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Evaluation and intervention of prodromal symptoms of bipolar I disorder
s200
PI. Aflective disorders and antidepressants
for noncompliance. The use of mood stabilizers to treat bipolar disorder is a commonplace and widely accepted. Recently novel antiepileptic drugs lamotrigine and topiramate with improved pharmacokinetic and tolerability profiles have been successfully used as mood stabilizers. Most of the trials have been short term with limited follow-up. Long term follow-up studies are essential to assess the efficacy and patient acceptability of mood stabilizers because of the chronic and recurrent nature of this illness. One hundred and thirty-five patients meeting DSM-IV criteria for Bipolar I or II mood disorder, depressed phase, received open label clinical treatment with topiramate. There were 46 males, 89 females, mean age 34 (18-68), mean age of onset 21 years (840), mean duration of current episode 11 weeks (2-23), Bipolar I (62) and Bipolar II (73). All had been previously treated with mood stabilizers and antidepressants and had failed to respond adequately. They were rated on the Hamilton Depression Rating Scale and met criteria for major depression. They were subsequently rated at 1-2-3-6-l 2-l 8-24-month intervals. Topiramate was given at a starting dose of 25 mg hs rising every two days to 200 mg hs and later if necessary to a maximum of 600 mgday. Of the 92 patients completing the 24-month trial, 75% (69-92) were full responders (HDRS score O-5); 25% of patients were close-to-full responders (HDRS score 68). Clinically significant responses were seen within 2-4 weeks of starting treatment. The number of patients who discontinued medication: l-month (24), 2-months (7), 3-months (3), 12-months (6), 18-months (3). Though clearly more studies are needed, the results from this study add to the evidence that topiramate is an effective mood stabilizer for bipolar disorder and is well accepted by the patient. Drop-out rate seen in this trial was less than expected and an improvement upon previous studies where up to half of patients frequently drop-out. There was no instance of affective switch, five patients had hypomania symptoms during follow-up and responded well to adjustment in dosage. Topiramate has an antidepressant efficacy as add-on therapy in bipolar depression. Among obese patients, weight loss and in others, lack of weightgain as a side effect of therapy provide additional benefit and make it more acceptable as long term maintenance treatment. This study supports the role of topiramate as a mood stabilizer to treat the entire bipolar condition and that topiramate is a significant addition to the available treatments for bipolar disorder particularly by reducing the need for antidepressants which may induce cycling and mania in bipolar depressed patients. References [l] Marcotte D. Use of topiramate: a new anti-epileptic lizer. JAffect Dis 1998: 50 245-25 1.
as a mood stabi-
influence on the long term outcome of the disorder. It should be seen as a critical period with implications for secondary prevention of the impairments and disabilities which accompany this illness. To allow early intervention, we need to deflne the early symptoms that predate the full syndrome and identify youth during that phase and also establish diagnosis in sub-threshold period of the syndrome. Controversy remains about the appropriateness of using criteria for adult bipolar illness for children, possible comorbid psychiatric disorders and identifying pediatric antecedents for this syndrome. Retrospective data is useful for illiciting diagnosis and early signs of illness. Review of the literature has shown that mania is underdiagnosed in prepubertal children and it is recognized that many adult patients had their onset of illness during adolescence and exhibited symptoms long before their formal diagnosis. Ideal investigations require prospective studies of the children at risk and scales which would reflect the atypical features of bipolar disorder in children and also recognize the comorbidities which add another dimension to the illness and evaluation. Forty-four children were diagnosed with bipolar I prodrome state. They had positive family history, episodic mood and energy symptom fluctuation, with anger dyscontrol, irritability, defiance, demanding behavior, conduct problems, sleep disturbance, anxiety, tension, worrying, stubborness, somatic complaints, bold, intrusive and excessive behaviors. A 25-item four point prodrome scale was created with items relevant to children from DSM-IV criteria for Bipolar I mood disorder, Hamilton Depression and Young Mania scale. This scale reflects the atypical presentation of bipolar disorder in childhood, cormorbidities were recognized which add another dimension to evaluation. The group of 28 males and 16 females with a mean age of 11 years (range 7-l 6) all received mainstay