ABSTRACT
Objective To study the clinical effect of aripiprazole combined with lithium carbonate in the treatment of acute mania .Methods 72 patients with acute mania were selected in this research .According to the order of admission,the patients with odd numbers were selected as the control group (n=36),and the patients with even numbers were selected as the observation group (n=36).The control group was treated with clozapine combined with lithium carbonate ,the observation group was treated by aripiprazole combined with lithium carbonate .The safety and efficacy of the treatment were evaluated by BRMS score , effective rate , incidence rate of adverse reaction etc .Results After treatment for 1 week,2 weeks,the BRMS scores of the observation group were (21.23 ±2.22)points and (20.02 ±2.12)points,which were significantly lower than those of the control group (t=4.0390,4.0025,all P<0.05).After treatment for 4 and 8 weeks,the BRMS scores of the two groups were similar .The effective rate of the observation group was 94.44%,which of the control group was 91.67%,the difference was not statistically signifi-cant (P>0.05).The incidence rate of adverse reactions of the observation group was 19.44%,which was significantly lower than 41.67% of the control group,the difference was statistically significant (χ2 =11.6446,P<0.05) .Conclusion Aripiprazole combined with lithium carbonate has similar effect with clozapine combined with lithium carbonate in the treatment of acute mania ,but the combination therapy of aripiprazole and lithium carbonate can effec -tively alleviate the symptoms of the disease ,and with less adverse reaction ,high safety,which can be promoted and applicated in clinical .
ABSTRACT
RESUMOObjetivo: Avaliar a custo-efetividade da associação de antipsicóticos atípicos e estabilizadores de humor na terapia de manutenção do transtorno bipolar no Sistema Único de Saúde (SUS). Métodos: Assumindo os custos diretos na perspectiva do SUS, construiu-se um modelo de Markov com as transições entre eutimia, mania, depressão, descontinuação e morte. Dados foram obtidos de ensaios clínicos, coortes prospectivas e bases assistenciais do SUS (valores correntes de 2015). Com uma coorte hipotética (n = 2000, idade = 40 anos), foram simulados ciclos trimestrais no horizonte de até 30 anos (ou efetividade < 1 dia em remissão). Adotaram-se taxas de desconto, correção de meio de ciclo e análises de sensibilidade. Resultados: Os dados de eficácia permitiram apenas a análise da associação com a quetiapina. No horizonte temporal de 12 anos (48 ciclos), ocorreram 512 episódios agudos (depressão: 285, mania: 227) com a monoterapia de lítio ou valproato e 306com associação de quetiapina (depressão: 166, mania: 139). A razão de custo-efetividade incremental (RCEI) da associação com a quetiapina foi de R$ 807,95 por mês adicional em remissão. A análise de sensibilidade demonstrou robustez do modelo, sendo a variação da dose e do preço da quetiapina seus maiores modificadores (amplitude da RCEI de R$ 541,60 a R$ 1.770,05). Conclusões: A terapia de manutenção com a associação da quetiapina ao lítio ou valproato demonstrou ser potencialmentecusto-efetiva. Considerando que o uso de antipsicóticos atípicos não é desprovido de riscos, a estratégia estudada pode ser uma alternativa terapêutica em populações específicas do SUS
ABSTRACTObjective: To evaluate the cost-effectiveness of the combination of atypical antipsychotic and mood stabilizers in maintenance treatment of bipolar disorder in the Brazilian Unified Health System (SUS). Methods: Taking direct costs, from the perspective of SUS, we built a Markov model withtransitions between the states: euthymia, mania, depression, discontinuation and death. Data were extracted from clinical trials, prospective cohorts and SUS databases (current values of 2015). In a hypothetical cohort (n = 2,000, age = 40 years), maintenance therapy was simulated over quarterly cycles through a timeframe up to 30 years (until effectiveness < 1 day in remission). Discount rates and half-cycle correction were applied and sensitivity analyses were run. Results: The efficacy data enabled to include only a combination with quetiapine in the analysis. After twelve years (48 cycles), there were 512 acute episodes (depression: 285, mania: 227) for monotherapy with lithium or valproate against 306 (depression: 166, mania 139) for the quetiapine combination. The incremental cost-effectiveness ratio (ICER) for the quetiapine combination was R$ 807.95 per additional month in remission. The sensitivity analysis demonstrated the model?s robustness, while dosage and quetiapine-price variations had most impact in ICER (ranging from R$ 541.60 to R$ 1,770.05 per additional month in remission). Conclusion: Maintenance therapy with the combination of quetiapine andlithium or valproate seems to be cost-effective. As the use of atypical antipsychotics is also associated with risks, the studied strategy can be a therapeutic alternative for specific populations in SUS.
Subject(s)
Humans , Antipsychotic Agents , Bipolar Disorder , Cost-Benefit AnalysisABSTRACT
OBJECTIVE: Early treatment choice is critical in first-episode schizophrenia-spectrum disorders. The purpose of this study was to describe prescribing trends of antipsychotics use in patients with first-episode schizophrenia in 2005 and 2010, respectively. METHODS: We reviewed the medical records of newly treated patients with schizophrenia from a university psychiatric hospital in 2005 (n=47) and 2010 (n=52). We defined patients as receiving a high antipsychotic dose if their ratio of prescribed daily dose (PDD) to defined daily dose (DDD) was greater than 1.5. RESULTS: The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic poly-pharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003). CONCLUSION: The practice of prescribing high-dose antipsychotics and associated antipsychotic polypharmacy were common even for initial treatment of first-episode schizophrenia in 2005 and 2010. In 2010, the list of the most common first-prescribed antipsychotics changed, and the use of mood stabilizers increased in non-affective schizophrenia.
Subject(s)
Humans , Antimanic Agents , Antipsychotic Agents , Haloperidol , Hospitals, Psychiatric , Medical Records , Polypharmacy , Prescriptions , Risperidone , Schizophrenia , Aripiprazole , Quetiapine FumarateABSTRACT
OBJECTIVE: We previously reported an association between dysbindin gene (DTNBP1) variants and bipolar I disorder (BID). This paper expands upon previous findings suggesting that DTNBP1 variants may play a role in the response to acute mood stabilizer treatment. METHODS: A total of 45 BID patients were treated with antimanic agents (lithium, valproate, or carbamazepine) for an average of 36.52 (+/-19.87) days. After treatment, the patients were evaluated using the Clinical Global Impression (CGI) scale and the Young Mania Rating Scale (YMRS) and genotyped for their DTNBP1 variants (rs3213207 A/G, rs1011313 C/T, rs2005976 G/A, rs760761 C/T and rs2619522 A/C). RESULTS: There was no association between the variants investigated and response to mood stabilizer treatment, even after considering possible stratification factors. CONCLUSION: Although the small number of subjects is an important limitation in our study, DTNBP1 does not seem to be involved in acute antimanic efficacy.
Subject(s)
Humans , Antimanic Agents , Bipolar Disorder , Pharmacogenetics , Valproic AcidABSTRACT
OBJECTIVE: This study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea. METHOD: Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected ; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents. RESULTS: During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithiumvalproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics. CONCLUSIONS: The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.