The Experts below are selected from a list of 168 Experts worldwide ranked by ideXlab platform
Jutta M Stoffers - One of the best experts on this subject based on the ideXlab platform.
-
The Cochrane Library - Pharmacological interventions for borderline personality disorder
The Cochrane database of systematic reviews, 2010Co-Authors: Jutta M Stoffers, Antje Timmer, Birgit Vollm, Gerta Rücker, Nick Huband, Klaus LiebAbstract:Background Drugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders ("off-label use"), mostly targeting affective or impulsive symptom clusters. Objectives To assess the effects of drug treatment in BPD patients. Search methods We searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field. Selection criteria Randomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects. Data collection and analysis Two authors selected trials, assessed quality and extracted data, independently. Main results Twenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, Valproate Semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants. The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed. Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition. Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes. Authors' conclusions The available evidence indicates some beneficial effects with second-generation antipsychotics, mood stabilisers, and dietary supplementation by omega-3 fatty acids. However, these are mostly based on single study effect estimates. Antidepressants are not widely supported for BPD treatment, but may be helpful in the presence of comorbid conditions. Total BPD severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment. Conclusions have to be drawn carefully in the light of several limitations of the RCT evidence that constrain applicability to everyday clinical settings (among others, patients' characteristics and duration of interventions and observation periods).
-
pharmacological interventions for borderline personality disorder
Cochrane Database of Systematic Reviews, 2010Co-Authors: Jutta M Stoffers, Antje Timmer, Birgit Vollm, Gerta Rücker, Nick Huband, Klaus LiebAbstract:Background Drugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders ("off-label use"), mostly targeting affective or impulsive symptom clusters. Objectives To assess the effects of drug treatment in BPD patients. Search methods We searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field. Selection criteria Randomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects. Data collection and analysis Two authors selected trials, assessed quality and extracted data, independently. Main results Twenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, Valproate Semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants. The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed. Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition. Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes. Authors' conclusions The available evidence indicates some beneficial effects with second-generation antipsychotics, mood stabilisers, and dietary supplementation by omega-3 fatty acids. However, these are mostly based on single study effect estimates. Antidepressants are not widely supported for BPD treatment, but may be helpful in the presence of comorbid conditions. Total BPD severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment. Conclusions have to be drawn carefully in the light of several limitations of the RCT evidence that constrain applicability to everyday clinical settings (among others, patients' characteristics and duration of interventions and observation periods).
-
pharmacotherapy for borderline personality disorder cochrane systematic review of randomised trials
British Journal of Psychiatry, 2010Co-Authors: Klaus Lieb, Antje Timmer, Birgit Vollm, Gerta Rücker, Jutta M StoffersAbstract:Background Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies. Aims To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder. Method A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability. Results Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and Valproate Semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness. Conclusions The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
Klaus Lieb - One of the best experts on this subject based on the ideXlab platform.
-
The Cochrane Library - Pharmacological interventions for borderline personality disorder
The Cochrane database of systematic reviews, 2010Co-Authors: Jutta M Stoffers, Antje Timmer, Birgit Vollm, Gerta Rücker, Nick Huband, Klaus LiebAbstract:Background Drugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders ("off-label use"), mostly targeting affective or impulsive symptom clusters. Objectives To assess the effects of drug treatment in BPD patients. Search methods We searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field. Selection criteria Randomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects. Data collection and analysis Two authors selected trials, assessed quality and extracted data, independently. Main results Twenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, Valproate Semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants. The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed. Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition. Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes. Authors' conclusions The available evidence indicates some beneficial effects with second-generation antipsychotics, mood stabilisers, and dietary supplementation by omega-3 fatty acids. However, these are mostly based on single study effect estimates. Antidepressants are not widely supported for BPD treatment, but may be helpful in the presence of comorbid conditions. Total BPD severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment. Conclusions have to be drawn carefully in the light of several limitations of the RCT evidence that constrain applicability to everyday clinical settings (among others, patients' characteristics and duration of interventions and observation periods).
