ASPOFAFF :: Journal - Volume 2 :: Volume 2 - Issue 1 :: Vol 2 - Iss 1 - Short Communication - Oxcarbazepine in Patients with Bipolar Disorders resistant or Intolerant to Standard Mood Stabilisers: A Naturalistic Case Series


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ASPOFAFF :: Journal - Volume 2 :: Volume 2 - Issue 1 :: Vol 2 - Iss 1 - Short Communication - Oxcarbazepine in Patients with Bipolar Disorders resistant or Intolerant to Standard Mood Stabilisers: A Naturalistic Case Series

Vol 2 - Iss 1 - Short Communication - Oxcarbazepine in Patients with Bipolar Disorders resistant or Intolerant to Standard Mood Stabilisers: A Naturalistic Case Series #69

Oxcarbazepine in Patients with Bipolar Disorders resistant or Intolerant to Standard Mood Stabilisers: A Naturalistic Case Series Giulio Perugi a b, Cristina Tonib, Franco Frarebc, Giuseppe Ruffoloa, Hagop S. Akiskald a Institute of Behavior Sciences "G. De Lisio", Carrara-Pisa, Italy bDepartment of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Psychiatry Section, University of Pisa, Pisa, Italy c Adults Mental Health Unit, Pistoia Zone, Pistoia, Italy d International Mood Center, Department of Psychiatry at the University of California at San Diego and Veterans Administration Medical Center, La Jolla, CA, (USA) Correspondence: Dr. Giulio Perugi Dipartimento di Psichiatria, Università di Pisa, Via Roma 67, 56100, Pisa, ITALY. Tel.: +39 050 835414 Fax.: +39 050 21581 E-mail: gperugi@psico.med.unipi.it Abstract: Objective: The limitations of standard mood stabilizers (lithium, valproate, carbamazepine) prompted the search for alternative options for the treatment of bipolar disorder (BD). The demonstration of the mood-stabilizing properties of other anticonvulsants, such as Oxcarbazepine (OXC), might significantly broaden the array of treatment options for BD. Method: A chart review was conducted on 48 patients with Bipolar I Disorder and current Manic (n=11, 22.9%), Mixed (n=21, 43.8%) or Major Depressive (n=16, 33.3%) Episode according to DSM-IV criteria, admitted to the day-hospital of the Department of Psychiatry at the University of Pisa or to the out-patient services of the Institute of Behavioral Sciences “G. De Lisio”. Diagnostic evaluation was done by means of the Semistructured Interview for Mood Disorder-revised version (SIMD-R). All patients were resistant or intolerant to standard mood stabilizers. OXC was utilized either as monotherapy (n=9, 18.8%) or added to the ongoing treatments (n=39, 81.2%) with conventional mood stabilizers, antidepressants, antypsychotics, which had induced no response in patients after a period of at least 12 weeks. In all patients, clinical state and adverse effects were assessed at each visit. Final CGI-Improvement scores of 1 or 2 were considered responders. Results: Mean duration of OXC treatment was 23.6 weeks (sd=17.5, range 4-64), with a mean final dose of 1218±448.0 mg/day (range 600-2400 mg/day). Treatment with OXC was well-tolerated and negative interactions with concomitant psychotropic medications were not reported. Only 4 patients had to interrupt OXC: 2 for reappearance of depression, 1 for nausea and vomiting and 1 for sedation and irritability; in the other patients the most frequent side effects were sedation (n=13, 20.8%), tremor (n=8 16.7%), nausea (n=6, 12.5%), and motor instability (n=4, 8.3%). Of the 2 patients that had to interrupt OXC because of the reappearance of depressive symptomatology, 1 had to be administered lithium and antidepressants, the other lamotrigine. Thirthy-one (64.5%) of 48 patients who began treatment were considered responders; 12 (25.0%) showed marked improvement (CGI=1) and 19 (39.6%) a moderate improvement (CGI=2); another 4 (8.3%) manifested a transient response not sustained to the endpoint. The mean±sd initial and final scores of CGI-Severity scale for all patients (responders and non-responders combined) were, respectively, 5.15±0.7 and 3.08±1.3. The mean change in CGI-Severity scale (-2.06) was statistically significant (t=11.98, p<.0001). Conclusion: OXC resulted well tolerated and potentially useful either as monotherapy or in the adjunctive treatment of patients with bipolar disorder resistant or intolerant to standard mood stabilizers. Controlled data are necessary to confirm this observation. Key Words: Oxcarbazepine, Bipolar Disorder, Mood Stabilizer

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