değişiklik görülmedi. Tipik ve atipik UEE antipsikotikler yan etkiler açısından tedavi öncesi ve sonrasında karşılaştırıldığında anlamlı bir farklılık saptanmadı. Tartışma: Çalışmamız bizim bilgilerimize göre, İUB’de atipik ve tipik UEE antipsikotiklerin birlikte dahil edildiği ilk çalışmadır. Sonuç olarak; UEE antipsikotiklerin manik atak korumasında etkin olabileceği ve yan etkiler açısından da tedavi öncesi ve sonrasında bir değişikliğin olmadığı gösterilmiştir. Hasta sayısı artırılarak yapılacak yeni çalışmalarla çalışmamızın sonuçlarının tekrar edilmesine ihtiyaç vardır.

Anahtar Kelimeler

uzun etkili antipsikotikler, tipik, atipik, iki uçlu bozukluk

Kaynakça

• 1. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007;64:543-52.
• 2. Murray CJ, Lopez AD. Evidence-based health policy--lessons from the Global Burden of Disease Study. Science. 1996;274:740-3.
• 3. Bowden CL, Calabrese JR, Sachs G, Yatham LN, Asghar SA, Hompland M, et al. Lamictal 606 Study Group. A placebocontrolled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry. 2003;60:392-400. Erratum in: Arch Gen Psychiatry. 2004;61:680.
• 4. El-Mallakh RS. Medication adherence and the use of long-acting antipsychotics in bipolar disorder. J Psychiatr Pract. 2007;13:79- 85.
• 5. Calabrese JR, Bowden CL, Sachs G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry. 2003;64:1013-24.
• 6. Coryell W, Endicott J, Maser JD, Mueller T, Lavori P, Keller M. The likelihood of recurrence in bipolar affective disorder: the importance of episode recency. J Affect Disord. 1995;33:201-6.
• 7. Eroglu MZ, Özpoyraz N. Long-term Treatment in Bipolar Disorder. Current Approaches In Psychiatry. 2010;2:206-36 (in Turkish).
• 8. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013;15:1-44.
• 9. Yıldız M, Yüksel AG. Why depot antipsychotic drug use in the treatment of psychotic disorders is still important? An investigation regarding clinical outcome. Bulletin of Clinical Psychopharmacology. 2006;16:98-103 (in Turkish).
• 10. Savas HA, Yumru M, Kaya MC, Selek S. Atypical antipsychotics as “mood stabilizers”: a retrospective chart review. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:1064-7.
• 11. Fountoulakis KN, Vieta E, Sanchez-Moreno J, et al. Treatment guidelines for bipolar disorder: a critical review. J Affect Disord. 2005;860:1-10.
• 12. Savas HA, Yumru M, Ozen ME. Use of long-acting risperidone in the treatment of bipolar patients. J Clin Psychopharmacol. 2006;26:530-1.
• 13. Fagiolini A, Casamassima F, Mostacciuolo W, Forgione R, Goracci A, Goldstein BI. Risperidone long-acting injection as monotherapy and adjunctive therapy in the maintenance treatment of bipolar I disorder. Expert Opin Pharmacother. 2010;11:1727-40.
• 14. Ahlfors UG, Baastrup PC, Dencker SJ, Elgen K, Lingjaerde O, Pedersen V, et al. Flupenthixol decanoate in recurrent manicdepressive illness. A comparison with lithium. Acta Psychiatr Scand. 1981;64:226-37.
• 15. Guy W. Clinical Global Impressions ECDEU Assessment Manual for Psychopharmacology, Revised (DHEW Publ. No. ADM 76-338). National Institute of Mental Health: Rockville, MD. 1976:218-22.
• 16. Karadag F, Oral ET,Yalcın FA, Erten E. Reliability and Validity of Turkish Translation of Young Mania Rating ScaleTürk Psikiyatri Dergisi. 2001;13:107-14 (in Turkish).
• 17. Akdemir A, Örsel S, Dağ İ, et al. Reability, validity and clinical use of Hamilton Depression Rating Scale. Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251-29 (in Turkish).
• 18. Hamann J, Mendel R, Heres S, et al. How much more effective do depot antipsychotics have to be compared to oral antipsychotics before they are prescribed? Eur Neuropsychopharmacol. 2010;20:276-9.
• 19. Glazer WM, Kane JM. Depot neuroleptic therapy: an underutilized treatment option. J Clin Psychiatry. 1992;53:426-33.
• 20. Jaeger M, Rossler W. Attitudes towards long-acting depot antipsychotics: A survey of patients, relatives and psychiatrists. Psychiatry Res. 2010;175:58-62.
• 21. Quiroz JA, Yatham LN, Palumbo JM, Karcher K, Kushner S, Kusumakar V. Risperidone long-acting injectable monotherapy in the maintenance treatment of bipolar I disorder. Biol Psychiatry. 2010;68:156-62.
• 22. Han C, Lee MS, Pae CU, Ko YH, Patkar AA, Jung IK. Usefulness of long-acting injectable risperidone during 12-month maintenance therapy of bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:1219-23.
• 23. Benabarre A, Castro P, Sánchez-Moreno J, Martínez-Arán A, Salamero M, Murru A, Franco C, et al. Efficacy and safety of longacting injectable risperidone in maintenance phase of bipolar and schizoaffective disorder. Actas Esp Psiquiatr. 2009;37:143-7.
• 24. Ahlfors UG, Baastrup PC, Dencker SJ, Elgen K, Lingjaerde O, Pedersen V, et al. Flupenthixol decanoate in recurrent manicdepressive illness. A comparison with lithium. Acta Psychiatr. Scand 1981;64:226-37.
• 25. Virit O, Altindag A, Bulbul F,Savas HA, Dalkilic A. LongActing Typical and Atypical Antipsychotics in Treatment of Schizophrenia: A Retrospective Comparison. Bulletin of Clinical Psychopharmacology. 2009;19:119-27.
• 26. Samalin L, Charpeaud T, Lorabi O, Llorca P. Patient perspectives on use of long-acting antipsychotics in bipolar disorder: focus on risperidone injection. Patient Prefer Adherence. 2010;4:325-34.
• 27. Weiden PJ. Switching antipsychotics: an updated review with a focus on quetiapine. J Psychopharmacol. 2006;20:104-18.