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C.10.03 What is new in treating patients with major depressive disorder who show inadequate response to antidepressants
C.ll Cognition from the laboratory to the clinic open-label comparison with olanzapine. Psychopharmacology (Ber!) 2006; 189:259-66. [3] Fleischhacker, w., Heikkinen, M.E., Olie, IP., et al. Long-term effect on weight of aripiprazole-clozapine in schizophrenia patients with suboptimal response on clozapine. European Neuropsychopharmacology 2008;18(SuppI4):S447-S448.
IC.10.021 Treating mania and managing long-term treatment of bipolar disorder
C. Arango1 '. 1Hospital General Universitario Gregorio Maranon Centro de Investigacion Biomedica en Red de Salud Mental, Psychiatry Department Adolescent Unit, Madrid, Spain Pharmacological treatments for bipolar disorder should ensure rapid control of mania, transitioning smoothly through continuation treatment to long-term symptom control and relapse prevention. Long-term compliance is often suboptimal in bipolar patients and poor adherence is a frequent cause of relapse; thus there remains a need for improved treatments. Atypical antipsychotics are first-line treatment options for mania. Monotherapy with aripiprazole, olanzapine, quetiapine or risperidone has shown significant benefit over placebo for the treatment of mania. Data from randomised, controlled trials (RCTs) also support antipsychotic use for long-term treatment. Unstable patients or those with inadequate response to monotherapy with antipsychotics or mood stabilisers may benefit from combination therapy with both classes of agent. Meta-analysis of RCTs evaluating combination therapy versus monotherapy for bipolar mania has demonstrated that adding an antipsychotic to established mood stabilisers is more effectivethan treatment with mood stabilisers alone. However, meta-analysis data also suggest that combination therapy may be less well tolerated than monotherapy, as the side-effects of both drugs can be additive. Thus, the choice of therapeutic agent is an important consideration. Data now support the use of aripiprazole in combination with lithium/valproate for prevention of manic episode relapses [1,2]; the benefits of therapy were still apparent after 52 weeks and weight gain was comparable to placebo. Atypical antipsychotics have proven short- and long-term efficacy as monotherapy or adjunctive treatment for bipolar I manic/mixed episodes, providing additional management options. It is interesting that a single drug class can be used to treat psychiatric disorders with putatively different pathophysiologies. References
[I] Vieta, E., T'joen, C., McQuade, R.D., et al. Efficacy of adjunctive aripiprazole to either valproate or lithium in bipolar mania patients partially nonresponsive to valproatellithium monotherapy: a placebocontrolled study. Am J Psychiatry 2008;165:1316-25. [2] Vieta, E., Baudelet, C., McQuade, R.D., Marcus, R.N., Sanchez, R. A 46-week evaluation of aripiprazole in combination with lithium/valproate in bipolar mania (CN138-134). European Neuropsychopharmacology 2008;18(SuppI4):S447.
