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Journal of Medical Economics 2023Antipsychotic discontinuation is common among patients with bipolar disorder, especially when psychotic symptoms are remitted. This analysis describes the prevalence,... (Observational Study)
Observational Study
BACKGROUND
Antipsychotic discontinuation is common among patients with bipolar disorder, especially when psychotic symptoms are remitted. This analysis describes the prevalence, predictors, and economic impact of antipsychotic discontinuation among patients with bipolar disorder.
METHODS
A retrospective, observational study was conducted using administrative claims data in the IBM MarketScan Commercial Database. Patients with ≥1 claim with a diagnosis for bipolar disorder (manic or mixed) and newly-initiating antipsychotic therapy between 1 January 2011 and 30 June 2016 were included. Baseline characteristics were assessed in the 12 months prior to the initiation. Outcomes were assessed during a 24-month follow-up. Discontinuation of antipsychotic therapy was utilized as a predictor of healthcare costs in models adjusted for baseline characteristics. Using limited set of variables in the claims database, predictors of discontinuation were also assessed.
RESULTS
A total of 18,259 commercially-insured patients were identified as initiators of antipsychotics. Common comorbidities among the cohorts included major depressive disorder and dyslipidemia. Discontinuation was very common among these patients (85%). Major depressive disorder, drug abuse, and other substance abuse/dependency were predictive of discontinuation. Controlling for differences in baseline characteristics, discontinuation was associated with 33% higher inpatient and emergency visit costs ( <.001) among those using these services, and 24% higher total healthcare costs ( <.001) for the overall cohort.
CONCLUSIONS
Most patients with bipolar mania or mixed states discontinue antipsychotic treatment in less than 2 years. Antipsychotic discontinuation contributes to excess healthcare costs. Future research focusing on the reasons for discontinuation and tailoring disease management based on comorbidities may inform adherence improvement initiatives.
Topics: Humans; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder, Major; Health Care Costs; Prevalence; Retrospective Studies; United States; Insurance Claim Review; Male; Female; Adult; Middle Aged
PubMed: 37455610
DOI: 10.1080/13696998.2023.2228165 -
Clinical Psychology Review Feb 2013Bipolar disorder is frequently associated with a number of poor outcomes including, but not limited to, a significant impairment in the ability to return to premorbid... (Review)
Review
Bipolar disorder is frequently associated with a number of poor outcomes including, but not limited to, a significant impairment in the ability to return to premorbid levels of occupational and psychosocial functioning, often despite the remission of mood symptoms. Sleep disturbance is an oft-reported residual symptom of manic and depressive episodes that has likewise been associated with the onset of manic episodes. Also present during affective episodes as well as the inter-episode periods are reports of deficits in cognitive functioning, which many reports have shown to play an important role in this persistent disability. Despite the presence of deficits in these two domains of functioning during affective episodes as well as the inter-episode phase, there has been no evaluation of the degree to which these systems may interact to maintain such high rates of functional disability. The aim of this review is to examine evidence for the study of the relationship between sleep disturbance and cognitive impairments in bipolar disorder as well as the ways in which deficits in these domains may work together to maintain functional impairment.
Topics: Bipolar Disorder; Cognition Disorders; Humans; Sleep Wake Disorders
PubMed: 23123569
DOI: 10.1016/j.cpr.2012.10.001 -
Bipolar Disorders Dec 2021Bipolar disorder (BP) is commonly researched in digital settings. As a result, standardized digital tools are needed to measure mood. We sought to validate a new survey...
OBJECTIVES
Bipolar disorder (BP) is commonly researched in digital settings. As a result, standardized digital tools are needed to measure mood. We sought to validate a new survey that is brief, validated in digital form, and able to separately measure manic and depressive severity.
METHODS
We introduce a 6-item digital survey, called digiBP, for measuring mood in BP. It has three depressive items (depressed mood, fidgeting, fatigue), two manic items (increased energy, rapid speech), and one mixed item (irritability); and recovers two scores (m and d) to measure manic and depressive severity. In a secondary analysis of individuals with BP who monitored their symptoms over 6 weeks (n = 43), we perform a series of analyses to validate the digiBP survey internally, externally, and as a longitudinal measure.
RESULTS
We first verify a conceptual model for the survey in which items load onto two factors ("manic" and "depressive"). We then show weekly averages of m and d scores from digiBP can explain significant variation in weekly scores from the Young Mania Rating Scale (R = 0.47) and SIGH-D (R = 0.58). Lastly, we examine the utility of the survey as a longitudinal measure by predicting an individual's future m and d scores from their past m and d scores.