-
pharmacological interventions for borderline personality disorder
Cochrane Database of Systematic Reviews, 2010Co-Authors: Jutta M Stoffers, Antje Timmer, Birgit Vollm, Gerta Rücker, Nick Huband, Klaus LiebAbstract:Background Drugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders ("off-label use"), mostly targeting affective or impulsive symptom clusters. Objectives To assess the effects of drug treatment in BPD patients. Search methods We searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field. Selection criteria Randomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects. Data collection and analysis Two authors selected trials, assessed quality and extracted data, independently. Main results Twenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, Valproate Semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants. The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed. Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition. Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes. Authors' conclusions The available evidence indicates some beneficial effects with second-generation antipsychotics, mood stabilisers, and dietary supplementation by omega-3 fatty acids. However, these are mostly based on single study effect estimates. Antidepressants are not widely supported for BPD treatment, but may be helpful in the presence of comorbid conditions. Total BPD severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment. Conclusions have to be drawn carefully in the light of several limitations of the RCT evidence that constrain applicability to everyday clinical settings (among others, patients' characteristics and duration of interventions and observation periods).
-
pharmacotherapy for borderline personality disorder cochrane systematic review of randomised trials
British Journal of Psychiatry, 2010Co-Authors: Klaus Lieb, Antje Timmer, Birgit Vollm, Gerta Rücker, Jutta M StoffersAbstract:Background Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies. Aims To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder. Method A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability. Results Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and Valproate Semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness. Conclusions The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
Martha Sajatovic - One of the best experts on this subject based on the ideXlab platform.
-
adjunct extended release Valproate Semisodium in late life schizophrenia
International Journal of Geriatric Psychiatry, 2008Co-Authors: Martha Sajatovic, Nicoleta Coconcea, Rosalinda V Ignacio, Frederic C Blow, Robert W Hays, Kristin A Cassidy, William J MeyerAbstract:Objective Adjunctive anticonvulsant medications may benefit some individuals with schizophrenia, however data on adjunct anticonvulsants in older adults with schizophrenia is limited. This prospective, 12-week open label study evaluated adjunct extended-release Valproate Semisodium (divalproex) in 20 older adults with schizophrenia. Methods The study was conducted at an academic psychiatry clinic in the mid-western United States. Participants were self-referred from posted advertisements or referred by clinic practitioners. Extended-release Valproate Semisodium was added onto antipsychotic treatment. Individuals with active substance use disorders or active significant medical comorbidity were excluded. Primary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Geriatric Depression Scale (GDS) and Global Assessment Scale (GAS). Tolerability was evaluated via patient self-reported side effects, change from baseline in body weight and change on abnormal movement scales. Results Patients (mean age 61 years, range 49.8–79.2 years) had significant reductions in psychosis scores as measured by the Positive and Negative Syndrome Scale (PANSS) p < 0.01, as well as in global functioning as measured by the Global Assessment Scale (GAS) p < 0.01 and depression as measured by the Geriatric Depression Scale (GDS) p < 0.05. Mean dose of extended-release Valproate Semisodium was 587.50 mg/day SD ± 247.02. Extended-release Valproate Semisodium was well tolerated in this older adult population. The primary adverse effect was sedation, which appeared to be relatively dose and titration-speed dependent. Weight change was not significant. Conclusion While extended-release Valproate Semisodium appears efficacious and well tolerated in older adults with schizophrenia, data from larger, controlled trials is needed. Copyright © 2007 John Wiley & Sons, Ltd.
