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Objective: To determine if quetiapine, an atypical antipsychotic agent approved for the treatment of schizophrenia, is effective in the treatment of bipolar disorder.Materials and Methods: A retrospective chart review identified six patients with DSM-IV bipolar disorder, type I, who received open uncontrolled treatment with quetiapine in the setting of nonresponse or intolerance to traditional mood-stabilizing treatments. Treatment response was based on moderate to marked improvement on the Clinical Global Impression-Bipolar Disorder (CGI-BP) scale.Results: Two of six patients showed evidence of response. The main side effect noted was sedation.Conclusions: Quetiapine may be a useful treatment for some patients with treatment-resistant bipolar disorder. Further studies are needed to assess quetiapine's effect more rigorously. 相似文献
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OBJECTIVE: Rapid cycling bipolar disorder presents a significant challenge with respect to treatment. The cyclical nature of bipolar disorder has been well recognised for over a century, and following Dunner and Fieve's landmark paper in 1974, investigators have increasingly turned their attention to issues such as the definition of rapid cycling, demographic characterisation, treatment response and pharmacologic intervention. METHODS: A literature search using Medline was performed, and selected articles which consider important developments in the definition, demographics and course of rapid cycling are reviewed. In addition, a systematic review of the literature published during the past 5 years (1999-2004) relating to treatment was conducted. RESULTS: Relevant articles are reviewed. CONCLUSIONS: This review highlights the important developments in our understanding of rapid cycling bipolar disorder, and focuses particularly on the recent literature regarding treatment. 相似文献
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Gentile S 《Bipolar disorders》2006,8(3):207-220
OBJECTIVES: Bipolar disorders are reported to have a high incidence during childbearing years and the need may arise to start or continue a pharmacological treatment during pregnancy and the postpartum period. In the last few years several investigations have evaluated the efficacy of emerging mood-stabilizing agents in the treatment of bipolar disorders, such as lamotrigine, olanzapine, risperidone, quetiapine, aripiprazole and ziprasidone. A number of studies, which examined the use of oxcarbazepine, point to its potential usefulness in prophylactic treatment. The aim of this review is to compare information from the literature on the safety of lamotrigine, oxcarbazepine, risperidone, olanzapine, and quetiapine to the safety data on classic mood stabilizers during pregnancy and the postpartum period. METHODS: A computerized search carried out from 1980 to April 5, 2006 led to the summarization of the results. (References were updated after acceptance and prior to publication.) RESULTS: Emerging mood stabilizers show uncertain safety parameters in pregnancy and lactation. Limited information on lamotrigine and oxcarbazepine does not suggest a clear increase in teratogenicity, while olanzapine appears to be associated with a higher risk of metabolic complications in pregnant women. Data about risperidone and quetiapine are still inconclusive. Finally, the literature on the safety of these compounds in breastfeeding is anecdotal. CONCLUSIONS: Untreated pregnant bipolar women are at an increased risk of poor obstetrical outcomes and relapse of affective symptoms. On the other hand, classic antiepileptic drugs are well-known human teratogens, whereas data on lithium are partially ambiguous. The safety of emerging mood stabilizers in pregnancy and breastfeeding has not been examined extensively. Therefore, when approaching bipolar disorder, if possible, each episode must be considered separately. 相似文献
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Harley C Li H Corey-Lisle P L'Italien GJ Carson W 《Social psychiatry and psychiatric epidemiology》2007,42(9):690-697
Background Bipolar disorder is the most expensive mental disorder for US employer health plans. No published studies have examined the
impact of comorbid diabetes on the cost of treating bipolar disorder. The objectives of this work were to determine the direct
costs incurred by patients with bipolar disorder in a US managed care plan, and to examine the influence (1) of drug therapy
regimen on bipolar-related costs, and (2) of diabetes on bipolar-related and all-cause costs.
Methods A retrospective analysis of claims in a US private insurance database from January 1, 1999 through December 31, 2002 was performed.
The database included at least 4.7 million enrollees each year. Diagnosis codes were used to identify patients with bipolar
disorder; patients with diabetes were identified using diagnosis codes and medication use.
Results From 1999–2002, treated bipolar disorder was identified in 262 (33.9) [mean (standard deviation)] cases per 100,000 enrollees.
Among patients with bipolar disorder in this cohort, between 6.3 and 7.4% were treated for diabetes each year. Among patients
with newly treated bipolar disorder, 61.8% received initial therapy with only mood stabilizers, 24.3% received only atypical
antipsychotics, and 13.9% received both. Mean all-cause cost for patients with bipolar disorder was US$2,690 in the 6 months
before the first bipolar-related claim, and US$6,826 in the following year. Of the latter cost, bipolar-related cost was US$1,272.
Patients with comorbid diabetes had much higher all-cause cost (US$11,317) than those without diabetes in the year following
the first bipolar-related claim, but only slightly higher bipolar-related cost (US$1,349). Among newly treated bipolar disorder
patients, all-cause and bipolar-related cost in the year after diagnosis was lowest in patients receiving only mood stabilizers.
Ordinary least squares regression analysis found that treatment with mood stabilizers only was associated with 41% lower bipolar-related
cost than treatment with atypical antipsychotics only (P < .001). Significant individual associations were also found between bipolar-related cost and bipolar disorder I diagnosis,
severe bipolar disorder and comorbid personality disorders (P < .001 for each) but not comorbid diabetes (P = .27).
Conclusions These results suggest that patients with bipolar disorder who receive only mood stabilizer therapy incur lower bipolar-related
and all-cause cost than those receiving only atypical antipsychotics. In contrast to that for all-cause cost, comorbid diabetes
had little impact on direct costs related to treating bipolar disorder itself. 相似文献
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Recent evidence suggests that the prevalence of bipolar disorder is as much as fivefold higher than previously believed, and may amount to nearly 5% of the population, making it almost as common as unipolar major depression. It is, therefore, not unrealistic to assume that primary care or family physicians will frequently encounter bipolar patients in their practice. Such patients may present with a depressive episode, for a variety of medical reasons, for longer-term maintenance after stabilization, and even with an acute manic episode. Whatever the reason, a working knowledge of current trends in the acute and longer-term management of bipolar disorder would be helpful to the primary care physician. In addition, an understanding of important side-effects and drug interactions that occur with drugs used to treat bipolar disorder, which may be encountered in the medical setting, are paramount. This paper will attempt to review existing and emerging therapies in bipolar disorder, as well as their common drug interactions and side-effects. 相似文献
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Tamara Pringsheim Lauren Hirsch David Gardner Daniel A Gorman 《Revue canadienne de psychiatrie》2015,60(2):52-61