Obsessive-compulsive disorder(OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder(BD) since the gold standard treatment for one disease(antidepressants for OCD) can worse...Obsessive-compulsive disorder(OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder(BD) since the gold standard treatment for one disease(antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessivecompulsive symptoms with remarkable improvement in social and occupational functioning for 24 months.Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines,which are greatly needed in patients with comorbid BDOCD.展开更多
To the editor:Apparent comorbidity between bipolar disorder（BD）and anxiety disorders is a common condition in psychiatry,[1,2]one of the most difficult to manage being the co-occurrence of BD and obsessive-compulsiv...To the editor:Apparent comorbidity between bipolar disorder（BD）and anxiety disorders is a common condition in psychiatry,[1,2]one of the most difficult to manage being the co-occurrence of BD and obsessive-compulsive disorder（OCD）.[3,4]In 1860 French psychiatrist BénédictAugustin Morel first described patients with symptoms typical of what is now considered comorbid BD and OCD.[5]A century later,when categorizing展开更多
Risperidone is a safe second-generation antipsychotic which is rarely associated with the emergence of a few adverse effects,such as oral lesions and stomatitis.We report the case of a 77-year-old woman affected by a ...Risperidone is a safe second-generation antipsychotic which is rarely associated with the emergence of a few adverse effects,such as oral lesions and stomatitis.We report the case of a 77-year-old woman affected by a neurocognitive disorder with psychotic features and treated with risperidone 2 mg/day.After 1 week,she showed a burning mouth syndrome with oral lesions and risperidone was discontinued.Antipsychotic-induced oral ulcerations may be caused by the reduction of saliva protection with minor adverse effects related to oral movement disorders or impairment of the bacterial flora of saliva.展开更多
Bipolar disorder (BD) is a chronic, recurrent, disabling disease, even when given currently-available pharmacological and psychological treatments. Currently, the etiology and pathogenesis of BD remain unclear. As a c...Bipolar disorder (BD) is a chronic, recurrent, disabling disease, even when given currently-available pharmacological and psychological treatments. Currently, the etiology and pathogenesis of BD remain unclear. As a consequence, patients with BD are frequently unrecognized, misdiagnosed, and inappropriately treated, which often yields a low treatment response and poor outcome.展开更多
English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder...English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety and tolerability.展开更多
文摘Obsessive-compulsive disorder(OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder(BD) since the gold standard treatment for one disease(antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessivecompulsive symptoms with remarkable improvement in social and occupational functioning for 24 months.Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines,which are greatly needed in patients with comorbid BDOCD.
文摘To the editor:Apparent comorbidity between bipolar disorder（BD）and anxiety disorders is a common condition in psychiatry,[1,2]one of the most difficult to manage being the co-occurrence of BD and obsessive-compulsive disorder（OCD）.[3,4]In 1860 French psychiatrist BénédictAugustin Morel first described patients with symptoms typical of what is now considered comorbid BD and OCD.[5]A century later,when categorizing
文摘Risperidone is a safe second-generation antipsychotic which is rarely associated with the emergence of a few adverse effects,such as oral lesions and stomatitis.We report the case of a 77-year-old woman affected by a neurocognitive disorder with psychotic features and treated with risperidone 2 mg/day.After 1 week,she showed a burning mouth syndrome with oral lesions and risperidone was discontinued.Antipsychotic-induced oral ulcerations may be caused by the reduction of saliva protection with minor adverse effects related to oral movement disorders or impairment of the bacterial flora of saliva.
基金supported by the National Key Research and Development Program of China (2016YFC1307100 and 2016YFC1307105)the Shanghai Key Medicine Specialties Program (ZK2015A06)+1 种基金Projects of International Cooperation and Exchanges National Natural Science Foundation of China (81761128032)the Sanming Project of Medicine in Shenzhen, China (SZSM201612006)
文摘Bipolar disorder (BD) is a chronic, recurrent, disabling disease, even when given currently-available pharmacological and psychological treatments. Currently, the etiology and pathogenesis of BD remain unclear. As a consequence, patients with BD are frequently unrecognized, misdiagnosed, and inappropriately treated, which often yields a low treatment response and poor outcome.
文摘English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety and tolerability.