-
Adjunct extended-release Valproate Semisodium in late life schizophrenia
International journal of geriatric psychiatry, 2008Co-Authors: Martha Sajatovic, Nicoleta Coconcea, Rosalinda V Ignacio, Frederic C Blow, Robert W Hays, Kristin A Cassidy, William J MeyerAbstract:Objective Adjunctive anticonvulsant medications may benefit some individuals with schizophrenia, however data on adjunct anticonvulsants in older adults with schizophrenia is limited. This prospective, 12-week open label study evaluated adjunct extended-release Valproate Semisodium (divalproex) in 20 older adults with schizophrenia. Methods The study was conducted at an academic psychiatry clinic in the mid-western United States. Participants were self-referred from posted advertisements or referred by clinic practitioners. Extended-release Valproate Semisodium was added onto antipsychotic treatment. Individuals with active substance use disorders or active significant medical comorbidity were excluded. Primary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Geriatric Depression Scale (GDS) and Global Assessment Scale (GAS). Tolerability was evaluated via patient self-reported side effects, change from baseline in body weight and change on abnormal movement scales. Results Patients (mean age 61 years, range 49.8–79.2 years) had significant reductions in psychosis scores as measured by the Positive and Negative Syndrome Scale (PANSS) p
-
Managing Bipolar Disorder in the Elderly
Drugs & Aging, 2005Co-Authors: Martha Sajatovic, Subramoniam Madhusoodanan, Nicoleta CoconceaAbstract:Clinical research in geriatric psychopharmacology has been a relatively neglected focus compared with the wealth of information on younger populations, and there is a dearth of published, controlled trials. Similarly, these are limited data in the area of geriatric bipolar disorder. Although there is an absence of rigorous, evidence-based information, preliminary data on older adults with bipolar disorder suggest some promising treatment options and important differences in older versus younger patients with bipolar illness. Lithium, while widely utilised in younger populations, is often poorly tolerated in the elderly. Clinical evidence regarding use of antiepileptic compounds in late-life bipolar disorder is generally compiled from bipolar disorder studies in mixed populations, studies in older adults with seizure disorders, and studies on dementia and psychotic conditions other than bipolar disorder. Valproate Semisodium and carbamazepine are widely prescribed compounds in older adults with bipolar disorder. However, the popularity of these compounds has occurred in context of an absence of evidence-based data. The atypical antipsychotics have expanded the treatment armamentarium for bipolar disorder in mixed populations and may offer particular promise in management of bipolar illness in older populations as well. Olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole are atypical antipsychotics that have been approved by the US FDA for the treatment of bipolar disorder; however, there are no published, controlled trials with atypical antipsychotics specific to mania in geriatric patients. Preliminary reports on the use of clozapine, risperidone, olanzapine and quetiapine suggest a role for the use of these agents in late-life bipolar disorder. Information with ziprasidone and aripiprazole specific to geriatric bipolar disorder is still lacking.
-
Managing Bipolar Disorder in the Elderly Defining the Role of the Newer Agents
Drugs & aging, 2005Co-Authors: Martha Sajatovic, Subramoniam Madhusoodanan, Nicoleta CoconceaAbstract:Clinical research in geriatric psychopharmacology has been a relatively neglected focus compared with the wealth of information on younger populations, and there is a dearth of published, controlled trials. Similarly, these are limited data in the area of geriatric bipolar disorder. Although there is an absence of rigorous, evidence-based information, preliminary data on older adults with bipolar disorder suggest some promising treatment options and important differences in older versus younger patients with bipolar illness. Lithium, while widely utilised in younger populations, is often poorly tolerated in the elderly. Clinical evidence regarding use of antiepileptic compounds in late-life bipolar disorder is generally compiled from bipolar disorder studies in mixed populations, studies in older adults with seizure disorders, and studies on dementia and psychotic conditions other than bipolar disorder. Valproate Semisodium and carbamazepine are widely prescribed compounds in older adults with bipolar disorder. However, the popularity of these compounds has occurred in context of an absence of evidence-based data. The atypical antipsychotics have expanded the treatment armamentarium for bipolar disorder in mixed populations and may offer particular promise in management of bipolar illness in older populations as well. Olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole are atypical antipsychotics that have been approved by the US FDA for the treatment of bipolar disorder; however, there are no published, controlled trials with atypical antipsychotics specific to mania in geriatric patients. Preliminary reports on the use of clozapine, risperidone, olanzapine and quetiapine suggest a role for the use of these agents in late-life bipolar disorder. Information with ziprasidone and aripiprazole specific to geriatric bipolar disorder is still lacking.
