Atypical antipsychotics in bipolar disorders

Atypical Antipsychotics In Bipolar Disorder Seminar Dr Ramkumar G S 10/3/2010 Chair person Dr Jagadisha

2 Asenapine 2 Ziprasidone 2 6 Aripirazole 2 5 11 40 Total 2 2 3 8 Quetiapine 1 2 9 Risperidone 6 13 Olanzapine Rapid cycling maintenance depression Mania

Overview of seminar ,[object Object],[object Object],[object Object],[object Object],[object Object]

Olanzapine- Mania QOL, working status haloperidol olan 234 +mixed, 6wks CBZ Olan+ CBZ 58 +mixed, 6wks olnz> plac in HDRS score Dival+Placebo Olan + dival 100 No difference in effect. RSPN Olanz 165 3wks, paediatric placebo Olanz 107 4wks lithium olan features control study n Maintenance, time to ist mood episode placebo Olanz 225 placebo olanz 55 RCT+open label ext.Qol placebo Olan placebo olan 70 Val & olan >placebo at 3ks: olan> val ar 12wks Olan vs dival vs placebo ~200 Response, remission val Olan 125 +mixed,response Placbo+ ms Olan+ MS 3wks val olan 63 47wks,Relapse rate was same dival olan Maintrnance,Clinical improv, QOL, Olanz alone Olanz+ MS 224 decreased disphoria,suicidality Val or Li olanz 85 12 months maintenance Lithium olanz CGI Lithium Olanz 69

Olanzapine- depression features control study n FLU VS PLACEBO VS Flu+ olenz ~370 LOW SWITCH FOR OLANZ FLU VS OLANZ VS (FLU+OLAN) 32 8WKS SAME effect, SIDE EFFECT NOT MORE FOR OLAN + FLUX OLAN VS placebo vs OLAN+ FLUOX ~370 OPEN LAB  RAND SHIFTING TO OLANZ ALONE CAUSED WORSENING OLANZ Fluo+ OLAN cgi lamotrigine Olan+ lamotrig 205 CGI, 6 month lamotrigine Olan +fluoxetine

Systematic review and meta analysis

Olanzapine alone or in combination for acute mania Rendell JM, Gijsman HJ, Keck PK, Goodwin G, Geddes J 2003 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Olanzapine in long-term treatment for bipolar disorder Cipriani A, Rendell JM, Geddes J; 2003 ,[object Object],[object Object],[object Object],[object Object]

Rendell JM, Gijsman HJ, Bauer MS, Goodwin G, Geddes J. Risperidone alone or in combination for acute mania. 2006 ,[object Object],[object Object],[object Object],[object Object]

Rendell JM, Geddes J. Risperidone in long-term treatment for bipolar disorder. 2006 ,[object Object],[object Object]

Atypical antipsychotics in the treatment of mania: a meta-analysis of randomized, placebo-controlled trials. Perlis et al 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Acute bipolar mania: a systematic review and meta-analysis of co-therapy vs. monotherapy. Smith et al 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Second-generation antipsychotic agents in the treatment of acute mania: a systematic review and meta-analysis of randomized controlled trials. Sherk et al 2007. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Atypical antipsychotics in bipolar disorder: systematic review of randomised trials.Derry S, Moore R A . 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: a systematic review. Gao K et al 2008 . ,[object Object],[object Object],[object Object],[object Object],[object Object]

A review of sensitivity and tolerability of antipsychotics in patients with bipolar disorder or schizophrenia: focus on somnolence. Gao et al 2008 ,[object Object],[object Object]

FDA approval ,[object Object],[object Object],[object Object]

Spectrum of Efficacy in Mania , Depression , anxiety

Psychopharmachological principles Stahl’s essential psychopharma 3rd edi. ,[object Object],[object Object],[object Object]

Mood stabilizing ,[object Object],[object Object],[object Object]

Atypical antipsychotics: not just for psychotic mania ,[object Object]

Putative pharmacological mechanism of atypical antipsychotics in mania and bipolar depression ,[object Object],[object Object]

Possible mechanisms ,[object Object],[object Object]

Other mechanisms in bipolar depression ,[object Object],[object Object],[object Object]

A RCT of maintenance treatment with adjunctive Risperidone long-acting therapy in patients with bipolar I disorder who relapse frequently. Macfadden et al Bipolar Disord 2009: 11: 827–839 ,[object Object],[object Object],[object Object]

Macfadden et al Bipolar Disord 2009: 11: 827–839 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicating mood with maintenance in mind: bipolar depression pharmacotherapy. Malhi et al Bipolar Disord 2009: 11 (Suppl. 2): 55–76 ,[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Atypical antipsychotics in bipolar disorders

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