Pharmacotherapy in bipolar disorders during hospitalization and at discharge predicts clinical and psychosocial functioning at follow‐up

Abstract

Having been prescribed anxiolytics and atypical antipsychotics during hospitalization predicted reduced psychosocial functioning, whereas prescription of lithium at discharge was associated with better psychosocial functioning at follow-up. Future studies are needed in order to investigate how psychosocial functioning may be related in the long-term to pharmacological treatment in patients after discharge.

A population‐based study of the comparative effectiveness of second‐generation antipsychotics vs older antimanic agents in bipolar disorder

“…Although hospitalization rate provides only a coarse marker of clinical outcome, it is highly relevant in terms not only of healthcare costs and service planning, but also of disruption of the life of an individual and their significant others; in fact, over one in four individuals in this population were hospitalized over one year of follow‐up (Table ). It is possible that measuring other, more fine‐grained measures, such as clinical and functional status, would tell a different story, although the only study to do so also found better outcome in those treated with lithium …”

“…It is possible that measuring other, more fine-grained measures, such as clinical and functional status, would tell a different story, although the only study to do so also found better outcome in those treated with lithium. 23 Combination therapy was associated with a higher probability of hospitalization but longer retention on treatment. While indices of severity and complexity did not differ substantively among monotherapy groups, except for the expectable differences in the rate of psychosis, the combination groups may have represented a more complex or severely ill population ( initiators may be more susceptible to intention bias than comparisons among monotherapies, and conclusions must be drawn carefully.…”

“…Among the few naturalistic studies of SGA effectiveness, a one‐year follow‐up study of 485 individuals with first‐episode mania from 2003 to 2010 found that a lower proportion were rehospitalized after beginning an SGA plus valproate (13.3%) compared to SGA plus lithium (23.1%) . In a telephone follow‐up study of 71 hospitalized individuals begun on lithium, SGAs, anticonvulsants, antidepressants, and/or anxiolytics, at 5–75 months postdischarge, those begun on an SGA plus anticonvulsants had worse psychosocial function compared to those begun on lithium . Thus, few postmarketing comparative outcome data are yet available.…”

“…22 In a telephone follow-up study of 71 hospitalized individuals begun on lithium, SGAs, anticonvulsants, antidepressants, and/or anxiolytics, at 5-75 months postdischarge, those begun on an SGA plus anticonvulsants had worse psychosocial function compared to those begun on lithium. 23 Thus, few postmarketing comparative outcome data are yet available.…”

Disturbo Bipolare e trattamento con sali di Litio

“…Uno studio compiuto presso il nostro reparto su 85 pazienti affetti da disturbo bipolare e seguiti in media per 31 mesi, ha rilevato che i pazienti ai quali era prescritto il litio alle dimissioni presentavano un migliore funzionamento psicosociale al follow-up rispetto a pazienti assegnati ad altre terapie come antipsicotici atipici e anticonvulsivanti. Questo dimostra che la terapia con litio restituisce una buona qualità di vita, favorendo attività psicosociali importanti per la quotidianità dei pazienti [24].…”