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Biomedical subjects

Klara J Rosenquist

Publications and source records attributed to Klara J Rosenquist.

9 recordsLinked to original sources
PubMed2006

Extrapyramidal side effects with atypical neuroleptics in bipolar disorder.

OBJECTIVE: To examine, in a real-world clinical setting, the risk of extrapyramidal symptoms (EPS) with atypical neuroleptics in bipolar patients. METHODS: The authors assessed 51 individual patient trials of atypical neuroleptic agents (17 risperidone, 13 olanzapine, 11 quetiapine, 8 ziprasidone, and 2 aripiprazole) in 37 bipolar patients (type I or type II). Risk of EPS was assessed using the Abnormal Involuntary Movement Scale, Barnes Akathisia Rating Scale, and the Simpson-Angus Scale. Mean duration of treatment was 25.5 weeks (range 3-107 weeks) and 60.8% of patients were female. RESULTS: 62.7% of trials resulted in moderate to severe EPS. EPS and discontinuation frequencies were similar between specific neuroleptic agents or between high potency (risperidone/ziprasidone/aripiprazole; 52.9%, 27/51 trials) and low potency (quetiapine/olanzapine; 47.1%, 24/51 trials) agents. In a multiple regression model adjusted for confounders, akathisia was less common with low potency agents. Younger age was associated with more akathisia. 31.4% (11/35) of trials discontinued due to side effects. 7.8% (4/51) of trials led to mild de novo tardive dyskinesia. CONCLUSIONS: Over one-half of bipolar patients experienced EPS in this real world clinical setting. This rate is much higher than the 5-15% range reported in clinical trials, suggesting potential problems with clinical trial generalizability.

Adult↗
PubMed2005

Sensitivity and specificity of a new bipolar spectrum diagnostic scale.

OBJECTIVE: To assess the sensitivity and specificity of a self-report questionnaire for bipolar disorder, the Bipolar Spectrum Diagnostic Scale (BSDS). METHODS: The BSDS was administered to 68 consecutive patients with bipolar illness and 27 consecutive patients with unipolar major depressive disorder. Created by Ronald Pies, it consists of a descriptive story that captures subtle features of bipolar illness, to which patients may assent on a sentence-by-sentence basis. BSDS scores were compared to clinicians' DSM-IV-based diagnoses. RESULTS: Sensitivity of the BSDS was 0.76, approximately equal in bipolar I and II/NOS subjects (0.75 and 0.79, respectively). The BSDS identified 85% of unipolar-depressed patients as not having bipolar spectrum illness. A shift in the threshold of the BSDS resulted in a large increase in specificity (from 0.85 to 0.93), without a significant loss of sensitivity. CONCLUSIONS: The BSDS was highly sensitive and specific for bipolar spectrum illness, especially with the amended threshold for positive diagnosis.

Awareness↗
PubMed2004

Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder.

BACKGROUND: This study aims to replicate the sensitivity and specificity of the Mood Disorder Questionnaire (MDQ) for bipolar disorder and assess the impact of insight on the MDQ's sensitivity. Unlike prior telephone-based validation, this is the first clinical study to assess the validity of the MDQ. METHODS: 37 consecutive patients with bipolar spectrum illness received the MDQ, as well as 36 consecutive patients with unipolar depression. MDQ diagnoses were compared to DSM-IV-based SCID diagnoses. A total of 16 bipolar patients also received the Scale to Assess Unawareness of Mental Disorder (SUMD) to measure insight. RESULTS: Overall sensitivity for the MDQ was 0.58, higher in bipolar I disorder (0.69) than in bipolar II/NOS (0.30, P=0.06). The sample was highly insightful, but the two patients with lowest insight both had false negative screens. Patients' low ratings of severity of mania (question 3 of the MDQ) explained almost half of all false negative results. Specificity was 0.67. CONCLUSIONS: The MDQ demonstrates good sensitivity in insightful patients with bipolar I disorder, but may be less useful in patients with impaired insight or milder bipolar spectrum conditions.

Adult↗
PubMed2004

Is insight in mania state-dependent?: A meta-analysis.

In the first meta-analysis of studies assessing insight in mania, we sought to determine whether insight in mania is state-dependent or a trait-like condition. In schizophrenia, insight is a trait-like condition. If state-dependent, insight in mania would differ from insight in schizophrenia, and different treatment and research implications would follow. Seven reports using standardized insight rating scales in mania were identified through a MEDLINE literature search. Four longitudinal studies were included in a meta-analysis. The meta-analysis found that insight appears to be state-dependent. Insight showed a 20% improvement (95% confidence intervals, 7% to 34%) after recovery from acute mania (p = .003). Insight improves in bipolar disorder with resolution of the acute manic episode, suggesting that insight is state-dependent in bipolar disorder. We suggest that impaired insight be considered as part of the diagnostic picture of acute mania.

Awareness↗
PubMed2004

Antidepressant treatment in bipolar versus unipolar depression.

