Recovery and functional outcomes following olanzapine treatment for bipolar I mania
ABSTRACT Typical experimental categorizations of treatment responses in bipolar disorder (BPD) patients may have limited relationship to clinical recovery or functional status, and there is inadequate research on such clinically important outcomes.
We analyzed data from a study of open continuation of olanzapine treatment following a 3-week placebo-controlled trial involving initially hospitalized adult subjects with DSM-IV BP-I mania to estimate rates and times to symptomatic remission (low scores on standardized symptomatic assessments) and clinical recovery (remission sustained>or=8 weeks), associated clinical factors, and functional outcomes.
During treatment with olanzapine for 27.9+/-20.1 weeks, symptomatic remission was attained by 70% of subjects, half by 8 weeks (95% CI 6-10) weeks, and later lost by 82% of remitted subjects; remitted (versus non-remitted) subjects had slightly lower baseline clinical global impression scores and greater trial-completion. Sustained clinical recovery was attained by only 40 of 113 (35%) of subjects, half by 36 (95% CI 20-40) weeks, and later lost by 45%. Subjects with above-median (>12) initial Hamilton-Depression rating scale depression scores were half as likely to recover (p=0.016) and did so much later (36 versus 12 weeks) than those with lower scores. At final assessment, self-rated well being (SF-36 psychosocial functioning scores) improved substantially more among recovered versus non-recovered subjects (mean changes: 87% versus 23%), and two-thirds of recovered subjects remained unemployed-for-pay while half received disability-compensation.
Clinically meaningful symptomatic remission and recovery in relatively severely ill adult bipolar I manic patients were achieved slowly and sustained by only some patients within an average of 7 months of continuous treatment. These clinically relevant outcomes were worse with relatively high initial dysphoria ratings. Well-being was rated higher by recovered subjects, but their ability to work and live independently were markedly impaired. These findings underscore the emerging view that BPD can often be severe, slow to remit, and disabling, particularly in association with prominent depression-dysphoria symptoms. Improved treatments for BPD are needed, guided by longitudinal assessments of clinically meaningful measures of symptomatic recovery and functional outcome.
- SourceAvailable from: Lee Mulligan
[Show abstract] [Hide abstract]
- "Although clinically helpful such reports define recovery in terms of symptom reduction and avoidance of relapse thus they miss the more idiosyncratic personal recovery experiences that are often most important to service users. They also do not incorporate research which indicates that trajectories of symptomatic and functional improvement are often different (Chengappa et al., 2005; Martinez-Aran et al., 2007) and that some individuals with significant residual symptoms can achieve high levels of functioning (Murray and Michalak, 2007). Furthermore, such approaches do not offer researchers or clinicians a time efficient tool to assess recovery in relation to new treatments or routine clinical practice. "
ABSTRACT: BACKGROUND: The importance of personal recovery in mental health is increasing widely recognised. However, there is no measure available to assess recovery experiences in individuals with a diagnosis of bipolar disorder. This paper reports on the development of the Bipolar Recovery Questionnaire (BRQ) to aid recovery informed developments in research and clinical practice. METHODS: A draft 45 item BRQ was developed based on prior literature review and qualitative research. In the current study a panel of clinicians, academics and consumers rated draft items on recovery relevance and comprehensibility leading to the 36 item questionnaire subjected to psychometric evaluation. 60 participants with bipolar disorder completed BRQ along with measures of mood, quality of life, functioning and personal growth. RESULTS: BRQ was internally consistent and reliable over a month long test-retest period. BRQ scores were significantly associated with lower depression and mania scores and with higher wellbeing. BRQ was also significantly associated with better functioning, better mental health quality of life and personal growth. Regression analysis indicated that depression, wellbeing and personal growth were all uniquely associated with BRQ. LIMITATIONS: Sample size did not permit exploration of the factor structure of BRQ. The sample is drawn from the North West of England thus it is not clear how these findings might generalise beyond this group. CONCLUSIONS: BRQ is designed to assess personal experiences of recovery in bipolar disorder. The present study indicates that it is reliable and valid, being associated with both symptomatic and functional outcomes consistent with established definitions of recovery.Journal of Affective Disorders 11/2012; DOI:10.1016/j.jad.2012.10.003 · 3.38 Impact Factor
