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P.2.d.006 The impact of second-generation antipsychotics on psychosocial functioning in bipolar disorder
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P.2.d. Mood disorders and treatment − Bipolar disorders (clinical)
disorder, 37, 10.9%; bipolar disorder NOS, 13, 3.8%) were selected. Patients’ prior episodes were identified as manic (199, 58.5%), hypomanic (33, 9.7%), mixed (25, 7.4%), and depressive (70, 20.6%). During the maintenance period, 295 (86.8%) patients took more than one mood stabilizer (MS), 306 patients (92.9%) took more than one antipsychotic (AP), 103 patients (30.3%) took more than one antidepressant (AD), and more than half of patients (192, 56.5%) took a MS+AP combination. Among MSs, valproate (149, 43.8%) was most prescribed, and lithium (98, 28.8%) was second, but as patients moved into maintenance treatment, lithium use decreased, and the use of lamotrigine (86, 25.3%) increased. Preferred APs were quetiapine (125, 36.8%), aripiprazole (67, 19.7%), risperidone (48, 14.1%), and olanzapine (39, 11.5%). The use of olanzapine in maintenance was greatly decreased compared with that during acute treatment (67, 19.7%). Most patients did not take an AD, but the proportion using an AD was increased during maintenance (18.0 to 30.3%), and bupropion (28, 8.2%) was the preferred AD. Doses were decreased in all drugs, but lamotrigine was maintained at a dose of 133.2±68.5 mg/day. Conclusions: This study shows that the most prescribed combination for maintenance of bipolar treatment is a MS+AP combination, but the types of MS and AP tended to be changed from those prescribed in the acute phase. Olanzapine and lithium were decreased, whereas lamotrigine was increased. The use of APs was decreased, whereas AD use in combination with MSs or APs was increased. Finally, the doses of MSs and APs were generally decreased in the maintenance periods, with the exception of lamotrigine. It can be assumed that clinicians in practice usually prescribe according to evidence about efficacy, but they should be just as concerned about safety and tolerability issues, which have only been studied for brief periods in prospective studies. P.2.d.006 The impact of second-generation antipsychotics on psychosocial functioning in bipolar disorder O. Aydemir1 ° , P. Cetinay-Aydin2 , D. Gulec-Oyeckin3 , S. Gulseren4 , G. Putgul-Koybasi5 , H. Sahin6 1 Celal Bayar University Medical School, Department of Psychiatry, Manisa, Turkey; 2 Bakirkoy Mazhar Osman Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey; 3 Onsekiz Mart University, Department of Psychiatry, Canakkale, Turkey; 4 Ataturk Research and Training Hospital, Department of Psychiatry, Izmir, Turkey; 5 Menemen State Hospital, Department of Psychiatry, Izmir, Turkey; 6 Bayindir State Hospital, Department of Psychiatry, Izmir, Turkey Objectives: Even if bipolar patients achieve remission, they do not reach premorbid psychosocial functioning. This is due to factors such as residual depressive symptoms, or the number of episodes. Second-generation antipsychotics have an important role in the treatment of bipolar disorder, being used either in combination therapy or as an alternative to mood stabilizers in routine daily practice. The impact of drug treatment on the impairment of psychosocial functioning in bipolar patients is not well studied. Yen et al. [1] state that the use of second-generation antipsychotics does not have any effect on quality of life, but there are some differences among the drugs themselves; however, they do not elaborate on the cause of this (non)effect and how it is related with daily life. The aim of the present study is to evaluate the impact of treatment modalities on psychosocial functioning in remitted bipolar patients.
