Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry

Fountoulakis, Konstantinos Ν.; Kasper, Siegfried; Andreassen, Ole A.; Blier, Pierre; Okasha, Ahmed; Severus, Emanuel; Versiani, Márcio; Tandon, Rajiv; Möller, Hans‐Jürgen; Vieta, Eduard

doi:10.1007/s00406-012-0323-x

Cited by 115 publications

(65 citation statements)

References 553 publications

(500 reference statements)

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“…Lithium is regarded as the first-line treatment in bipolar disorder, but several studies suggest some negative impact of this drug on sexual function, as it may reduce sexual desire, worsen erectile function and decrease sexual satisfaction 127,128 . Approximately one-third of patients receiving lithium experience sexual dysfunction, which usually involves more than a single domain, in both male and female patients 119 .…”

Section: Influence Of Treatment Of Bipolar Disorder On Sexualitymentioning

confidence: 99%

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The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

2018

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Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.

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Section: Influence Of Treatment Of Bipolar Disorder On Sexualitymentioning

confidence: 99%

“…Oxcarbazepine is not usually associated with changes in hormonal levels and sexual dysfunction 127 , but there are occasional reports of anorgasmia and retrograde ejaculation 144,145 . Lamotrigine is not associated with sexual adverse effects in patients with bipolar disorder 146,147 .…”

Section: Influence Of Treatment Of Bipolar Disorder On Sexualitymentioning

confidence: 99%

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

2018

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“…There are a number of effective maintenance treatments for bipolar disorder (4,5). Inadequate treatment results in increased rates of relapse, whereas multiple episodes may create utter vulnerability to subsequent episodes and reduce the response to therapy (6), impact patients' psychosocial functioning (7,8), and increase morbidity and mortality (9).…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study

Popović

Torrent

Goikolea

et al. 2013

Acta Psychiatr Scand

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Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study.Objective: Predominant polarity (PP) is an important variable in maintenance treatment of bipolar disorder (BD). This study aimed at determining the role of polarity index (PI), a metric indicating antimanic versus antidepressive prophylactic potential of drugs, in clinical decision-making. Method: Two hundred and fifty-seven of 604 (43%) of patients with BD-I or II fulfilled criteria for manic (MPP) or depressive PP (DPP). The PI, representing the ratio of number needed to treat (NNT) for depression prevention to NNT for mania prevention, was calculated for patients' current treatment. MPP and DPP groups were compared regarding sociodemographic, clinical and therapeutic characteristics. Results: One hundred and forty-three patients (55.6%) fulfilled criteria for DPP and 114 (44.4%) for MPP. Total PI, Antipsychotics' PI, and mood stabilizers PI were higher, indicating a stronger antimanic action, in MPP. MPP presented higher prevalence of BD-I, male gender, younger age, age at onset and at first hospitalization, more hospitalizations, primary substance misuse, and psychotic symptoms. DP correlated with BD-II, depressive onset, primary life events, melancholia, and suicide attempts. Conclusion:The results confirm the usefulness of the PI. In this large sample, clinical differences among these groups justify differential treatment approach. The PI appears to be a useful operationalization of what clinicians do for maintenance therapy in BD.

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“…Such general information is not in the scope of this review. General guidelines for the pharmacological treatment of bipolar disorder are available [181][182][183].…”

Section: Long-term Treatment Of Violent Behavior In Bipolarmentioning

confidence: 99%

Aggression in Psychoses

Volavka

2014

Advances in Psychiatry

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Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.

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Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry

Cited by 115 publications

References 553 publications

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study

Aggression in Psychoses

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