Drug treatment developments in schizophrenia and bipolar mania: Latest evidence and clinical usefulness
Division of Psychiatry, Haukeland University Hospital, and Section of Psychiatry, Department of Clinical Medicine, University of Bergen, Sandviksleitet 1, N-5035 Bergen, Norway.Therapeutic Advances in Chronic Disease 11/2012; 3(6):287-300. DOI: 10.1177/2040622312462275
Schizophrenia and bipolar disorder are often highly debilitating with chronic courses, and psychotropic drugs represent cornerstones in the treatment. The primary aim of the review was to summarize the latest evidence with regards to the efficacy and effectiveness of drug treatment of schizophrenia and the manic phases of bipolar disorder. Schizophrenia systematic reviews conclude that antipsychotic drugs are effective in treating overall symptoms of psychosis and in preventing relapse. Some of the newer agents, the second-generation antipsychotics (SGAs), have demonstrated superiority compared with the older first-generation drugs and other SGAs but side-effect differences among the drugs are of a greater magnitude than effect differences. The pragmatic randomized trials of effectiveness have shown a longer time until treatment discontinuation for olanzapine compared with other antipsychotics. Cohort studies have found superiority for the long-acting injection formulations compared with the oral formulations of the drugs, and lower total mortality risk in users of antipsychotics compared with non-users. In bipolar mania SGAs have shown superior antimanic efficacy compared with other mood-stabilizing drugs. In conclusion antipsychotics, in particular some of the SGAs, seem to be drugs of first choice for both schizophrenia and bipolar mania. This perspective review focused on mean effects but the group means may not always be particularly useful as schizophrenia and bipolar mania are biologically heterogeneous disorders with large inter-individual variations in drug response and tolerance. In patients with a prior drug history the different pharmacological and clinical profiles may be exploited in subsequent choices of drugs.
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ABSTRACT: IntroductionMultiple reforms in Sweden appreciably enhanced prescribing efficiency for proton pump inhibitors, statins and renin-angiotensin inhibitor drugs. Potential exists to extend this to atypical antipsychotic drugs (AAPs), given their expenditure and oral generic risperidone available in Sweden from January 2009. However schizophrenia and bipolar disease are complex to treat and there is a need to tailor treatments, given the considerable inter-patient variability in responses and side-effects to different AAPs. Objectives Assess changes in risperidone utilisation before and after oral generic risperidone reimbursed in January 2009 alongside any specific demand-side measures. In addition, to: (a) assess price reductions for risperidone over time and overall AAP expenditure; (b) suggest additional measures that could potentially be introduced; and (c) provide guidance to other European countries on the implications of any findings. Method Principally a retrospective observational study and interrupted time series design. Key findingsNo specific measures to encourage the prescribing of risperidone, and no appreciable change in its utilisation, after generics reimbursed. Oral risperidone was 96% generic, and its price 80% below pre-patent loss prices, by August 2011. This limited the increase in AAP expenditure compared with utilisation after generics. Conclusion No apparent effectiveness or safety problems with generic risperidone. Authorities cannot rely on a spill-over from other disease areas to effect changes in physician prescribing habits. Specific measures are needed to encourage the prescribing of generic AAPs first line, where appropriate, exacerbated by the complexity of the disease areas. Their influence will be probably limited by the need to tailor treatment.
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