William J Meyer - One of the best experts on this subject based on the ideXlab platform.
-
adjunct extended release Valproate Semisodium in late life schizophrenia
International Journal of Geriatric Psychiatry, 2008Co-Authors: Martha Sajatovic, Nicoleta Coconcea, Rosalinda V Ignacio, Frederic C Blow, Robert W Hays, Kristin A Cassidy, William J MeyerAbstract:Objective Adjunctive anticonvulsant medications may benefit some individuals with schizophrenia, however data on adjunct anticonvulsants in older adults with schizophrenia is limited. This prospective, 12-week open label study evaluated adjunct extended-release Valproate Semisodium (divalproex) in 20 older adults with schizophrenia. Methods The study was conducted at an academic psychiatry clinic in the mid-western United States. Participants were self-referred from posted advertisements or referred by clinic practitioners. Extended-release Valproate Semisodium was added onto antipsychotic treatment. Individuals with active substance use disorders or active significant medical comorbidity were excluded. Primary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Geriatric Depression Scale (GDS) and Global Assessment Scale (GAS). Tolerability was evaluated via patient self-reported side effects, change from baseline in body weight and change on abnormal movement scales. Results Patients (mean age 61 years, range 49.8–79.2 years) had significant reductions in psychosis scores as measured by the Positive and Negative Syndrome Scale (PANSS) p < 0.01, as well as in global functioning as measured by the Global Assessment Scale (GAS) p < 0.01 and depression as measured by the Geriatric Depression Scale (GDS) p < 0.05. Mean dose of extended-release Valproate Semisodium was 587.50 mg/day SD ± 247.02. Extended-release Valproate Semisodium was well tolerated in this older adult population. The primary adverse effect was sedation, which appeared to be relatively dose and titration-speed dependent. Weight change was not significant. Conclusion While extended-release Valproate Semisodium appears efficacious and well tolerated in older adults with schizophrenia, data from larger, controlled trials is needed. Copyright © 2007 John Wiley & Sons, Ltd.
-
Adjunct extended-release Valproate Semisodium in late life schizophrenia
International journal of geriatric psychiatry, 2008Co-Authors: Martha Sajatovic, Nicoleta Coconcea, Rosalinda V Ignacio, Frederic C Blow, Robert W Hays, Kristin A Cassidy, William J MeyerAbstract:Objective Adjunctive anticonvulsant medications may benefit some individuals with schizophrenia, however data on adjunct anticonvulsants in older adults with schizophrenia is limited. This prospective, 12-week open label study evaluated adjunct extended-release Valproate Semisodium (divalproex) in 20 older adults with schizophrenia. Methods The study was conducted at an academic psychiatry clinic in the mid-western United States. Participants were self-referred from posted advertisements or referred by clinic practitioners. Extended-release Valproate Semisodium was added onto antipsychotic treatment. Individuals with active substance use disorders or active significant medical comorbidity were excluded. Primary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Geriatric Depression Scale (GDS) and Global Assessment Scale (GAS). Tolerability was evaluated via patient self-reported side effects, change from baseline in body weight and change on abnormal movement scales. Results Patients (mean age 61 years, range 49.8–79.2 years) had significant reductions in psychosis scores as measured by the Positive and Negative Syndrome Scale (PANSS) p
Lesley Smith - One of the best experts on this subject based on the ideXlab platform.