OBJECTIVE: Antidepressant responses were compared in DSM-IV bipolar and unipolar depression. METHOD: The authors analyzed clinical records for outcomes of antidepressant trials for 41 patients with bipolar depression and 37 with unipolar depression, similar in age and sex distribution. RESULTS: Short-term nonresponse was more frequent in bipolar (51.3%) than unipolar (31.6%) depression. Manic switching occurred only in bipolar depression but happened less in patients taking mood stabilizers (31.6% versus 84.2%). Cycle acceleration occurred only in bipolar depression (25.6%), with new rapid cycling in 32.1%. Late response loss (tolerance) was 3.4 times as frequent, and withdrawal relapse into depression was 4.7 times less frequent, in bipolar as in unipolar depression. Mood stabilizers did not prevent cycle acceleration, rapid cycling, or response loss. Modern antidepressants, in general, did not have lower rates of negative outcomes than tricyclic antidepressants. CONCLUSIONS: The findings suggest an unfavorable cost/benefit ratio for antidepressant treatment of bipolar depression.

Antidepressive Agents, Tricyclic↗
PubMed2003

Long-term outcome with divalproex in children and adolescents with bipolar disorder.

OBJECTIVE: To assess the outcome and safety of divalproex treatment in children and adolescents with bipolar disorder. METHODS: We conducted a chart review of children and adolescents who were treated with divalproex and who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for bipolar disorder (dose 966 +/- 501 mg/day, level 79.4 +/- 23.1 micro g/mL, duration 1.4 +/- 1.5 years). Responders were defined as those showing moderate to marked response on the Clinical Global Impression-Improvement (CGI-I) scale. RESULTS: Eight of 15 (53%) patients responded to divalproex treatment for mixed episode (n = 6), disruptive behavior (n = 4), pure mania (n = 3), or depression (n = 2). Six of 15 (40%) discontinued divalproex, most due to side effects (n = 5). The most common side effect was weight gain (4/15, 27%). CONCLUSION: In children aged 4-18 years, divalproex treatment was related to improved outcome in the long-term treatment of bipolar disorder. One third of the patients discontinued treatment secondary to side effects, including a case of reversible liver enzyme elevation.

Adolescent↗
PubMed2003

Oxcarbazepine treatment of bipolar disorder.

OBJECTIVE: To assess the effectiveness and safety of oxcarbazepine in bipolar disorder. METHOD: A chart review of naturalistic treatment with oxcarbazepine in 42 outpatients with DSM-IV bipolar disorder (10 males, 32 females; mean +/- SD age = 33.3 +/- 12.4 years; 25 with bipolar disorder type I, 4 with bipolar disorder type II, and 13 with bipolar disorder not otherwise specified) was conducted. Patients had received oxcarbazepine monotherapy or adjunctive therapy between April 2000 and April 2002. Treatment response was defined as a Clinical Global Impressions-Improvement scale score of 1 (marked improvement) or 2 (moderate improvement). RESULTS: Oxcarbazepine was moderately to markedly effective in 24 subjects (57%). Mixed symptoms were the most common indication (52% [22/42]). The mean oxcarbazepine dose was 1056.6 mg/day, and mean treatment duration was 16.2 weeks. Sedation (17/42, 40%) was the most common side effect, but 16 patients (38%) had no side effects. Twenty-two patients (52%) stopped treatment, mostly due to side effects (12/22). Males were more likely to respond than females (10/10 vs. 14/32, p =.006). Dose, bipolar subtype, indication, past nonresponse to mood stabilizers, concurrent mood stabilizer use, and monotherapy use of oxcarbazepine did not differentially predict response. CONCLUSION: Oxcarbazepine appeared effective in about one half of patients with bipolar disorder and was well tolerated.

Adolescent↗
PubMedDate not supplied

Long-term observational comparison of risperidone and olanzapine in bipolar disorder.

To compare long-term effectiveness and safety of risperidone versus olanzapine as adjunctive maintenance treatments of bipolar disorder. Retrospective observational chart review of 29 outpatients with bipolar or schizoaffective disorder (type I = 15, type II = 3, NOS = 5, schizoaffective = 6) who received risperidone or olanzapine added to lithium or valproate >3 months. Acute indications were depression (n = 8), manic/hypomanic/mixed states (n = 8), rapid cycling (n = 6), other indications (n = 6), and prophylaxis (n = 1). Logistic regression models adjusted for potential confounding factors (i.e., severity of illness, comorbid substance abuse, diagnostic subtype). Overall duration of follow-up was 65.9+/-70.1 weeks. Mild to moderate response was similar in the risperidone and olanzapine groups after adjusting for potential confounders (OR = 0.91, 95% CI [0.05, 16.17]). Somewhat greater adjusted moderate to marked response (OR >3.60, 95% CI [0.31, >42.00]) and longer duration of treatment (HR = 0.52, 95% CI [0.22, 1.22]) occurred in the risperidone group, but were still compatible with the null hypothesis. Weight gain occurred more frequently with olanzapine (57%) than risperidone (13%). EPS was similar, and tardive dyskinesia did not occur. Risperidone and olanzapine appeared to have similar real-world maintenance effectiveness for bipolar disorder, but differed somewhat in side effects.

Adult↗