[Show abstract] [Hide abstract]
- "For example, one longitudinal study has shown that 37% of patients taking mood stabilizing medications will relapse back into an episode of depression or mania within one year, 60% in two years, and 73% in five or more years . Further, psychosocial functioning and quality of life (QoL) can remain compromised between mood episodes [11-13]. "
ABSTRACT: The Collaborative RESearch team to study psychosocial factors in bipolar disorder (CREST.BD) is a multidisciplinary, cross-sectoral network dedicated to both fundamental research and knowledge exchange on bipolar disorder (BD). The core mission of the network is to advance the science and understanding of psychological and social issues associated with BD, improve the care and wellness of people living with BD, and strengthen services and supports for these individuals. CREST.BD bridges traditional and newer research approaches, particularly embracing community-based participatory research (CBPR) methods. Membership of CREST is broad, including academic researchers, people with BD, their family members and supports, and a variety of health care providers. Here, we describe the origins, evolution, approach to planning and evaluation and future vision for our network within the landscape of CBPR and integrated knowledge translation (KT), and explore the keys and challenges to success we have encountered working within this framework.International Journal of Mental Health Systems 09/2012; 6(1):16. DOI:10.1186/1752-4458-6-16 · 1.06 Impact Factor
[Show abstract] [Hide abstract]
- "The clinical relevance of some efficacy outcomes has also been challenged. For instance, re-analysis of an open-label extension of a randomised trial suggested a better outcome of sustained clinical recovery, where remission was sustained for at least eight weeks, rather than just occurring for any duration . This outcome was not reported in any trial included in the review, and if used would give a much lower, but perhaps more realistic, impression of efficacy. "
ABSTRACT: Atypical antipsychotics are increasingly used for treatment of mental illnesses like schizophrenia and bipolar disorder, and considered to have fewer extrapyramidal effects than older antipsychotics. We examined efficacy in randomised trials of bipolar disorder where the presenting episode was either depression, or manic/mixed, comparing atypical antipsychotic with placebo or active comparator, examined withdrawals for any cause, or due to lack of efficacy or adverse events, and combined all phases for adverse event analysis. Studies were found through systematic search (PubMed, EMBASE, Cochrane Library), and data combined for analysis where there was clinical homogeneity, with a special reference to trial duration. In five trials (2,206 patients) participants presented with a depressive episode, and in 25 trials (6,174 patients) the presenting episode was manic or mixed. In 8-week studies presenting with depression, quetiapine and olanzapine produced significantly better rates of response and symptomatic remission than placebo, with NNTs of 5-6, but more adverse event withdrawals (NNH 12). With mania or mixed presentation atypical antipsychotics produced significantly better rates of response and symptomatic remission than placebo, with NNTs of about 5 up to six weeks, and 4 at 6-12 weeks, but more adverse event withdrawals (NNH of about 22) in studies of 6-12 weeks. In comparisons with established treatments, atypical antipsychotics had similar efficacy, but significantly fewer adverse event withdrawals (NNT to prevent one withdrawal about 10). In maintenance trials atypical antipsychotics had significantly fewer relapses to depression or mania than placebo or active comparator. In placebo-controlled trials, atypical antipsychotics were associated with higher rates of weight gain of >or=7% (mainly olanzapine trials), somnolence, and extrapyramidal symptoms. In active controlled trials, atypical antipsychotics were associated with lower rates of extrapyramidal symptoms, but higher rates of weight gain and somnolence. Atypical antipsychotics are effective in treating both phases of bipolar disorder compared with placebo, and as effective as established drug therapies. Atypical antipsychotics produce fewer extrapyramidal symptoms, but weight gain is more common (with olanzapine). There is insufficient data confidently to distinguish between different atypical antipsychotics.BMC Psychiatry 08/2007; 7(1):40. DOI:10.1186/1471-244X-7-40 · 2.21 Impact Factor