IC.10.031 What is new in treating patients with major depressive disorder who show inadequate response to antidepressants
A.H. Young1 '. 1 University of British Columbia, Institute of Mental Health, f1zncouver, Canada Major depressive disorder is a common and disabling condition that presents a challenge to physicians. While antidepressants form
S713
the mainstay of treatment, almost two-thirds of patients fail to achieve remission with initial therapy and a significant number of patients do not achieve remission even after multiple courses of pharmacotherapy. Remission, defined as a return to optimal levels of psychosocial functioning, should be the aim of treatment. Patients who do not reach remission, including those who respond but do not remit, are at greater risk for relapse, are more likely to suffer recurrent depressive episodes and are more likely to be affected by psychological, behavioral and somatic residual symptoms compared to patients who achieve this therapeutic goal. Thus, there remains a clear need for more effective treatment options for patients with inadequate response to antidepressants. For patients who do not achieve remission following initial antidepressant treatment, a range of augmentation and combination strategies can be used. One augmentation strategy for patients who have not obtained complete remission is to use atypical antipsychotics to augment the effects of antidepressant treatment. For example, aripiprazole has been shown to be effective and well tolerated as adjunctive therapy to new generation antidepressants in three, large, randomised, short-term, double-blind studies [1-3] and one long-term safety trial. Based on these studies, aripiprazole has been approved by the US Food and Drug Administration as adjunctive therapy for major depressive disorder. Such new treatment options will hopefully allow more patients to achieve remission, avoid relapse and achieve long-term treatment success. References
[I] Berman, R.M., Marcus, R.N., Swanink, R., et al. The Efficacy and Safety of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder: A Multicenter, Randomized, Double-blind, Placebo-controlled Study. J Clin Psych 2007;68:843-853. [2] Marcus, R.N., McQuade, R.D., Carson, W.H., et al. The Efficacy and Safety of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder A Second Multicenter, Randomized, Double-Blind, PlaceboControlled Study. J Clin PsychopharmacoI2008;28:156--165. [3] Berman, R.M., Fava, M., Thase, M.E., et al. Aripiprazole Augmentation in Major Depressive Disorder: A Double-Blind, Placebo-Controlled Study in Patients with Inadequate Response to Antidepressants. CNS Spectr 2009;14:197-206.
C.II Cognition from the laboratory to the clinic IC.11.011 Multidimensional approach to sensory gating functions and cognition in humans F. Vollenweider1 '. 1Psychiatric University Hospital, Heffter Research Center, Ziirich, Switzerland
Cognitive deficits represent an integral feature of schizophrenia. Increased appreciation of the limits that such deficits impose on rehabilitation and outcomes in schizophrenia has emphasised the need for treatments targeted toward optimising cognitive function. Current theoretical concepts on the neuronal basis of schizophrenia symptomatology suggest that deficits in early information processing engender the cognitive disturbances, and even the psychosis, observed in psychotic disorders. This deficit is associated with an inability to filter irrelevant external stimuli and subsequent stimulus overload. This, in turn, is thought to contribute to the cognitive impairments and psychotic features observed in schizophrenia, such as poor selective attention and inability to discriminate between self and non-self. There is increasing evidence that atypical, but not typical, antipsychotics improve sensorimotor gating [1]. The validity of various measures
IC.10.021 Treating mania and managing long-term treatment of bipolar disorder
C. Arango1 '. 1Hospital General Universitario Gregorio Maranon Centro de Investigacion Biomedica en Red de Salud Mental, Psychiatry Department Adolescent Unit, Madrid, Spain Pharmacological treatments for bipolar disorder should ensure rapid control of mania, transitioning smoothly through continuation treatment to long-term symptom control and relapse prevention. Long-term compliance is often suboptimal in bipolar patients and poor adherence is a frequent cause of relapse; thus there remains a need for improved treatments. Atypical antipsychotics are first-line treatment options for mania. Monotherapy with aripiprazole, olanzapine, quetiapine or risperidone has shown significant benefit over placebo for the treatment of mania. Data from randomised, controlled trials (RCTs) also support antipsychotic use for long-term treatment. Unstable patients or those with inadequate response to monotherapy with antipsychotics or mood stabilisers may benefit from combination therapy with both classes of agent. Meta-analysis of RCTs evaluating combination therapy versus monotherapy for bipolar mania has demonstrated that adding an antipsychotic to established mood stabilisers is more effectivethan treatment with mood stabilisers alone. However, meta-analysis data also suggest that combination therapy may be less well tolerated than monotherapy, as the side-effects of both drugs can be additive. Thus, the choice of therapeutic agent is an important consideration. Data now support the use of aripiprazole in combination with lithium/valproate for prevention of manic episode relapses [1,2]; the benefits of therapy were still apparent after 52 weeks and weight gain was comparable to placebo. Atypical antipsychotics have proven short- and long-term efficacy as monotherapy or adjunctive treatment for bipolar I manic/mixed episodes, providing additional management options. It is interesting that a single drug class can be used to treat psychiatric disorders with putatively different pathophysiologies. References
[I] Vieta, E., T'joen, C., McQuade, R.D., et al. Efficacy of adjunctive aripiprazole to either valproate or lithium in bipolar mania patients partially nonresponsive to valproatellithium monotherapy: a placebocontrolled study. Am J Psychiatry 2008;165:1316-25. [2] Vieta, E., Baudelet, C., McQuade, R.D., Marcus, R.N., Sanchez, R. A 46-week evaluation of aripiprazole in combination with lithium/valproate in bipolar mania (CN138-134). European Neuropsychopharmacology 2008;18(SuppI4):S447.
