Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective@#The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). @*Methods@#A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. @*Results@#The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). @*Conclusion@#The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Validation of the Korean Version of the Depression in Old Age Scale and Comparison with Other Depression Screening Questionnaires Used in Elderly Patients in Medical Settings

OBJECTIVE: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings. METHODS: A total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery–Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically. RESULTS: The K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cut-off point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For “any depressive disorder”, the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033). CONCLUSION: The present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.

Pharmacological Treatment of Major Depressive Episodes with Mixed Features: A Systematic Review

We reviewed clinical studies investigating the pharmacological treatment of major depressive episodes (MDEs) with mixed features diagnosed according to the dimensional criteria (more than two or three [hypo]manic symptoms+principle depressive symptoms). We systematically reviewed published randomized controlled trials on the pharmacological treatment of MDEs with mixed features associated with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). We searched the PubMed, Cochrane Library, and ClinicalTrials.gov databases through December 2017 with the following key word combinations linked with the word OR: (a) mixed or mixed state, mixed features, DMX, mixed depression; (b) depressive, major depressive, MDE, MDD, bipolar, bipolar depression; and (c) antidepressant, antipsychotic, mood stabilizer, anticonvulsant, treatment, medication, algorithm, guideline, pharmacological. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found few randomized trials on pharmacological treatments for MDEs with mixed features. Of the 36 articles assessed for eligibility, 11 investigated MDEs with mixed features in mood disorders: six assessed the efficacy of antipsychotic drugs (lurasidone and ziprasidone) in the acute phase of MDD with mixed features, although four of these were post hoc analyses based on large randomized controlled trials. Four studies compared antipsychotic drugs (olanzapine, lurasidone, and ziprasidone) with placebo, and one study assessed the efficacy of combination therapy (olanzapine+fluoxetine) in the acute phase of BD with mixed features. Pharmacological treatments for MDEs with mixed features have focused on antipsychotics, although evidence of their efficacy is lacking. Additional well-designed clinical trials are needed.

Predictors of a Shorter Time to Hospitalization in Patients with Bipolar Disorder: Medication during the Acute and Maintenance Phases and Other Clinical Factors

OBJECTIVE: The present study was conducted to compare the effects of pharmacological treatments during the acute and maintenance phases of mood episodes, sociodemographic, and clinical characteristics between a shorter time to hospitalization group (<12 months) and a longer time to hospitalization group (≥12 months). METHODS: The discharge medication for the first hospitalization was considered the acute treatment and the medication used during the week prior to the second hospitalization at the outpatient clinic was considered the maintenance treatment. Additionally, the charts were reviewed to examine a variety of demographic and clinical characteristics. RESULTS: Patients in the shorter time to hospitalization group were more likely to be unmarried and/or unemployed, have had a previous hospital admission for a mood episode, and have used antidepressant during the acute phase than those in the longer time to hospitalization group. Patients in the shorter time to hospitalization group were also less likely to use olanzapine, serotonin-norepinephrine reuptake inhibitors, or mood stabilizer monotherapy as a maintenance treatment than were patients in the longer time to hospitalization group. CONCLUSION: Predictors for shorter time to hospitalization were associated with number of previous hospital admissions for a mood episode, being unmarried and/or unemployed, and antidepressant use during the acute phase.

Dose Trends of Aripiprazole from 2004 to 2014 in Psychiatric Inpatients in Korea

OBJECTIVE: Although aripiprazole has been widely used to treat various psychiatric disorders, little is known about the adequate dosage for Asian patients in clinical practice. Hence, we evaluated the initial and maximum doses of aripiprazole from 2004 to 2014 to estimate the appropriate dosage for Korean psychiatric inpatients in clinical practice. METHODS: In this retrospective study, we reviewed the medical records of patients who were hospitalized in five university hospitals in Korea from March 2004 to December 2014. The psychiatric diagnosis according to the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition during index hospitalization and the initial and maximum doses of aripiprazole were evaluated. RESULTS: There were 74 patients in Wave 1 (2004–2006), 201 patients in Wave 2 (2007–2010), and 353 patients in Wave 3 (2011–2014). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. The maximum doses of aripiprazole in each diagnostic group were not significantly different among Waves 1, 2, and 3. CONCLUSION: The relatively low initial doses of aripiprazole documented in our study may reflect a strategy by clinicians to minimize the side effects associated with aripiprazole use, such as akathisia.

