Aripiprazole for the maintenance treatment of bipolar disorder: a review of available evidence

We aimed to review and synthesize results reporting on the maintenance efficacy of Aripiprazole in adults with bipolar I disorder. Aripiprazole is FDA approved for the acute and maintenance treatment of bipolar I disorder. Aripiprazole’s efficacy during the long-term treatment of bipolar disorder is supported by extension of acute phase studies and long-term (ie, 100-week) double-blind placebo controlled recurrence prevention registration trials. Aripiprazole is not established as efficacious in the acute or maintenance treatment of bipolar depression. Moreover, aripiprazole’s efficacy during the acute or maintenance phase of bipolar II disorder has not been sufficiently studied. Aripiprazole has a relatively lower hazard for metabolic disruption and change in body composition when compared to other atypical agents (eg, olanzapine, quetiapine). Moreover, aripiprazole has minimal propensity for sedation, somnolence and prolactin elevation. Aripiprazole is associated with extrapyramidal side effects, notably akathisia, which in most cases is not severe or treatment limiting. Future research vistas are to explore aripiprazole’s efficacy in bipolar subgroups; recurrence prevention of bipolar depression; and in combination with other mood stabilizing agents

Utility of Two PANSS 5-Factor Models for Assessing Psychosocial Outcomes in Clinical Programs for Persons with Schizophrenia

Using symptom factors derived from two models of the Positive and Negative Syndrome Scale (PANSS) as covariates, change over time in consumer psychosocial functioning, medication adherence/compliance, and treatment satisfaction outcomes are compared based on a randomized, controlled trial assessing the effectiveness of antipsychotic medications for 108 individuals diagnosed with schizophrenia. Random effects regression analysis was used to determine the relative performance of these two 5-factor models as covariates in estimating change over time and the goodness of fit of the regression equations for each outcome. Self-reported psychosocial functioning was significantly associated with the relief of positive and negative syndromes, whereas patient satisfaction was more closely and significantly associated with control of excited/activation symptoms. Interviewer-rated psychosocial functioning was significantly associated with relief of positive and negative symptoms, as well as excited/activation and disoriented/autistic preoccupation symptoms. The VDG 5-factor model of the PANSS represents the best “goodness of fit” model for assessing symptom-related change associated with improved psychosocial outcomes and functional recovery. Five-factor models of the syndromes of schizophrenia, as assessed using the PANSS, are differentially valuable in determining the predictors of psychosocial and satisfaction changes over time, but not of improved medication adherence/compliance

Impact of Robustness of Program Implementation on Client Outcomes in Dual Diagnosis Programs

Three types of treatment—behavioral skills training, a 12-step recovery model, and intensive case management—provided to 132 clients at four facilities were identified as being robustly or not robustly implemented, depending on whether core elements of these treatments were emphasized. Outcomes and costs of services to clients were examined over 18 months. Clients receiving robustly implemented behavioral skills training had significantly higher psychosocial functioning and lower costs for supportive services than those receiving nonrobustly implemented training. Clients receiving robustly implemented case management also exhibited significantly higher psychosocial functioning and lower costs for intensive services than those in the nonrobust intervention. To be effective, dual diagnosis programs should better manage the robustness of implementation of planned interventions

The Relative Impact of Treatment Program Robustness and Dosage on Client Outcomes

The relationship between two aspects of program quality (robustness of model implementation and service dosage), clientoutcomes of self-reported and observer-rated psychosocial functioning, and intensive mental health service utilization costs was examined for 132 persons with dual mental and substance disorders. Membership in the ‘robustly implemented’ behavioral skills intervention was significantly associated with higher levels of self-reported and observer-rated psychosocial functioning, while membership in the ‘robustly implemented’ 12-step group was significantly related to higher intensive mental health service costs. Dosage of supportive service exhibited a significant, positive relationship to lower intensive mental health service costs but not to functioning. Although the addition of qualitative data was useful in interpreting the findings from the main study analyses, it had no discernable statistical impact on the regression equations for three major outcome variables

Community-Based Care for Youths With Early and Very-Early Onset Bipolar I Disorder

Objective: Phenomenological and treatment differences between children and adolescents with bipolar I disorder in a public mental health system were examined. Method: A systematic medical record review was performed on a sample of 83 patients, focusing on documented DSM IV symptoms of mania or depression, attention deficit hyperactivity disorder, conduct disorder, schizophrenia, and post-traumatic stress disorder. Cross-tabulation and logistic regression analyses were performed comparing the presence/absence of symptoms for each disorder and treatments provided for children and adolescents. Results: Prepubertal patients were significantly more likely to be male, easily distracted, inattentive, detached from others, hyper-vigilant, prescribed stimulant medication, and to meet the diagnostic criteria for attention-deficit/hyperactivity disorder or Conduct Disorder than adolescents. Conclusions: Consistent with the published literature, phenomenological differences between children and adolescents are present and being recognized for differential diagnosis and treatment by community practitioners. More attention to documenting some cardinal symptoms of mania, the persistence of bipolar symptoms, and the nature of cycling for those with mixed states is needed