ABSTRACT
OBJECTIVE: To examine the efficacy and tolerability of aripiprazole treatment for acute bipolar depression. METHODS: A six-week prospective, nonrandomized, open label study was conducted in depressed bipolar outpatients (types I, II, and NOS), as diagnosed by DSM-IV criteria. Previous treatments were continued unchanged, and new treatments not permitted, except lorazepam up to 2 mg daily. Aripiprazole was dosed flexibly up to a maximum of 30 mg daily, based on tolerability and efficacy. Montgomery-Asberg Depression Rating Scale (MADRS) and Mania Rating Scale (MRS) scores were used to assess changes in mood symptoms. Side effect outcomes were measured. Data was analyzed using last observation carried forward methodology and Analysis of Variance. RESULTS: Twenty patients (15 men, 5 women) with bipolar disorder (10 type I, 7 type II, 3 type NOS) enrolled in the study. Mean endpoint dose was 13.6 mg/d+/-10.0 mg/d. Thirteen (65%) patients completed 6 weeks of treatment. MADRS and MRS scores significantly improved during treatment. 44% of patients who completed at least one week of treatment were considered responders, based on > or =50% decrease in MADRS scores from baseline. Side effect measures were mostly unchanged during treatment. CONCLUSION: Depressive symptoms improved in bipolar patients treated with open-label aripiprazole.
Subject(s)
Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Piperazines/therapeutic use , Quinolones/therapeutic use , Acute Disease , Adolescent , Adult , Akathisia, Drug-Induced/etiology , Ambulatory Care , Antidepressive Agents/therapeutic use , Antipsychotic Agents/adverse effects , Aripiprazole , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/psychology , Diagnostic and Statistical Manual of Mental Disorders , Drug Administration Schedule , Drug Therapy, Combination , Endpoint Determination , Female , Humans , Lorazepam/therapeutic use , Male , Middle Aged , Nausea/chemically induced , Piperazines/adverse effects , Prospective Studies , Psychiatric Status Rating Scales/statistics & numerical data , Quinolones/adverse effects , Treatment OutcomeABSTRACT
Patients with disturbances in affect, behavior, and cognition present a variety of challenges to healthcare providers; their evaluation and treatment becomes especially problematic in the setting of speech and language difficulties. The authors present the case of a man who sustained a left-side cerebrovascular accident with aphasia and discuss the approach to his diagnosis and treatment. Moreover, since a variety of speech and language problems can arise after stroke and since patients and their treaters can become frustrated by impaired communication and diagnostic uncertainties, authors review the clinical manifestations, timing, and treatment of such conditions so that treatment can be improved.
