Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features: A Review of Clinical and Cost-Effectiveness and Guidelines

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Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features: A Review of Clinical and Cost-Effectiveness and Guidelines

Book. 2016 09 06

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Abstract
Bipolar disorder is a mental condition characterized by episodic mood swings between euphoric or irritable mania and hopeless depression which can affect social activities, functioning, and relationships. Episodes are typically followed by symptom-free periods referred to as euthymia. According to a survey conducted in 2002, one percent (1%) of Canadians 15 years and older demonstrated symptoms satisfying the criteria for bipolar disorder in the previous 12 months. Multiple types of bipolar disorders exist such as bipolar I, bipolar II and are defined in the Diagnostic and Statistical Manual (5(th) edition; DSM-V) from the American Psychiatric Association. Symptoms associated with mania can include increased creativity and productivity; however, mania can also lead to immediate hospitalization or involuntary committal under the Mental Health Act. Symptoms associated with depression can lead to increased rates of suicide and suicide ideation. Bipolar disorder with psychotic features refers to manic or depressive episodes including psychotic symptoms such as delusions or hallucinations. Psychotic features manifest in over 50% of manic episodes and are more common in the latter than in depressive episodes. Pharmacological treatment usually depends on the type of bipolar disorder (manic or depressive); however, the most common treatments include lithium and valproic acid. Antipsychotic medications are also used to treat bipolar disorder and can be classified as typical (first generation) or atypical (second generation). First generation antipsychotics mitigate bipolar disorder symptoms by antagonizing dopamine D2 receptors, while second generation antipsychotics have an affinity for serotonin 5-hydroxytryptamine receptors and adrenergic receptors in addition to being D2 receptor antagonists. Atypical antipsychotics, such as aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone can be prescribed as monotherapy or in combination with mood stabilizers and antidepressants, as well as other treatment options. Although combinations of atypical antipsychotics have been used for the treatment of other disorders, such as schizophrenia, the effectiveness of combination therapy in bipolar disorder is unclear. This Rapid Response report aims to review the clinical and cost-effectiveness of combination atypical antipsychotics in adolescents or adults with bipolar disorder with psychotic features. Guidelines associated with the use of combination atypical antipsychotics in adolescents or adults with bipolar disorder with psychotic features will also be examined.


PMID: 27831672