-
effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder a systematic review of randomized controlled trials
Bipolar Disorders, 2007Co-Authors: Lesley Smith, Victoria Cornelius, Adrian Warnock, Angus Bell, Allan H. YoungAbstract:Background:? Bipolar disorder (BD) is a leading cause of disability. Systematic reviews of randomized trials for the treatment of the maintenance phase of BD are lacking. Objectives:? To determine the efficacy and tolerability of mood stabilizers and antipsychotics in the maintenance treatment of BD. Methods:? We systematically reviewed randomized controlled trials of licensed medications for the treatment of any phase of BD. We included randomized controlled trials comparing a medication to placebo or another medication. Comprehensive searches of electronic databases were conducted to March 2005. Outcomes investigated were relapse due to mania, depression or any mood episode, and withdrawal due to any reason or due to an adverse event. Data were combined through meta-analysis. Results:? Fourteen studies (n = 2,526) met the inclusion criteria. Lithium, lamotrigine, olanzapine and Valproate Semisodium each demonstrated evidence to support long-term use. Compared with placebo, all medications were more effective at preventing relapse because of any mood episode. Hazard ratios (HR) were 0.68 [95% confidence interval (CI) = 0.53–0.86] for lithium, 0.68 (95% CI = 0.55–0.85) for lamotrigine, and 0.82 (95% CI = 0.57–1.20) for Valproate Semisodium; for olanzapine, the risk ratio (RR) was 0.58 (95% CI = 0.49–0.69). Lithium and olanzapine significantly reduced manic relapses (HR = 0.53; 95% CI = 0.35–0.79 and RR = 0.37; 95% CI = 0.24–0.57, respectively). Lamotrigine and Valproate Semisodium significantly reduced depressive relapses (HR = 0.65; 95% CI = 0.46–0.91 and RR = 0.40; 95% CI = 0.20–0.82, respectively). Lithium significantly reduced manic relapses compared with lamotrigine (HR = 0.56; 95% CI = 0.34–0.92) and olanzapine significantly reduced manic relapses compared with lithium (RR = 1.69; 95% CI = 1.12–2.55). Withdrawal due to an adverse event was approximately twice as likely with lithium compared with Valproate Semisodium (RR = 1.81; 95% CI = 1.08–3.03) and lamotrigine (RR = 2.20; 95% CI = 1.31–3.70). There were few data for carbamazepine or medications given as adjunct therapy. Conclusions:? Mood stabilizers have differing profiles of efficacy and tolerability, suggesting complementary roles in long-term maintenance treatment.
-
Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo‐controlled trials
Bipolar disorders, 2007Co-Authors: Lesley Smith, Victoria Cornelius, Adrian Warnock, Mary Jane Tacchi, David TaylorAbstract:Objectives: We conducted a systematic review and meta-analysis of randomized, placebo-controlled trials in acute bipolar mania to summarize available data on drug treatment of mania. Methods: We included trials of medications licensed in the USA or UK for the treatment of any phase of bipolar disorder. Outcomes investigated were changes in mania scores, attrition, extrapyramidal effects and weight change. Data were combined through meta-analyses. Results: We included 13 studies (involving 3,089 subjects) and identified 2 studies for each of the following medications: carbamazepine, haloperidol, lithium, olanzapine, quetiapine, risperidone, Valproate Semisodium and aripiprazole. All drugs showed significant benefit compared with placebo for reduction in mania scores. Compared with placebo, for all antipsychotics pooled, response to treatment (?50% reduction in Young Mania Rating Scale scores) was increased more than 1.7 times [relative risk (RR) = 1.74, 95% confidence interval (CI) = 1.54, 1.96]; for all mood stabilizers pooled, response to treatment was doubled (RR 2.01, 95% CI = 1.66, 2.43). Overall withdrawals were 34% fewer (24–43%) with antipsychotics, and 26% fewer (10–39%) with mood stabilizers. However, for carbamazepine, aripiprazole and lithium an increase in risk of withdrawal could not be excluded. Small but significant increases in extrapyramidal side effects occurred with risperidone and aripiprazole. Conclusions: Antipsychotics and mood stabilizers are significantly more effective than placebo for the treatment of acute mania. Their effect sizes are similar. Small differences between effect sizes may be due to differences in the patients included in the studies or to chance. Carbamazepine and lithium may be more poorly tolerated, and antipsychotics cause more extrapyramidal side effects.