CONCLUSIONS
While further validation is warranted in larger, diverse populations, these validation analyses should encourage researchers to consider digiBP for their next digital study of BP.
Topics: Affect; Bipolar Disorder; Humans; Irritable Mood; Psychiatric Status Rating Scales; Self Report; Surveys and Questionnaires
PubMed: 33587813
DOI: 10.1111/bdi.13058 -
AMIA ... Annual Symposium Proceedings.... 2019This study captured daily and weekly mood ratings using a smartphone from bipolar disorder (BD) and unipolar major depression disorder (MDD) subjects at high (HRMDD) and...
UNLABELLED
This study captured daily and weekly mood ratings using a smartphone from bipolar disorder (BD) and unipolar major depression disorder (MDD) subjects at high (HRMDD) and low risk (LRMDD) for developing Bipolar Disorder (BD) and healthy controls (HC).
METHOD
40 subjects (18 - 30 yr) (6 BD, 13 HRMDD, 16 LRMDD and 5 HC) were studied and a total of 2401 daily and 744 weekly ratings were collected. HRMDD and LRMDD subjects were naturalistically treated with antidepressants. We investigate if latent-class analyses of ratings can detect mood instability among MDD and BD groups.
RESULTS
Our analyses revealed four underlying mood states correlating with clinical mood states. There was a trend for greater number of state changes in BD and HRMDD subjects compared to LRMDD and HC groups.
CONCLUSION
Smartphone ratings may adequately capture mood instability in BD subjects and at risk HRMDD subjects and offers a prudent way for monitoring development of serious manic symptoms.
Topics: Adolescent; Adult; Antidepressive Agents; Bipolar Disorder; Depressive Disorder, Major; Female; Humans; Latent Class Analysis; Male; Mobile Applications; Self Report; Smartphone; Young Adult
PubMed: 32308814
DOI: No ID Found -
Journal of Affective Disorders May 2012We examined the association between mood symptoms and 10-year CVD risk estimated by Framingham risk score in a cohort of patients with bipolar disorder.
OBJECTIVES
We examined the association between mood symptoms and 10-year CVD risk estimated by Framingham risk score in a cohort of patients with bipolar disorder.
METHODS
Veterans with bipolar disorder and CVD risk factors (N=118) were recruited from outpatient VA clinics. CVD risk factor data were collected from electronic medical records and patient surveys, and used to calculate patient Framingham Scores. The relationship between mood symptoms (depressive, manic) and Framingham scores was examined, as was the relationship between mental health symptoms and individual CVD risk factors (lipids, blood pressure, weight, smoking, and fasting glucose).
RESULTS
Mean sample age was 53 years (SD=9.9), 17% were female, and 5% were African-American. Almost 70% were obese (BMI≥30), 84% had hyperlipidemia, 70% were hypertensive, and 25% had diabetes. Nineteen percent had a Framingham score of >20%, indicative of elevated 10-year risk of developing CVD. After adjusting for age, gender, diabetes diagnosis, smoking status, and mood symptoms, patients with clinically significant depressive symptoms had a 6-fold increased odds of having a Framingham score of >20% (OR=6.1, p=0.03) while clinically significant manic symptoms were not associated with the Framingham score (OR=0.6, p=0.36). Depressive symptoms were also associated with elevated BMI, fasting glucose, and blood pressure.
LIMITATIONS
Single-site study reliant on cross-sectional and self-reported mood measures.
CONCLUSION
After controlling for physiologic correlates, depressive symptoms were associated with greater relative 10-year risk for CVD mortality among patients with bipolar disorder. Interventions that address self-management of depressive symptoms may help persons with bipolar disorder decrease CVD risk.
Topics: Adult; Bipolar Disorder; Cardiovascular Diseases; Cohort Studies; Female; Humans; Male; Middle Aged; Risk Factors; Veterans
PubMed: 22357338
DOI: 10.1016/j.jad.2012.01.005 -
Journal of Affective Disorders May 2013The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) nomenclature for the co-occurrence of manic and depressive symptoms... (Review)
Review
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) nomenclature for the co-occurrence of manic and depressive symptoms (mixed states) has been revised in the new DSM-5 version to accommodate a mixed categorical-dimensional concept. The new classification will capture subthreshold non-overlapping symptoms of the opposite pole using a "with mixed features" specifier to be applied to manic episodes in bipolar disorder I (BD I), hypomanic, and major depressive episodes experienced in BD I, BD II, bipolar disorder not otherwise specified, and major depressive disorder. The revision will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations. The new concept is data-driven and overcomes the problems derived from the extremely narrow definition in the DSM-IV-TR. However, it is unclear how clinicians will deal with the possibility of diagnosing major depression with mixed features and how this may impact the bipolar-unipolar dichotomy and diagnostic reliability. Clinical trials may also need to address treatment effects according to the presence or absence of mixed features. The medications that are effective in treating mixed episodes per the DSM-IV-TR definition may also be effective in treating mixed features per the DSM-5, but new studies are needed to demonstrate it.