treatment with topiramate in a dose range of 25-200 mg qhs with some subjects requiring adjunct treatment. Eleven discontinued treatment secondary to adverse effects and poor response. They were rated at baseline, l-2-3-6-9-12-month intervals. Thirty-three subjects responded with 7&90% symptom reduction in consecutive assessments. Topiramate is an effective treatment in prodromal or subthreshold bipolar mood disorder. From the profile of these children, the emerging symptoms and the features of bipolar 1 disorder revealed prominence of family history of mood disorder, fluctuating energy symptoms, sleep disturbance, defiance, behavior and conduct problems. Though sample size is small, the response was good and was maintained over prolonged period. More studies are needed to better chart prodromal symptoms and effective intervention in sub-threshold bipolar illness. References
[l] Marcotte D. Use of topiramate: a new anti-epileptic as a mood stabiIp.1.0431 Evaluation and intervention of prodromal symptoms of bipolar I disorder M.Z. Hussain, Z.A. Chaudhry, S. Hussain. Prince Albert Health District, Mental Health Centre, Prince Albert, Saskatchavan, Canada Bipolar disorder is a serious illness with estimated lifetime prevalence of 0.5-7.5%. The illness accounts for high degree of stress, disability and suicidal behavior. Frequent treatment failure and partial response remains a major concern. Often bipolar mood disorder emerges in childhood or adolescence but the average interval between prodromal symptoms and diagnosis is ten or more years. It is recognized that early phase of illness has a major
lizer. J Affect Dis 1998.50.245-251.
[p.]
Adjunctive topiramate in bipolar II disorder
E. Vieta, G. Parramon, J.M. Goikolea, C. Torrent, A. Benabarre, F. Colom, A. Martinez-A&, B. Corbella. Bipolar Disorders Program, Barcelona Stanley Foundation Research Center, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain Objective: To evaluate the efficacy and safety of adjunctive topiramate in bipolar II patients who were treatment-resistant or unable to tolerate conventional mood-stabilisers.
PI. Aflective disorders and antidepressants
for noncompliance. The use of mood stabilizers to treat bipolar disorder is a commonplace and widely accepted. Recently novel antiepileptic drugs lamotrigine and topiramate with improved pharmacokinetic and tolerability profiles have been successfully used as mood stabilizers. Most of the trials have been short term with limited follow-up. Long term follow-up studies are essential to assess the efficacy and patient acceptability of mood stabilizers because of the chronic and recurrent nature of this illness. One hundred and thirty-five patients meeting DSM-IV criteria for Bipolar I or II mood disorder, depressed phase, received open label clinical treatment with topiramate. There were 46 males, 89 females, mean age 34 (18-68), mean age of onset 21 years (840), mean duration of current episode 11 weeks (2-23), Bipolar I (62) and Bipolar II (73). All had been previously treated with mood stabilizers and antidepressants and had failed to respond adequately. They were rated on the Hamilton Depression Rating Scale and met criteria for major depression. They were subsequently rated at 1-2-3-6-l 2-l 8-24-month intervals. Topiramate was given at a starting dose of 25 mg hs rising every two days to 200 mg hs and later if necessary to a maximum of 600 mgday. Of the 92 patients completing the 24-month trial, 75% (69-92) were full responders (HDRS score O-5); 25% of patients were close-to-full responders (HDRS score 68). Clinically significant responses were seen within 2-4 weeks of starting treatment. The number of patients who discontinued medication: l-month (24), 2-months (7), 3-months (3), 12-months (6), 18-months (3). Though clearly more studies are needed, the results from this study add to the evidence that topiramate is an effective mood stabilizer for bipolar disorder and is well accepted by the patient. Drop-out rate seen in this trial was less than expected and an improvement upon previous studies where up to half of patients frequently drop-out. There was no instance of affective switch, five patients had hypomania symptoms during follow-up and responded well to adjustment in dosage. Topiramate has an antidepressant efficacy as add-on therapy in bipolar depression. Among obese patients, weight loss and in others, lack of weightgain as a side effect of therapy provide additional benefit and make it more acceptable as long term maintenance treatment. This study supports the role of topiramate as a mood stabilizer to treat the entire bipolar condition and that topiramate is a significant addition to the available treatments for bipolar disorder particularly by reducing the need for antidepressants which may induce cycling and mania in bipolar depressed patients. References [l] Marcotte D. Use of topiramate: a new anti-epileptic lizer. JAffect Dis 1998: 50 245-25 1.
