Subjective response to antipsychotics in bipolar disorders: A review of a neglected area

Abstract

Background: The term “subjective response to antipsychotic” (SRA) refers to changes in the subjective state experienced due to antipsychotic (AP) exposition that is independent of the therapeutic or physical side effects of these drugs. This dimension of analysis has been extensively explored in schizophrenic disorders, finding that negative SRA is an early and independent predictor of compliance as well as a successful pathway to construct current theoretical frameworks of these disorders. There is an increasing use of AP in bipolar disorders’ treatment (BD) but no reviews on the topic have been published to date in this population. The aim of this work is to review published data of SRA in BD patients and to discuss their clinical and theoretical implications. Methods: An extensive search in online databases was performed. Reports were reviewed and included if they described SRA in BD or included instruments aimed to assess it. Reports of cognitive, sexual, motor autonomic side effects were excluded. Findings were summarized in a narrative fashion. Results: Nine reports fulfilled the inclusion criteria and were included in the revision, reporting data from 1282 BD patients. Among these, three were prospective studies and three explored relations between SRA and treatment compliance. Conclusions: There is an asymmetry between the increase in the use of antipsychotics in BD and the lack of data regarding the SRA. Phenomenologically, SRA in BD is similar to that found in schizophrenic subjects. Some of these symptoms may be misdiagnosed as depressive symptoms. The existing data show that SRA has a strong correlation with treatment compliance as well as a promising way to develop theoretical paradigms for these disorders.

Actualización en el uso y el manejo del litio en neuropsiquiatría

“…Una persona afectada por TB pasa tres veces más tiempo sufriendo síntomas anímicos subsindrómicos interepisódicos (especialmente depresivos) que experimentando episodios agudos (Judd et al, 2003). Sumado a esto, el tiempo que una persona sufre síntomas depresivos subsindrómicos se correlaciona estrechamente con la capacidad de que vuelva a tener una vida plena y funcional (Keck et al, 1998;Burdick et al, 2022), mientras que la intensidad de los episodios no (Strejilevich et al, 2013). Aun luego de controlados los episodios, las personas afectadas por TB continúan experimentando fluctuaciones anímicas subsindrómicas (Bonsall et al, 2012), las que se correlacionan estrechamente con el nivel de recuperación funcional (Strejilevich et al, 2013;Szmulewicz et al, 2019).…”

“…Sumado a esto, el tiempo que una persona sufre síntomas depresivos subsindrómicos se correlaciona estrechamente con la capacidad de que vuelva a tener una vida plena y funcional (Keck et al, 1998;Burdick et al, 2022), mientras que la intensidad de los episodios no (Strejilevich et al, 2013). Aun luego de controlados los episodios, las personas afectadas por TB continúan experimentando fluctuaciones anímicas subsindrómicas (Bonsall et al, 2012), las que se correlacionan estrechamente con el nivel de recuperación funcional (Strejilevich et al, 2013;Szmulewicz et al, 2019). Además, más del 40 % de las personas afectadas por TB presentan disfunciones cognitivas que persisten aún luego de controlados los episodios y los síntomas subsindrómicos de la enfermedad (Ehrlich et al, 2022).…”

“…Por el contrario, otros tratamientos muestran efectos adversos conductuales y emocionales clínicamente significativos (para una revisión ver Szmulewicz et al, 2016). Más específicamente, el tratamiento con antipsicóticos ha sido frecuentemente asociado a aplanamiento emocional y/o malestar subjetivo, factores que, al igual que en otras patologías, comprometen el cumplimiento terapéutico y la calidad de vida del paciente durante el tratamiento (Strejilevich et al, 2019).…”

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

“…No information was available about the patient perspective on taking atypical antipsychotics or other psychiatric drugs. Some patients feel uneasy about taking antipsychotics, for reasons including stigma, side effects such as weight gain, experiencing changes to the subjective state, and concerns about long-term use [48][49][50][51]. Financial considerations and the costs of psychiatric drugs were not considered.…”

Are all antidepressants the same? The consumer has a point

“…An alternative way to find the optimal AD for a given patient could be found in the users' opinions and experiences while receiving these drugs. Prior research has shown that inquiry about the subjective experiences of consumers is a valid way to predict adherence and other outcomes in both schizophrenia and mood disorders (for a revision see Strejilevich et al, 2019). On the other hand, exploring users' experiences and opinions is useful to highlight clinical or adverse effects not routinely evaluated.…”