Methods: The study was carried out with 108 patients diagnosed with bipolar disorder. All patients were in remission and the remission state was confirmed using the appropriate scales. The study was approved by the Local Ethical Committee of Celal Bayar University. In the assessment of functioning, we used the Functioning Assessment Short Test (FAST), which covers domains such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relations, and leisure time. The treatment modality groups were mood stabilizers only (MS) versus mood stabilizers plus second-generation antipsychotics (MS+SGA). Forty-one patients (38%) were on MS only, 67 patients (62%) were on MS+SGA. In the statistical analysis, multiple linear regression analysis was performed. Results: In the multiple linear regression analysis where a model for each domain of psychosocial functioning was tested, autonomy, interpersonal relations, and leisure time activities were found to be statistically significant. For autonomy, R squared was calculated as 0.146, and the model was statistically significant (F = 2.702, p = 0.018). MS+SGA treatment (b = 3.086, p < 0.01) and HAM-D score (b = 2.186, p < 0.05) both had an effect on this domain. For interpersonal relations, R squared was 0.158 (F = 2.605, p = 0.023). HAM-D score (b = 2.753, p < 0.01) and MS+SGA (b = 2.807, p < 0.01) both had an effect on this domain. For leisure time activities, R squared was 0.201 (F = 3.982, p = 0.001). MS+SGA treatment (b = 3.293, p < 0.01) and HAM-D score (b = 3.396, p < 0.05) both had an effect on this domain. The models for domains of occupational functioning, cognitive functioning, and financial issues were not statistically significant. Conclusions: Even though bipolar patients achieve remission, they cannot return to their premorbid level of psychosocial functioning. In addition to residual depressive symptoms, secondgeneration antipsychotics used in the treatment also have negative impact. In the long-term follow-up of patients with bipolar disorder, psychotropic drugs should be monitored, tapering off those drugs that are not needed anymore, and the cost/benefit ratio of ongoing psychotropic drugs should be taken into account. References [1] Yen, C.-F., Cheng, C.-P., Huang, C.-F., Yen, J.-Y., Ko, C.-H., Chen, C.-S., 2008. Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disord 10, 617–624.
P.2.d.007 Misdiagnosis and role of duration of untreated illness (DUI)/untreated psychosis (DUP) in psychotic bipolar patients M. Buoli1 ° , L. Caron1 , C. Cumerlato Melter1 , A. Caldiroli1 , C. Dobrea1 , M. Cigliobianco1 , F. Zanelli1 , A.C. Altamura1 1 University of Milan Fondazione IRCCS Ospedale Maggiore Policlinico, Department of Psychiatry, Milan, Italy Purpose of the Study: A number of data show the negative role of Duration of Untreated Psychosis (DUP) on outcome in schizophrenia as well as in first-episode psychotic patients [1], but no investigation has been carried out about the impact of this variable in bipolar disorder (BD). Clinical experience shows how a lot of psychotic bipolar patients are misdiagnosed and chronically treated with First-Generation Antipsychotics (e.g. haloperidol). Haloperidol can ameliorate acute psychotic manic symptoms but
P.2.d. Mood disorders and treatment − Bipolar disorders (clinical)
disorder, 37, 10.9%; bipolar disorder NOS, 13, 3.8%) were selected. Patients’ prior episodes were identified as manic (199, 58.5%), hypomanic (33, 9.7%), mixed (25, 7.4%), and depressive (70, 20.6%). During the maintenance period, 295 (86.8%) patients took more than one mood stabilizer (MS), 306 patients (92.9%) took more than one antipsychotic (AP), 103 patients (30.3%) took more than one antidepressant (AD), and more than half of patients (192, 56.5%) took a MS+AP combination. Among MSs, valproate (149, 43.8%) was most prescribed, and lithium (98, 28.8%) was second, but as patients moved into maintenance treatment, lithium use decreased, and the use of lamotrigine (86, 25.3%) increased. Preferred APs were quetiapine (125, 36.8%), aripiprazole (67, 19.7%), risperidone (48, 14.1%), and olanzapine (39, 11.5%). The use of olanzapine in maintenance was greatly decreased compared with that during acute treatment (67, 19.7%). Most patients did not take an AD, but the proportion using an AD was increased during maintenance (18.0 to 30.3%), and bupropion (28, 8.2%) was the preferred AD. Doses were decreased in all drugs, but lamotrigine was maintained at a dose of 133.2±68.5 mg/day. Conclusions: This study shows that the most prescribed combination for maintenance of bipolar treatment is a MS+AP combination, but the types of MS and AP tended to be changed from those prescribed in the acute phase. Olanzapine and lithium were decreased, whereas lamotrigine was increased. The use of APs was decreased, whereas AD use in combination with MSs or APs was increased. Finally, the doses of MSs and APs were generally decreased in the maintenance periods, with the exception of lamotrigine. It can be assumed that clinicians in practice usually prescribe according to evidence about efficacy, but they should be just as concerned about safety and tolerability issues, which have only been studied for brief periods in prospective studies. P.2.d.006 The impact of second-generation antipsychotics on psychosocial functioning in bipolar disorder O. Aydemir1 ° , P. Cetinay-Aydin2 , D. Gulec-Oyeckin3 , S. Gulseren4 , G. Putgul-Koybasi5 , H. Sahin6 1 Celal Bayar University Medical School, Department of Psychiatry, Manisa, Turkey; 2 Bakirkoy Mazhar Osman Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey; 3 Onsekiz Mart University, Department of Psychiatry, Canakkale, Turkey; 4 Ataturk Research and Training Hospital, Department of Psychiatry, Izmir, Turkey; 5 Menemen State Hospital, Department of Psychiatry, Izmir, Turkey; 6 Bayindir State Hospital, Department of Psychiatry, Izmir, Turkey Objectives: Even if bipolar patients achieve remission, they do not reach premorbid psychosocial functioning. This is due to factors such as residual depressive symptoms, or the number of episodes. Second-generation antipsychotics have an important role in the treatment of bipolar disorder, being used either in combination therapy or as an alternative to mood stabilizers in routine daily practice. The impact of drug treatment on the impairment of psychosocial functioning in bipolar patients is not well studied. Yen et al. [1] state that the use of second-generation antipsychotics does not have any effect on quality of life, but there are some differences among the drugs themselves; however, they do not elaborate on the cause of this (non)effect and how it is related with daily life. The aim of the present study is to evaluate the impact of treatment modalities on psychosocial functioning in remitted bipolar patients.
