Betül UYAR, Abdullah ATLI, Derya GÜL BİLEN

Bipolar bozukluk tip I hastalarının tedavisinde uzun etkili antipsikotiklerin klinik kullanımı

Amaç: Bu çalışmada, Dicle Üniversitesi Tıp Fakültesi Psikiyatri polikliniğine başvuran Bipolar Bozukluk Tip 1 hastalarının uzun etkili enjektabl antipsikotik kullanım sıklığı ve hastaların klinik özellikleri ile klinisyenlerin bu ilaca yönelik tercihlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamız, 18 yaş üstü, 111 bipolar bozukluk tanısı almış hastanın katılımı ile gerçekleştirildi. Hasta verileri elektronik veri kayıtlarından retrospektif olarak elde edildi. Veriler araştırmacılar tarafından literatür destekli olarak hazırlanmış veri kayıt formuna kaydedildi.. Bulgular: İkinci kuşak uzun etkili enjektabl antipsikotik kullanan hastaların oranı %58,3 olup en çok tercih edilen paliperidon palmitat idi ve hastaların %21,6'sı uzun etkili enjektabl antipsikotik kullanıyordu. Uzun etkili enjektabl antipsikotik kullanan hastalarda çalışamama oranı ve hastanede kalış anlamlı olarak daha yüksekti. Sonuç: Bulgularımız uzun etkili enjektabl antipsikotiklerin, Bipolar Bozuklukların ileri evrelerinde, ilaç uyumu ve işlevselliği kötü olan ve poliklinikte klinisyenler tarafından daha fazla yatış endikasyonu olan hastalarda tercih edildiğini göstermiştir. Uzun etkili enjektabl antipsikotiklerin bipolar bozukluğun erken evrelerinde, hatta ilk atakta başlanması, tedaviye uyumu artırabilir, hastaneye yatış sayısını azaltabilir ve hastaların işlevselliğine katkıda bulunabilir.

Clinical use of long-acting antipsychotics for the treatment of bipolar disorder type I patients

Purpose: This study aims to determine the usage frequency of long-acting injectable antipsychotics among bipolar disorder type 1 patients who presented to the Dicle University Faculty of Medicine Psychiatry and Mental Health outpatient clinic, the clinical characteristics of these patients, and the preferences of clinicians about these agents. Materials and Methods: Our study included 111 patients older than 18 years old with bipolar disorder.The ’data of the patients were retrospectively obtained from electronic data records. The data were recorded in the data collection form prepared by the researchers with the support of the literature. Results: The rate of the patients who used long-acting injectable antipsychotics was 21.6%. Among the patients who used long-acting injectable antipsychotics, the rate of those who used second-generation long-acting injectable antipsychotics was 58.3%, and the most frequently preferred agent was paliperidone palmitate. The patients who were using long-acting injectable antipsychotics had significantly higher rates of not working and numbers of hospitalizations. Conclusion: Our results showed that long-acting injectable antipsychotics are preferred by clinicians in our outpatient clinic in the later stages of bipolar disorders and for patients with poor drug compliance, poor functionality, and more hospitalizations. Starting long-acting injectable antipsychotics in the early stages of bipolar disorders, even following the first attack, may increase treatment compliance, reduce the duration of hospitalization, and contribute to the functionality of patients.

