Complex polypharmacy in bipolar disorder: Results from a real-world inpatient psychiatric unit

Aguglia, Andrea; Natale, Antimo; Fusar-Poli, Laura; Amerio, Andrea; Costanza, Alessandra; Fesce, Fabio; Gnecco, Giovanni Battista; Marino, Margherita; Placenti, Valeria; Serafini, Gianluca; Aguglia, Eugenio; Amore, Mario

doi:10.1016/j.psychres.2022.114927

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…In fact, the presence of different psychopathological and clinical dimensions as well as potential multiple comorbidities (i.e., medical, psychiatric, and substance use) may limit the effectiveness of monotherapy. [35] Second, patients with chronicity, treatment resistance, and comorbid conditions are often transferred to public mental hospitals for treatment. [36] Third, over the past 3 decades, the US FDA has approved multiple psychotropic drugs for bipolar disorder treatment, expanding the prescribing options for psychiatrists.…”

Section: Discussionmentioning

confidence: 99%

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan

Chiu,

Shih,

Lin

2024

Medicine

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Bipolar disorder is a complex mental illness. Pharmacological therapy, including antipsychotics and mood stabilizers, is the primary treatment approach for manic episode. The study aimed to analyze prescribing patterns over a 14-year period for patients with bipolar mania discharged from a psychiatric hospital in Taiwan. Patients with bipolar mania discharged from the study hospital between 2006 and 2019 (n = 2956) were included in the analysis. Prescribed drugs for the treatment of manic episode, included mood stabilizers (i.e., lithium, valproate, carbamazepine) and any antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs). Monotherapy, simple polypharmacy, and complex polypharmacy were also examined. Simple polypharmacy was defined as being prescribed 2 different bipolar drugs (lithium, valproate, carbamazepine, and any antipsychotics), while complex polypharmacy at least 3 bipolar drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The prescription rates of valproate, SGAs, and complex polypharmacy significantly increased over time, whereas the prescription rates of any mood stabilizers, FGAs, and simple polypharmacy significantly decreased. Prescription rates of lithium and monotherapy did not significantly change. The study highlights the shifts in prescribing practices for bipolar mania. SGAs were prescribed more while FGAs declined, likely due to SGAs’ favorable properties. Complex polypharmacy increased, reflecting the complexity of treating bipolar disorder. Long-term outcomes of these changes require further research.

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Section: Discussionmentioning

confidence: 99%

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan

Chiu,

Shih,

Lin

2024

Medicine

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“…Polypharmacy perspective is an important barrier and concern in mental diseases’ drug management. According to the literature, a great percentage of bipolar disorder and schizophrenia patients are under extensive polypharmacy by being prescribed more than five psychotropic medications especially in elder patients 23 and they frequently experienced side-effects owing to drug–drug interactions. In our study, it was observed that less participants of the PGx-guided arm (22.67%) were under psychiatric polypharmacy compared to the control arm (27.03%), and that patients in the PGx-guided arm consumed fewer antipsychotic medications.…”

Section: Discussionmentioning

confidence: 99%

Clinical implementation of preemptive pharmacogenomics in psychiatry

Skokou,

Karamperis,

Koufaki

et al. 2024

eBioMedicine

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“…In fact, the presence of personality disorders (in particular BPD) is associated with a worse prognosis in the case of BD as a result of the higher risk of lack of treatment response, higher frequency and longer duration of the episodes, and decline of overall functioning (Fan and Hassell, 2008; Latalova et al ., 2013; Post et al ., 2020). Moreover, the presence of psychiatric comorbidity in BD patients is a known prognostic factor for complex pharmacotherapies, with consequently higher risk of side effects (Aguglia et al ., 2022). However, it is important to underline how none of the included studies has as main objective the assessment of the efficacy of combined pharmacological and psychotherapeutic treatments, which instead represent the most frequent condition in real-life clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of comorbidity, a combination of pharmacotherapy with psychological treatment may be necessary (Fornaro et al ., 2016). It is also interesting to underline that psychiatric comorbidity was identified as a marker of complex polypharmacotherapy in BD patients, with consequently a higher risk of disability and adverse effects (Aguglia et al ., 2022).…”

Section: Introductionmentioning

confidence: 99%

Does the comorbidity of borderline personality disorder affect the response to treatment in bipolar patients?

Esposito

Barkin

Ceresa

et al. 2023

International Clinical Psychopharmacology

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Bipolar disorder (BD) is a highly prevalent condition whose response to pharmacological treatment is associated with a number of factors including psychiatric comorbidity. Borderline personality disorder (BPD) shares clinical symptoms and biological vulnerability with BD and the two conditions are frequently comorbid, thus representing a clinical challenge. The purpose of the present review is to summarize the data related to treatment response in bipolar patients with comorbid BPD. According to systematic review process, a literature search was performed on the PubMed, Embase, PsycInfo, Isi Web of Knowledge, Medscape, and Cochrane Library databases. Peer-reviewed articles until December 2022 were eligible for inclusion. Comorbidity with BPD seems to be associated with a more difficult clinical stabilization in bipolar patients, often requiring poly-therapy or a longer duration of hospitalization. However, three studies, assessing the effectiveness of mood stabilizers in bipolar patients, did not demonstrate a prominent influence of BPD comorbidity in achieving clinical response. The most frequently administered pharmacological treatments in the selected studies include mood stabilizers and atypical antipsychotics. The presence of comorbid BPD in bipolar patients may hamper treatment effectiveness. Future studies, comparing different treatments and with larger samples, are needed to confirm the results critically summarized in the present review.

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Complex polypharmacy in bipolar disorder: Results from a real-world inpatient psychiatric unit

Cited by 7 publications

References 31 publications

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan

Clinical implementation of preemptive pharmacogenomics in psychiatry

Does the comorbidity of borderline personality disorder affect the response to treatment in bipolar patients?

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