* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Combination Atypical Antipsychotics in Adolescents or
Mental status examination wikipedia , lookup
Moral treatment wikipedia , lookup
Separation anxiety disorder wikipedia , lookup
Major depressive disorder wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Schizophrenia wikipedia , lookup
Panic disorder wikipedia , lookup
Excoriation disorder wikipedia , lookup
Rumination syndrome wikipedia , lookup
Child psychopathology wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Abnormal psychology wikipedia , lookup
History of mental disorders wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Conduct disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Spectrum disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Bipolar disorder wikipedia , lookup
Bipolar II disorder wikipedia , lookup
TITLE: Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features: A Review of Clinical and Cost-Effectiveness and Guidelines DATE: 06 September 2016 CONTEXT AND POLICY ISSUES Bipolar disorder is a mental condition characterized by episodic mood swings between euphoric or irritable mania and hopeless depression which can affect social activities, functioning, and relationships.1 Episodes are typically followed by symptom-free periods referred to as euthymia.1 According to a survey conducted in 2002, one percent (1%) of Canadians 15 years and older demonstrated symptoms satisfying the criteria for bipolar disorder in the previous 12 months.2 Multiple types of bipolar disorders exist such as bipolar I, bipolar II and are defined in the Diagnostic and Statistical Manual (5th edition; DSM-V) from the American Psychiatric Association.3 Symptoms associated with mania can include increased creativity and productivity; however, mania can also lead to immediate hospitalization or involuntary committal under the Mental Health Act. Symptoms associated with depression can lead to increased rates of suicide and suicide ideation.1 Bipolar disorder with psychotic features refers to manic or depressive episodes including psychotic symptoms such as delusions or hallucinations. Psychotic features manifest in over 50% of manic episodes and are more common in the latter than in depressive episodes.4 Pharmacological treatment usually depends on the type of bipolar disorder (manic or depressive); however, the most common treatments include lithium and valproic acid.5 Antipsychotic medications are also used to treat bipolar disorder and can be classified as typical (first generation) or atypical (second generation).6 First generation antipsychotics mitigate bipolar disorder symptoms by antagonizing dopamine D 2 receptors, while second generation antipsychotics have an affinity for serotonin 5-hydroxytryptamine receptors and adrenergic receptors in addition to being D2 receptor antagonists.6 Atypical antipsychotics, such as aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone can be prescribed as monotherapy or in combination with mood stabilizers and Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic review s. The intent is to provide a list of sources of the best evidence on the topic that the Canadian Agency for Drugs and Technologies in Health (CADTH) could identify using all reasonable efforts within the time allow ed. Rapid responses should be considered along w ith other ty pes of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for w hich little information can be found, but w hich may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Copyright: This report contains CADTH copyright material and may contain material in w hich a third party ow ns copyright. This report m ay be used for the purposes of research or private study only. It may not be copied, posted on a w eb site, redistributed by email or stored on an electronic system w ithout the prior w ritten permission of CADTH or applicable copyrigh t ow ner. Links: This report may contain links to other information available on the w ebsites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the ow ners’ ow n terms and conditions. antidepressants, as well as other treatment options.5 Although combinations of atypical antipsychotics have been used for the treatment of other disorders, such as schizophrenia, the effectiveness of combination therapy in bipolar disorder is unclear.7-9 This Rapid Response report aims to review the clinical and cost-effectiveness of combination atypical antipsychotics in adolescents or adults with bipolar disorder with psychotic features. Guidelines associated with the use of combination atypical antipsychotics in adolescents or adults with bipolar disorder with psychotic features will also be examined. RESEARCH QUESTIONS 1. What is the clinical effectiveness of combination atypical antipsychotics in adolescent or adult patients with bipolar disorder with psychotic features? 2. What is the cost-effectiveness of combination atypical antipsychotics in adolescent or adult patients with bipolar disorder with psychotic features? 3. What are the evidence-based guidelines associated with the use of combination atypical antipsychotics in adolescent or adult patients with bipolar disorder with psychotic features? KEY FINDINGS No relevant literature was identified pertaining to the clinical or cost effectiveness of combination treatment of any atypical antipsychotics in adolescents and adults suffering from bipolar disorder with psychotic features. Similarly, no evidence-based guidelines were identified from the literature search METHODS Literature Search Methods A limited literature search was conducted on key resources including Medline, PsychInfo, Embase, PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. Methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses, guidelines, economic studies, randomized controlled trials and non-randomized studies. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2011 and August 4, 2016. Selection Criteria and Methods One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in Table 1. Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features 2 Population Intervention Comparator Outcomes Study Designs Table 1: Selection Criteria Adolescents and adults with bipolar disorder with psychotic features Combination of any atypical antipsychotics (using either high or regular dosing regimens) Other drug combinations, atypical antipsychotics monotherapy, placebo alone or in combination with an atypical antipsychotic, no comparator Clinical effectiveness, safety, cost-effectiveness and guidelines Health technology assessment, systematic reviews, meta-analyses, randomized controlled trials, non-randomized trials, economic evaluations and guidelines Exclusion Criteria Articles were excluded if they did not meet the selection criteria outlined in Table 1, they were duplicate publications, or were published prior to 2011. SUMMARY OF EVIDENCE Quantity of Research Available A total of 874 citations were identified in the literature search. Following screening of titles and abstracts, 848 citations were excluded and 26 potentially relevant reports from the electronic search were retrieved for full-text review. No relevant reports were identified in the grey literature. Of these potentially relevant articles, all 26 publications were excluded because they did not meet the inclusion criteria. Appendix 1 describes the PRISMA flowchart of the study selection. Summary of Findings No relevant literature on the clinical or cost effectiveness of combination treatment of any atypical antipsychotics in adolescents and adults suffering from bipolar disorder with psychotic features was identified. Similarly, no evidence-based guidelines were identified. CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING No relevant clinical evidence or guidelines of combination treatment of any atypical antipsychotics in adolescents and adults suffering from bipolar disorder with psychotic features were identified. However, NICE guidance on the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care may provide some insight on atypical antipsychotic combination treatments.10 Based on evidence related to schizophrenia, the guideline suggests not to initiate regular combined antipsychotic medication, except for short periods of time (e.g. when changing medication). Although the NICE guideline does not recommend the combination of atypical antipsychotics for treatment of bipolar disorder, it should be noted that the recommendation is made on the basis that antipsychotics will have the same metabolic effects on people with bipolar disorder as they do on people with schizophrenia and based on the general bipolar population (i.e. not necessarily patients suffering from bipolar disorder with psychotic features).10 Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features 3 PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 www.cadth.ca Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features 4 REFERENCES 1. Bipolar disorder: identifying and supporting patients in primary care. BPJ [Internet]. 2014 Jul [cited 2016 Aug 10];62:7-17. Available from: http://bpac.org.nz/BPJ/2014/July/docs/BPJ62-bipolar.pdf 2. What should I know about bipolar disorder (manic-depression)? [Internet]. Ottawa: Public Health Agency of Canada; 2016. [cited 2016 Aug 10]. Available from: http://www.phacaspc.gc.ca/cd-mc/mi-mm/bipolar-bipolaire-eng.php 3. Diagnostic and statistical manual of mental disorders: DSM-V. Arlington (VA): American Psychiatric Association; 2013. 4. Hirschfeld R, Bowden CL, Gitlin MJ, Keck PE, Suppes T, Thase ME, et al. Practice guideline for the treatment of patients with bipolar disorder [Internet]. 2nd ed. Arlington (VA): American Psychiatric Association Publishing; 2016. [cited 2016 Aug 10]. Available from: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pd f 5. Severus E, Schaaff N, Moller HJ. State of the art: treatment of bipolar disorders. CNS Neurosci Ther. 2012 Mar;18(3):214-8. 6. Chauhan A, Mittal A, Arora OK. Atypical antipsychotics from scratch to the present. International Journal of Pharmaceutical Sciences and Research. 2013;4(1):184-204. 7. Yasui-Furukori N, Kaneda A, Sugawara N, Tomita T, Kaneko S. Effect of adjunctive treatment with aripiprazole to atypical antipsychotics on cognitive function in schizophrenia patients. J Psychopharmacol. 2012 Jun;26(6):806-12. 8. Kontis D, Theochari E, Ritsner MS. Antipsychotic polypharmacy in psychosis. Directions in Psychiatry. 2014;34(2):85-99. 9. Gee S, Taylor D. Overview of pharmacological treatments and guidelines. In: Buckley PF, Gaughran F, editors. Treatment--refractory schizophrenia. Cham (CH): Springer; 2014 Jan 28. Chapter 5. p. 65-80. 10. National Collaborating Centre for Mental Health. Bipolar disorder: The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care [Internet]. Updated ed. London (GB): The British Psychological Society and The Royal College of Psychiatrists; 2014. [cited 2016 Sep 23]. (National clinical guideline no. 185). Available from: https://www.nice.org.uk/guidance/cg185/evidence/fullguideline-193212829 Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features 5 APPENDIX 1: Selection of Included Studies 874 citations identified from electronic literature search and screened 848 citations excluded 26 potentially relevant articles retrieved for scrutiny (full text, if available) 0 potentially relevant reports retrieved from other sources (grey literature, hand search) 26 potentially relevant reports 26 reports excluded: -irrelevant population (5) -irrelevant intervention (20) -other (review articles, editorials)(1) 0 reports included in review Combination Atypical Antipsychotics in Adolescents or Adults with Bipolar Disorder with Psychotic Features 6