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1. Greene M, Yan T, Chang E, Hartry A, Touya M, Broder MS. Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder. J Med Economics. 2018;21:127–34.
2. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20:97–170.
3. Miasso AI, Monteschi M, Giacchero KG. Bipolar affective disorder: medication adherence and satisfaction with treatment and guidance by the health team in a mental health service. Rev Lat Am Enfermagem. 2009;17:548–56.
4. Crowe M, Wilson L, Inder M. Patients’ reports of the factors influencing medication adherence in bipolar disorder - an integrative review of the literature. Int J Nurs Stud. 2011;48:894–903.
5. Riley W, Velligan D, Sajatovic M, Valenstein M, Safren S, LewisFernandez R et al. Adherence to psychiatric treatments. CML-Psychiatry. 2009;20:89– 96.
6. Colom F. Achieving remission and recovery in bipolar disorder. J Clin Psychiatry. 2010;71:27532.
7. Garcia S, Martınez-Cengotitabengoa M, LopezZurbano S, Zorrilla I, Lopez P, Vieta E et al. Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review. J Clin Psychopharmacol. 2016;36:355–71.
8. Wu CS, Hsieh MH, Tang CH, Chang CJ. Comparative effectiveness of long-acting injectable risperidone vs. Long-acting injectable first-generation antipsychotics in bipolar disorder. J Affect Disord. 2016;197:189–95.
9. Llorca PM, Abbar M, Courtet P, Guillaume S, Lancrenon S, Samalin L. Guidelines for the use and management of long-acting injectable antipsychotics in serious mental illness. BMC Psychiatry. 2013;13:340.
10. Gigante AD, Lafer B, Yatham LN. Long-acting injectable antipsychotics for the maintenance treatment of bipolar disorder. CNS Drugs. 2012;26:403–20.
11. Prajapati AR, Wilson J, Song F, Maidment I. Secondgeneration antipsychotic long-acting injections in bipolar disorder: systematic review and meta-analysis. Bipolar Disord. 2018;20:687–96.
12. Quiroz JA, Yatham LN, Palumbo JM, Karcher K, Kushner S, Kusumakar V. Risperidone long-acting injectable monotherapy in the maintenance treatment of bipolar I disorder. Biol Psychiatry. 2010;68:156–62.
13. Macfadden W, Alphs L, Haskins JT, Turner N, Turkoz I, Bossie C et al. A randomized, double-blind, placebo-controlled study of maintenance treatment with adjunctive risperidone long-acting therapy in patients with bipolar I disorder who relapse frequently. Bipolar Disord. 2009;11:827–39.
14. Vieta E, Montgomery S, Sulaiman AH, Cordoba R, Huberlant B, Martinez L et al. A randomized, doubleblind, placebo-controlled trial to assess prevention of mood episodes with risperidone long-acting injectable in patients with bipolar I disorder. Eur Neuropsychopharmacol. 2012;22:825–35.
15. Calabrese JR, Sanchez R, Jin N, Amatniek J, Cox K, Johnson B et al. Efficacy and safety of aripiprazole once-monthly in the maintenance treatment of bipolar I disorder: a double-blind, placebo-controlled, 52- week randomized withdrawal study. J Clin Psychiatry. 2017;78:324–31.
16. Calabrese JR, Sanchez R, Jin N, et al. Symptoms and functioning with aripiprazole once-monthly injection as maintenance treatment for bipolar I disorder. J Affect Disord. 2018;227:649–56.
17. Keramatian K, Chakrabarty T, Yatham LN. Longacting injectable Second-Generation/Atypical antipsychotics for the management of bipolar disorder: a systematic review. CNS Drugs. 2019;33:431–56.
18. Chou YH, Chu PC, Wu SW, Lee JC, Lee YH, Sun IW, et al. A systemic review and experts’ consensus for long-acting injectable antipsychot. Clin Psychopharmacol Neurosci. 2015;13:121–8.
19. Nikoli´c N, Page N, Akram A, Khan M. The impact of paliperidone palmitate long-acting injection on hospital admissions in a mental health setting. Int. Clin. Psychopharmacol. 2017;32:95–102.
20. Buoli M, Ciappolino V, Altamura AC. Paliperidone palmitate depot in the long-term treatment of psychotic bipolar disorder: A case series. J Clin Neuropharmacol. 2015;38:209–11.
21. Caliskan AM, Calisir S, Caliskan S, Arslan M, Inanli I, Eren I. Impact of initiating long-acting injectable paliperidone palmitate on relapse and hospitalization in patients with bipolar I disorder: A mirror image retrospective study. Asian J Psychiatry. 2020;54:102457.
22. Pinto JV, Saraf G, Vigo D, Keramatian K, Chakrabarty T, Yatham LN. Cariprazine in the treatment of Bipolar Disorder: A systematic review and meta-analysis. Bipolar Disord. 2020;22:360–71.
23. Chakrabarty T, Keramatian K, Yatham LN. Treatment of mixed features in bipolar disorder: an updated view. Curr Psychiatry Rep. 2020;22:1–13.
24. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, Am Psychiatric Publishing. 2013.
25. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.
26. Bahar G, Savaş HA, Ünal A, Savaş E, Kaya H, Bahar A. Morisky tedavi uyum ölçeğinin iki uçlu duygudurum bozukluğu için geçerlilik ve güvenilirlik çalışması. Anadolu Psikiyatri Derg.. 2014;15:141–9.
27. Walburrn J, Gray R, Gournay K, Quraishi S, David AS. Systematic review of patient and nurse attitudes to depot antipsychotic medication. Br J Psychiatry. 2001;179:300–7.
28. Boyce P, Irwin L, Morris G, Hamilton A, Mulder R, Malhi GS et al. Long-acting injectable antipsychotics as maintenance treatments for bipolar disorder: a critical review of the evidence. Bipolar Disord. 2018;20:25–36.
29. Munday J, Greene M, Chang E, Hartry A, Yan T, Broder MS. Early initiation of long-acting injectable antipsychotic treatment is associated with lower hospitalization rates and healthcare costs in patients with schizophrenia: real-world evidence from US claims data. Curr Med Res Opin. 2019;35:1231–39.
30. Tohen M, Goldberg JF, Hassoun Y, Sureddi S. Identifying profiles of patients with bipolar i disorder who would benefit from maintenance therapy with a long-acting injectable antipsychotic. J Clin Psychiatry. 2020;81:8462.
31. Inanç L, Ozdemir AD, Güleç H, Semiz ÜB. Efficacy and tolerability of depot antipsychotic use in patients with schizophrenia and bipolar disorder. Cukurova Med J. 2018;43:38–43.
32. Pilon D, Tandon N, Lafeuille MH, Kamstra R, Emond B, Lefebvre P et al. Treatment patterns, health care resource utilization, and spending in Medicaid beneficiaries initiating second-generation long-acting injectable agents versus oral atypical antipsychotics. Clin Ther. 2017;39:1972-85.