1,355,075 research outputs found
Practical guidance for prescribing with aripiprazole in bipolar disorder
No full textBackground: Aripiprazole differs from other atypical antipsychotics in its pharmacological and clinical profile. Scope: As aripiprazole has been available in the USA for bipolar mania since 2004, clinical experience-sharing from clinical and research use of this agent can assist with initiation and administration in practice. The clinical experience-guided recommendations provided herein are based on clinical practice of the author (intended as clinical opinions and general suggestions of the author and/or hypotheses to be scientifically tested) and a review of the literature (based on a PubMed search and limited to double-blind, randomised, controlled clinical trials) to provide the most current aripiprazole studies in bipolar mania. This article is designed to share the experience gained over time by the author on the prescribing of aripiprazole, how best to approach initiation of and switching to aripiprazole, and how and when to use adjunctive medications. Findings: In the treatment of a manic episode, aripiprazole may be initiated at 15 mg/day and adjusted as required (down to 5-10 mg/day or up to 30 mg/day). When switching to aripiprazole, it is frequently advisable to maintain the therapeutic dose of current medication, add aripiprazole 5, 10 or 15 mg/day, and adjust between 10 and 30 mg/day depending on response and tolerability. Only once an effective aripiprazole dose is reached can the prior medication be gradually discontinued. A tolerability profile different from other atypical antipsychotics should be expected. Side-effects, if they occur, are usually manageable and frequently resolve soon after initiation. Conclusions: Practical guidance for prescribing aripiprazole in bipolar mania is provided to assist clinicians using aripiprazole for the treatment of bipolar mania in real-world practice; for example, with dose selection, for the switching strategies and for the management of side-effects. © 2008 Informa UK Ltd
Advanced Psychopharmacology: practical strategies for rational polypharmacy in mood disorders
No full textAripiprazole in bipolar disorder: clinical strategies to maximize efficacy and tolerability
No full textA number of double-blind, randomized, controlled trials have confirmed the clinical efficacy of aripiprazole in
bipolar disorder and schizophrenia. Aripiprazole is the prototype of the ‘third generation’ atypical antipsychotics, or dopamine-serotonin- stabilizers and is characterized by a relatively low risk of inducing metabolic
adverse effects, causing sedation and other side effects such as hyperprolactinemia. As a partial agonist at dopamine D2 receptors, aripiprazole acts as a functional antagonist in the mesolimbic dopamine pathway, where excessive dopamine activity is thought to cause positive symptoms, but acts as a functional agonist activity in the mesocortical pathway, where reduced dopamine activity is thought to be associated with negative symptoms and cognitive impairment. This presentation will review the available research data on the efficacy of aripiprazole in bipolar disorder and discuss how this data translate in the real world clinical practice and what the best strategies are to maximize the efficacy and tolerability of this medication
Medical monitoring in patients with bipolar disorder: a review of data
No full textPatients with bipolar disorder have been found to have high rates of endocrine and cardiovascular disorders as well as obesity. Some health problems may be influenced by the psychiatric disorder itself, and, similarly, health problems may influence the course of bipolar disorder. Further, some pharmacologic treatments used for bipolar disorder have been associated with obesity, diabetes, hyperglycemia, dyslipidemia, metabolic syndrome, prolonged QTc, and thyroid dysfunction. To optimize care and achieve the best possible treatment outcomes, integrated psychiatric and medical care is needed
Appropriate treatments for agitation associated with schizophrenia: Control of acute agitation and maintenance of efficacy
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Exploring treatment strategies for mood stabilization in patients with major depressive disorder and mixed features
No full textWe discuss strategies for mood stabilization in patients with major depressive disorder (MDD) and mixed features, challenging traditional paradigms and calling for a reevaluation of current diagnostic classifications. The DSM-5 "mixed features specifier" applies to several mood disorders, including MDD. In patients with MDD, this specifier blurs the traditional distinctions between depression and mania by introducing criteria that include symptoms such as elevated, expansive mood, inflated self-esteem, increased talkativeness, flight of ideas, increased energy, involvement in activities with potentially painful consequences, and decreased need for sleep. According to the DSM, when 3 of the above 7 symptoms are present during a major depressive episode, the episode may be characterized by the specifier "with mixed features". Despite the relatively high prevalence of mixed features in patients with MDD, no specific pharmacological treatments have been approved for these cases. We propose a treatment approach that includes: 1) initiating treatment with an antimanic agent (e.g., a mood stabilizer or a new-generation antipsychotic); 2) considering adjunctive low-dose serotonergic antidepressants; and then 3) considering discontinuation of the antimanic agent once the acute episode has resolved. We emphasize the lack of adequate studies of maintenance treatment with mood stabilizers and antipsychotics in patients with MDD and mixed features and the need for further research to improve our mood stabilization strategies for these patients
The effects of undertreated chronic medical illnesses in patients with severe mental disorders
No full textSevere mental disorders such as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. These comorbidities are associated with a more severe course of mental illness, reduced quality of life, and premature mortality. Although the association between mental disorders and physical health complications has long been recognized, medical conditions remain undertreated in clinical psychiatric practice, and the life expectancy for individuals with serious psychiatric disorders is approximately 30% shorter than that of the general US population. Factors that are related to the mental illness (eg, cognitive impairment, reduced ability to function, and a lack of communication skills) as well as factors such as the high cost of medical care may make accessing general health care a difficult task for patients. Even when medical care is received by patients, the quality is often poor, and dangerous illnesses may be undiagnosed and untreated. In addition, harmful side effects of medications used to treat psychiatric disorders, unhealthy habits and lifestyles, and a possible genetic susceptibility to medical conditions increase the likelihood of comorbid physical conditions in patients with severe mental illness. Implementing behavioral interventions into clinical practice may help patients improve their overall health and prevent chronic medical conditions
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