IC.10.031 What is new in treating patients with major depressive disorder who show inadequate response to antidepressants
A.H. Young1 '. 1 University of British Columbia, Institute of Mental Health, f1zncouver, Canada Major depressive disorder is a common and disabling condition that presents a challenge to physicians. While antidepressants form
S713
the mainstay of treatment, almost two-thirds of patients fail to achieve remission with initial therapy and a significant number of patients do not achieve remission even after multiple courses of pharmacotherapy. Remission, defined as a return to optimal levels of psychosocial functioning, should be the aim of treatment. Patients who do not reach remission, including those who respond but do not remit, are at greater risk for relapse, are more likely to suffer recurrent depressive episodes and are more likely to be affected by psychological, behavioral and somatic residual symptoms compared to patients who achieve this therapeutic goal. Thus, there remains a clear need for more effective treatment options for patients with inadequate response to antidepressants. For patients who do not achieve remission following initial antidepressant treatment, a range of augmentation and combination strategies can be used. One augmentation strategy for patients who have not obtained complete remission is to use atypical antipsychotics to augment the effects of antidepressant treatment. For example, aripiprazole has been shown to be effective and well tolerated as adjunctive therapy to new generation antidepressants in three, large, randomised, short-term, double-blind studies [1-3] and one long-term safety trial. Based on these studies, aripiprazole has been approved by the US Food and Drug Administration as adjunctive therapy for major depressive disorder. Such new treatment options will hopefully allow more patients to achieve remission, avoid relapse and achieve long-term treatment success. References
[I] Berman, R.M., Marcus, R.N., Swanink, R., et al. The Efficacy and Safety of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder: A Multicenter, Randomized, Double-blind, Placebo-controlled Study. J Clin Psych 2007;68:843-853. [2] Marcus, R.N., McQuade, R.D., Carson, W.H., et al. The Efficacy and Safety of Aripiprazole as Adjunctive Therapy in Major Depressive Disorder A Second Multicenter, Randomized, Double-Blind, PlaceboControlled Study. J Clin PsychopharmacoI2008;28:156--165. [3] Berman, R.M., Fava, M., Thase, M.E., et al. Aripiprazole Augmentation in Major Depressive Disorder: A Double-Blind, Placebo-Controlled Study in Patients with Inadequate Response to Antidepressants. CNS Spectr 2009;14:197-206.
C.II Cognition from the laboratory to the clinic IC.11.011 Multidimensional approach to sensory gating functions and cognition in humans F. Vollenweider1 '. 1Psychiatric University Hospital, Heffter Research Center, Ziirich, Switzerland
Cognitive deficits represent an integral feature of schizophrenia. Increased appreciation of the limits that such deficits impose on rehabilitation and outcomes in schizophrenia has emphasised the need for treatments targeted toward optimising cognitive function. Current theoretical concepts on the neuronal basis of schizophrenia symptomatology suggest that deficits in early information processing engender the cognitive disturbances, and even the psychosis, observed in psychotic disorders. This deficit is associated with an inability to filter irrelevant external stimuli and subsequent stimulus overload. This, in turn, is thought to contribute to the cognitive impairments and psychotic features observed in schizophrenia, such as poor selective attention and inability to discriminate between self and non-self. There is increasing evidence that atypical, but not typical, antipsychotics improve sensorimotor gating [1]. The validity of various measures