Methods: The study was carried out with 108 patients diagnosed with bipolar disorder. All patients were in remission and the remission state was confirmed using the appropriate scales. The study was approved by the Local Ethical Committee of Celal Bayar University. In the assessment of functioning, we used the Functioning Assessment Short Test (FAST), which covers domains such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relations, and leisure time. The treatment modality groups were mood stabilizers only (MS) versus mood stabilizers plus second-generation antipsychotics (MS+SGA). Forty-one patients (38%) were on MS only, 67 patients (62%) were on MS+SGA. In the statistical analysis, multiple linear regression analysis was performed. Results: In the multiple linear regression analysis where a model for each domain of psychosocial functioning was tested, autonomy, interpersonal relations, and leisure time activities were found to be statistically significant. For autonomy, R squared was calculated as 0.146, and the model was statistically significant (F = 2.702, p = 0.018). MS+SGA treatment (b = 3.086, p < 0.01) and HAM-D score (b = 2.186, p < 0.05) both had an effect on this domain. For interpersonal relations, R squared was 0.158 (F = 2.605, p = 0.023). HAM-D score (b = 2.753, p < 0.01) and MS+SGA (b = 2.807, p < 0.01) both had an effect on this domain. For leisure time activities, R squared was 0.201 (F = 3.982, p = 0.001). MS+SGA treatment (b = 3.293, p < 0.01) and HAM-D score (b = 3.396, p < 0.05) both had an effect on this domain. The models for domains of occupational functioning, cognitive functioning, and financial issues were not statistically significant. Conclusions: Even though bipolar patients achieve remission, they cannot return to their premorbid level of psychosocial functioning. In addition to residual depressive symptoms, secondgeneration antipsychotics used in the treatment also have negative impact. In the long-term follow-up of patients with bipolar disorder, psychotropic drugs should be monitored, tapering off those drugs that are not needed anymore, and the cost/benefit ratio of ongoing psychotropic drugs should be taken into account. References [1] Yen, C.-F., Cheng, C.-P., Huang, C.-F., Yen, J.-Y., Ko, C.-H., Chen, C.-S., 2008. Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disord 10, 617–624.
P.2.d.007 Misdiagnosis and role of duration of untreated illness (DUI)/untreated psychosis (DUP) in psychotic bipolar patients M. Buoli1 ° , L. Caron1 , C. Cumerlato Melter1 , A. Caldiroli1 , C. Dobrea1 , M. Cigliobianco1 , F. Zanelli1 , A.C. Altamura1 1 University of Milan Fondazione IRCCS Ospedale Maggiore Policlinico, Department of Psychiatry, Milan, Italy Purpose of the Study: A number of data show the negative role of Duration of Untreated Psychosis (DUP) on outcome in schizophrenia as well as in first-episode psychotic patients [1], but no investigation has been carried out about the impact of this variable in bipolar disorder (BD). Clinical experience shows how a lot of psychotic bipolar patients are misdiagnosed and chronically treated with First-Generation Antipsychotics (e.g. haloperidol). Haloperidol can ameliorate acute psychotic manic symptoms but