A Trend of Drug Use in Inpatients with Bipolar Disorder: Comparing 2009-2012 with 1998-2001 in One University Hospital / 대한정신약물학회지

OBJECTIVE: The aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital. METHODS: A retrospective chart review was performed and data of 188 cases (2009-2012) and 118 cases (1998-2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed. RESULTS: The proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased. CONCLUSION: This study showed significant changes have occurred in the prescription patterns in patients with bipolar disorder in the last four years. These results seem to reflect the accumulating evidence-based data for the treatment of bipolar disorder, and will provide the useful information to clinicians in practical situations.

A Trend of Medication Prescription Pattern for Outpatients with Bipolar Disorder in a University Hospital: Focusing on Atypical Antipsychotics / 대한정신약물학회지

OBJECTIVE: Atypical antipsychotics and newly developed anticonvulsants have become increasingly popular medication for bipolar disorder. Especially, atypical antipsychotics have increasing importance in treatment of bipolar disorder and a number of treatment guideline recommend atypical antipsychotics for pharmacological treatment of bipolar manic and depressed episodes. This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics. METHODS: Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics. RESULTS: In 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity. CONCLUSION: The development of bipolar disorder's psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

Changes in Aripiprazole Usage in the Psychiatric Inpatients at a University Hospital between 2004-2008 and 2009-2013 / 대한정신약물학회지

OBJECTIVE: Patterns of clinical use of aripiprazole have changed greatly in the past decade. We aimed to assess changes in these patterns in an inpatient unit at a university hospital between 2004-2008 and 2009-2013. METHODS: The subjects (n=182) were inpatients treated with aripiprazole between September 2004 and May 2013 who were categorized according to time period: Sep 2004-Dec 2008 (n=42) or Jan 2009-May 2013 (n=142). Aripiprazole was approved as an adjunctive therapy for patients with major depressive disorder by the Korea Food and Drug Administration in 2008. The subjects' charts were retrospectively reviewed to ascertain the distribution of psychiatric diagnoses and to identify other factors related to diagnosis, such as demographic characteristics, starting/maximum doses, and treatment regimen. RESULTS: Comparison of the two time periods showed that the most common psychiatric diagnoses changed from schizophrenia and other psychotic disorders to mood disorders such as major depressive disorder and bipolar disorder. Aripiprazole was more often prescribed for bipolar disorder, depressed patients during 2009-2013 than during 2004-2008 (15.5% vs. 2.4%, p=0.047). Patients with schizophrenia and other psychotic disorders (p=0.005), major depressive disorder (p=0.006), bipolar disorder, manic/mixed (p=0.006) and other diagnoses (p=0.029) had significantly lower starting doses during 2009-2013 than during 2004-2008. Although a trend was found toward a higher aripiprazole dose for schizophrenia and other psychotic disorders during 2009-2013 than during 2004-2008, the difference was not significant (28.3+/-1.4 vs. 22.1+/-2.1, p=0.061). CONCLUSION: Treatment with aripiprazole has been extended beyond schizophrenia and other psychotic disorders to mood disorders and other diagnoses in clinical practice. The majority of patients treated with aripiprazole during the later period received lower starting doses than did those during the earlier one, although maximum doses varied depending on the psychiatric diagnosis.

Changes in Antipsychotic Drug Usage in the Psychiatric Inpatients at a University Hospital between 1997, 2003-2004 and 2009-2010 / 대한정신약물학회지

OBJECTIVE: Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors' goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. METHODS: We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). RESULTS: The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). CONCLUSION: The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.