Topics: Biomedical Research; Bipolar Disorder; Comorbidity; Cyclothymic Disorder; Depression; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychiatry; Reproducibility of Results
PubMed: 23561484
DOI: 10.1016/j.jad.2013.03.007 -
Acta Psychiatrica Scandinavica Mar 2011This study of 236 individuals with bipolar disorders employed longitudinal analyses to determine whether the symptoms of mania and depression can be understood as one...
OBJECTIVE
This study of 236 individuals with bipolar disorders employed longitudinal analyses to determine whether the symptoms of mania and depression can be understood as one dimension (with depression and mania as opposites) or two relatively independent dimensions.
METHOD
Weekly severity ratings of manic and depression were assessed using the Longitudinal Interval Follow-up Evaluation-II for 72 weeks. The within-subjects correlation of manic and depressive severity was examined using random effects regression.
RESULTS
Contrary to the one-dimension model, mania and depression symptoms were not negatively related. Indeed, the correlations of mania with depressive symptoms were quite small.
CONCLUSION
The data suggest that depressive and manic symptoms are not opposite poles. Rather depressive and manic symptoms appear to fluctuate relatively independently within bipolar disorder.
Topics: Bipolar Disorder; Depression; Humans; Longitudinal Studies; Psychiatric Status Rating Scales; Regression Analysis; United Kingdom
PubMed: 20825373
DOI: 10.1111/j.1600-0447.2010.01602.x -
Medicine Oct 2020Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated...
INTRODUCTION/RATIONALE
Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated with BD, MS can also induce manic symptoms. However, it is crucial to distinguish which condition is causing mania since medical management is different based on its etiology. Herein, we report a case of a manic episode in a middle-aged female with a prolonged history of BD who received a recent diagnosis of MS 1 year ago.
PATIENT CONCERNS
A 56-year-old female presented with an episode of mania and psychosis while receiving a phenobarbital taper for chronic lorazepam use. She had a prolonged history of bipolar type 1 disorder and depression. She showed optic neuritis and was diagnosed with MS a year prior.
DIAGNOSES
The patient was diagnosed with BD-induced mania based on the absence of increased demyelination compared to previous MRI and lack of new focal or lateralizing neurologic findings of MS.
INTERVENTIONS
Lithium was given for mood stabilization and decreased dosage of prior antidepressant medication. Risperidone was given for ongoing delusions.
OUTCOMES
After 8 days of hospitalization, patient's mania improved but demonstrated atypical features and ongoing delusions. She was discharged at her request to continue treatment in an outpatient setting.
CONCLUSION/LESSON
In BD patients with an episode of mania, MS should be included in the differential, since both conditions can cause manic symptoms. The origin of mania should be delineated through a detailed neurological exam, neuroimaging, and thorough patient-family psychiatric history for appropriate clinical treatment.
Topics: Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Female; Humans; Lithium Compounds; Middle Aged; Multiple Sclerosis; Risperidone
PubMed: 33080761
DOI: 10.1097/MD.0000000000022823 -
Bipolar Disorders Aug 2014The aim of the present study was to systematically evaluate the prodrome to mania in youth.
OBJECTIVES
The aim of the present study was to systematically evaluate the prodrome to mania in youth.
METHODS
New-onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale-Retrospective.
RESULTS
The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3-14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) 'specific' subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0-14.0), 3.5 ± 3.5 months (95% CI: 2.0-4.9), and 3.0 ± 3.2 months (95% CI: 1.0-5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively.
CONCLUSIONS
In youth with BD-I, a relatively long, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.
Topics: Adolescent; Bipolar Disorder; Child; Diagnosis, Differential; Disease Progression; Early Diagnosis; Female; Humans; Male; Prodromal Symptoms; Psychiatric Status Rating Scales; Young Adult
PubMed: 24597782
DOI: 10.1111/bdi.12194 -
International Journal of Environmental... Aug 2021Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to...
Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (-LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.
Topics: Bipolar Disorder; Humans; Predictive Value of Tests; Primary Health Care; Psychiatric Status Rating Scales; Reproducibility of Results
PubMed: 34444069
DOI: 10.3390/ijerph18168318