Bipolar I Psycho-Pharm Quiz

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Q: Which of the following medication is NOT indicated for maintenance treatment of Bipolar I ?

(a) Aripiprazole tabs
(b) Olanzapine tabs
(c) Quetiapine tabs
(d) Risperidone tabs
(e) Ziprasidone tabs

Admin wrote:.
Q: Which of the following medication is NOT indicated for maintenance treatment of Bipolar I ?

(a) Aripiprazole tabs
(b) Olanzapine tabs
(c) Quetiapine tabs
(d) Risperidone tabs
(e) Ziprasidone tabs

Answer: (d) Risperidone tabs.

The first line medications consistently supported across multiple randomized trials for maintenance of bipolar disorder are:
(a) Lithium (more effective in preventing manic recurrences)
(b) Lamotrigine (more effective in delaying or preventing depression than manic or mixed episodes)
(c) Risperidone intramuscular injection (for nonadherent patients)- Most trials done on long acting IM form of risperidone, but no trial was done on oral formulation of risperidone (more efficacious in delaying or preventing mania than major depression)
Source:
- Deeks ED et al, Drugs. 2010;70(8 ):1001.
- Risperidone long-acting injectable monotherapy in the maintenance treatment of bipolar I disorder. Quiroz JA et al, Biol Psychiatry. 2010;68(2):156.

The second line medications include:
(a) Aripiprazole:
Proven efficacy for acute mania and the prevention of mania, but the evidence available thus far does not support the efficacy of aripiprazole for the treatment of acute bipolar depression and prevention of depressive relapse.
Negative findings for aripiprazole in the treatment of acute bipolar depression have been attributed to high study doses, rapid titration, and high placebo rates.
Source: A clinical review of aripiprazole in bipolar depression and maintenance therapy of bipolar disorder. Yatham LN, J Affect Disord. 2011;128 Suppl 1:S21.

In 2011 Aripiprazole received FDA approval as an adjunct to the mood stabilizers lithium or valproate for the maintenance treatment of Bipolar I Disorder.

(b) Divalproex

(c) Quetiapine:
In 2008 FDA approved Quetiapine for the maintenance treatment of patients with bipolar I disorder, as adjunct to lithium or divalproex.
The FDA approval was based on 2 multicentre, randomised, double-blind, placebo-controlled clinical trials which are part of the clinical trial program known as BOLDER (Bipolar Depression). Pooled study results indicated that patients treated with Quetiapine plus Lithium or Divalproex had a risk reduction of 70% relative to those in the placebo arm for time to recurrence of a mood event. This reduction in risk was significant for both recurrence of manic episodes and recurrence of depressive episodes.

(d) Olanzapine: second line for risk of metabolic side effects.
Olanzapine appeared to delay or prevent mania more effectively than major depression.
Source: Olanzapine in long-term treatment for bipolar disorder. Cipriani A et al. Cochrane Database Syst Rev. 2009.
Olanzapine in the long-term treatment of bipolar disorder: a systematic review and meta-analysis. Cipriani A et al. Psychopharmacol. 2010;24(12):1729.
in 2004 FDA approved Olanzapine for maintenance treatment of bipolar disorder.

(e) Ziprasidone:
In 2009 FDA approved Ziprasidone as an adjunct to lithium or valproate for the maintenance treatment of bipolar disorder in adults.
Approval of the indication was based on data from a double-blind, placebo-controlled trial of 240 stabilized patients showing that the addition of ziprasidone to mood stabilizers significantly delayed time to recurrence of a mood episode.


Please add your comments below. Thanks

all atypical anti psychotics  could be used, olanzapine, qutiapin, aripiprazol, resperidon, ziprasidon. but in clinical practices less of resperidon. may be its odd man out!

koustubh.bagul wrote:all atypical anti psychotics  could be used, olanzapine, qutiapin, aripiprazol, resperidon, ziprasidon. but in clinical practices less of resperidon. may be its odd man out!

Yes Koustubh.bagul. we can use all atypical antipsychotics. FDA had not approved Risperidone oral formulation, because no studies available.