as a mood stabi-
influence on the long term outcome of the disorder. It should be seen as a critical period with implications for secondary prevention of the impairments and disabilities which accompany this illness. To allow early intervention, we need to deflne the early symptoms that predate the full syndrome and identify youth during that phase and also establish diagnosis in sub-threshold period of the syndrome. Controversy remains about the appropriateness of using criteria for adult bipolar illness for children, possible comorbid psychiatric disorders and identifying pediatric antecedents for this syndrome. Retrospective data is useful for illiciting diagnosis and early signs of illness. Review of the literature has shown that mania is underdiagnosed in prepubertal children and it is recognized that many adult patients had their onset of illness during adolescence and exhibited symptoms long before their formal diagnosis. Ideal investigations require prospective studies of the children at risk and scales which would reflect the atypical features of bipolar disorder in children and also recognize the comorbidities which add another dimension to the illness and evaluation. Forty-four children were diagnosed with bipolar I prodrome state. They had positive family history, episodic mood and energy symptom fluctuation, with anger dyscontrol, irritability, defiance, demanding behavior, conduct problems, sleep disturbance, anxiety, tension, worrying, stubborness, somatic complaints, bold, intrusive and excessive behaviors. A 25-item four point prodrome scale was created with items relevant to children from DSM-IV criteria for Bipolar I mood disorder, Hamilton Depression and Young Mania scale. This scale reflects the atypical presentation of bipolar disorder in childhood, cormorbidities were recognized which add another dimension to evaluation. The group of 28 males and 16 females with a mean age of 11 years (range 7-l 6) all received mainstay treatment with topiramate in a dose range of 25-200 mg qhs with some subjects requiring adjunct treatment. Eleven discontinued treatment secondary to adverse effects and poor response. They were rated at baseline, l-2-3-6-9-12-month intervals. Thirty-three subjects responded with 7&90% symptom reduction in consecutive assessments. Topiramate is an effective treatment in prodromal or subthreshold bipolar mood disorder. From the profile of these children, the emerging symptoms and the features of bipolar 1 disorder revealed prominence of family history of mood disorder, fluctuating energy symptoms, sleep disturbance, defiance, behavior and conduct problems. Though sample size is small, the response was good and was maintained over prolonged period. More studies are needed to better chart prodromal symptoms and effective intervention in sub-threshold bipolar illness. References
[l] Marcotte D. Use of topiramate: a new anti-epileptic as a mood stabiIp.1.0431 Evaluation and intervention of prodromal symptoms of bipolar I disorder M.Z. Hussain, Z.A. Chaudhry, S. Hussain. Prince Albert Health District, Mental Health Centre, Prince Albert, Saskatchavan, Canada Bipolar disorder is a serious illness with estimated lifetime prevalence of 0.5-7.5%. The illness accounts for high degree of stress, disability and suicidal behavior. Frequent treatment failure and partial response remains a major concern. Often bipolar mood disorder emerges in childhood or adolescence but the average interval between prodromal symptoms and diagnosis is ten or more years. It is recognized that early phase of illness has a major
lizer. J Affect Dis 1998.50.245-251.
[p.]
Adjunctive topiramate in bipolar II disorder
E. Vieta, G. Parramon, J.M. Goikolea, C. Torrent, A. Benabarre, F. Colom, A. Martinez-A&, B. Corbella. Bipolar Disorders Program, Barcelona Stanley Foundation Research Center, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain Objective: To evaluate the efficacy and safety of adjunctive topiramate in bipolar II patients who were treatment-resistant or unable to tolerate conventional mood-stabilisers.