Abstract
Background: The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup. Methods: We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale–Severity–Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission. Results: Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P <.001) and after (37.2 ± 19.7 vs. 26.3 ± 18.0; P =.003) 6-month treatment. The CGI-S-BP yielded similar results. Participants with and without psychosis had similar course of symptom improvement and similar time to remission. There was no significant difference in the treatment outcomes of lithium (n = 11) and quetiapine (n = 21) among the psychotic subgroup. Conclusion: Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 402-410 |
| Number of pages | 9 |
| Journal | Depression and Anxiety |
| Volume | 35 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2018 |
Keywords
- bipolar depression
- bipolar disorder
- psychosis
- psychotic mood disorders
- treatment outcome
ASJC Scopus subject areas
- Clinical Psychology
- Psychiatry and Mental health
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Treatment outcomes of acute bipolar depressive episode with psychosis. / Caldieraro, Marco Antonio; Dufour, Steven; Sylvia, Louisa G.; Gao, Keming; Ketter, Terence A.; Bobo, William V.; Walsh, Samantha; Janos, Jessica; Tohen, Mauricio; Reilly-Harrington, Noreen A.; McElroy, Susan L.; Shelton, Richard C.; Bowden, Charles L.; Deckersbach, Thilo; Nierenberg, Andrew A.
In: Depression and Anxiety, Vol. 35, No. 5, 05.2018, p. 402-410.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Treatment outcomes of acute bipolar depressive episode with psychosis
AU - Caldieraro, Marco Antonio
AU - Dufour, Steven
AU - Sylvia, Louisa G.
AU - Gao, Keming
AU - Ketter, Terence A.
AU - Bobo, William V.
AU - Walsh, Samantha
AU - Janos, Jessica
AU - Tohen, Mauricio
AU - Reilly-Harrington, Noreen A.
AU - McElroy, Susan L.
AU - Shelton, Richard C.
AU - Bowden, Charles L.
AU - Deckersbach, Thilo
AU - Nierenberg, Andrew A.
N1 - Funding Information: The Bipolar CHOICE study was funded by the Agency for Healthcare Research and Quality (AHRQ), 1R01HS019371-01. Part of this work has been supported by the Dauten Family Center for Bipolar Treatment Innovation. Marco Antonio Caldieraro was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), program 227—Pesquisa Pós-doutoral no Exterior (grant 88881.120434/2016-01). Funding Information: Ms. Samantha Walsh reports no competing interests. Ms. Jessica Janos reports no competing interests. Dr. William V. Bobo has received research support from NIMH, AHRQ, and the Mayo Foundation for Medical Education and Research. Dr. Keming Gao have been on a speakers bureau and an advisory board of Sunovion, and received grant supports from AstraZeneca, Brain and Behavior Research Foundation, and Cleveland Foundation. Dr. Mauricio Tohen is a former full-time employee at Lilly (1997–2008). He has been a consultant for AstraZeneca, Abbott, BMS, Lilly, GSK, J&J, Otsuka, Roche, Lund-beck, Elan, Alkermes, Merck, Pamlab, Alexza, Forest, Teva, Sunovion, Gedeon Richter, and Wyeth. His spouse is a former employee at Lilly (1998–2013). Dr. Noreen A. Reilly-Harrington receives royalties from Oxford University Press, the American Psychological Association, and New Harbinger. She serves as a consultant for United Biosource Corporation and was a shareholder in Concordant Rater Systems. Dr. Terence A. Ketter has the following financial interests/arrangements or affiliations that could be perceived as real or apparent conflicts of interest: Grant/research support from the AstraZeneca Pharmaceuticals LP, Cephalon Inc., Eli Lilly and Company, Pfizer Inc., and Sunovion Pharmaceuticals; Consultant Fees from Allergan, Inc., Avanir Pharmaceuticals, Bristol-Myers Squibb Company, Cephalon Inc., Forest Pharmaceuticals, Janssen Pharmaceutica Products, LP, Merck & Co., Inc., Sunovion Pharmaceuticals, Teva Pharmaceuticals; Lecture Honoraria from Abbott Laboratories, Inc., AstraZeneca Pharmaceuticals LP, Glax-oSmithKline, and Otsuka Pharmaceuticals; and Publication Royalties from American Psychiatric Publishing, Inc. In addition, Dr. Ketter's spouse is an employee of and holds stock in Janssen Pharmaceuticals. Dr. Susan L. McElroy is a consultant to or member of the scientific advisory boards of Allergen, Alkermes, Corcept, Ironshore, MedA-vante, Naurex, NovoNordisk, Shire, Sunovian, and Teva. She is a principal or co-investigator on studies sponsored by the Agency for Healthcare Research & Quality (AHRQ), Azevan, Alkermes, AstraZeneca, Cephalon, Eli Lilly and Company, Marriott Foundation, National Institute of Mental Health, Orexigen Therapeutics, Inc., Shire, Sunovian, Takeda Pharmaceutical Company Ltd., and Transcept Pharmaceutical, Inc. She is also an inventor on U.S. Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patient's assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. Dr. Richard C. Shelton has received grant funding from Alkermes, Inc.; Assurex Health; Avanir Pharmaceuticals; Cerecor, Inc.; Janssen Pharmaceutica; Novartis, Inc.; Otsuka Pharmaceuticals; Nestle’ Health, and Takeda Pharmaceuticals. He has been a consultant for Allergan; Cerecor, Inc.; Clintara LLC; Janssen Pharmaceutica; Medtronic, Inc.; MSI Methylation Sciences, Inc.; Nestle’ Health; Pfizer, Inc.; and Takeda Pharmaceuticals. Dr. Charles L. Bowden has no competing interests. Dr. Thilo Deckersbach research has been funded by NIH, NIMH, NARSAD, TSA, IOCDF, Tufts University, DBDAT, Otsuka Pharmaceuticals, and Cogito, Inc. He has received honoraria, consultation fees, and/or royalties from the MGH Psychiatry Academy, BrainCells Inc., Clintara, LLC., Systems Research and Applications Corporation, Boston University, the Catalan Agency for Health Technology Assessment and Research, the National Association of Social Workers Massachusetts, the Massachusetts Medical Society, Tufts University, NIDA, NIMH, and Oxford University Press. He has also participated in research funded by DARPA, NIH, NIMH, NIA, AHRQ, PCORI, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, Northstar, Takeda, and Sunovion. Dr. Andrew A. Nierenberg is a consultant for Abbott Laboratories, Alkermes, American Psychiatric Association, Appliance Computing Inc. (Mindsite), Basliea, Brain Cells, Inc., Brandeis University, Bristol Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Dainippon Sumitomo (now Sunovion), Eli Lilly and Company, EpiQ, L.P./Mylan Inc., Forest, Genaissance, Genentech, GlaxoSmithKline, Healthcare Global Village, Hoffman LaRoche, Infomedic, Intra-Cellular Therapies, Lundbeck, Janssen Pharmaceutica, Jazz Pharmaceuticals, Medavante, Merck, Methylation Sciences, NeuroRx, Naurex, Novartis, PamLabs, Parexel, Pfizer, PGx Health, Otsuka, Ridge Diagnostics Shire, Schering-Plough, Somerset, Sunovion, Takeda Pharmaceuticals, Targa-cept, and Teva; consulted through the MGH Clinical Trials Network and Institute (CTNI) for Astra Zeneca, Brain Cells, Inc, Dianippon Sumitomo/Sepracor, Johnson and Johnson, Labopharm, Merck, Methylation Science, Novartis, PGx Health, Shire, Schering-Plough, Targacept, and Takeda/Lundbeck Pharmaceuticals. He is a stakeholder in Appliance Computing, Inc. (MindSite), Brain Cells, Inc., and Medavante. He receives research support from American Foundation for Suicide Prevention, AHRQ, Brain and Behavior Research Foundation, Bristol-Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly, Forest, GlaxoSmithKline, Intra-Cellular Therapies, Janssen Pharmaceu-tica, Lichtwer Pharma, Marriott Foundation, Mylan, NIMH, PamLabs, PCORI, Pfizer Pharmaceuticals, Shire, Stanley Foundation, Takeda, and Wyeth-Ayerst. Honoraria include Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol-Myers Squibb, Hillside Hospital, American Drug Utilization Review, American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, Harold Grinspoon Charitable Foundation, IMEDEX, International Society for Bipolar Disorder, Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Wisconsin, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, APSARD, ISBD, SciMed, Slack Publishing and Wolters Kluwer Publishing, ASCP, NCDEU, Rush Medical College, Yale University School of Medicine, NNDC, Nova Southeastern University, NAMI, Institute of Medicine, CME Institute, ISCTM, World Congress on Brain Behavior and Emotion, Congress of the Hellenic Society for Basic and Clinical Pharmacology, and ADAA. He has copyright joint ownership with MGH for Structured Clinical Interview for MADRS and Clinical Positive Affect Scale. Funding Information: Grant sponsor: Agency for Healthcare Research and Quality (AHRQ); Grant number: 1R01HS019371-01; Grant sponsor: Dauten Family Center for Bipolar Treatment Innovation; Grant sponsor: Coordenação de Aperfeiçoa-mento de Pessoal de Nível Superior (CAPES); Grant number: 88881.120434/2016-01. Publisher Copyright: © 2018 Wiley Periodicals, Inc. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/5
Y1 - 2018/5
N2 - Background: The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup. Methods: We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale–Severity–Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission. Results: Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P <.001) and after (37.2 ± 19.7 vs. 26.3 ± 18.0; P =.003) 6-month treatment. The CGI-S-BP yielded similar results. Participants with and without psychosis had similar course of symptom improvement and similar time to remission. There was no significant difference in the treatment outcomes of lithium (n = 11) and quetiapine (n = 21) among the psychotic subgroup. Conclusion: Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample.
AB - Background: The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup. Methods: We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale–Severity–Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission. Results: Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P <.001) and after (37.2 ± 19.7 vs. 26.3 ± 18.0; P =.003) 6-month treatment. The CGI-S-BP yielded similar results. Participants with and without psychosis had similar course of symptom improvement and similar time to remission. There was no significant difference in the treatment outcomes of lithium (n = 11) and quetiapine (n = 21) among the psychotic subgroup. Conclusion: Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample.
KW - bipolar depression
KW - bipolar disorder
KW - psychosis
KW - psychotic mood disorders
KW - treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=85046337565&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046337565&partnerID=8YFLogxK
U2 - 10.1002/da.22716
DO - 10.1002/da.22716
M3 - Article
C2 - 29329498
AN - SCOPUS:85046337565
VL - 35
SP - 402
EP - 410
JO - Anxiety
JF - Anxiety
SN - 1091-4269
IS - 5
ER -