Background: Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carrysignificant burden in the clinical management of bipolar depression, whereas the use of antidepressants raisesboth efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlatesof TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients.Methods: Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-IIdepressed outpatients exposed to antidepressants.Results: Second-generation antipsychotics (SGA) (p = .005), lithium (<= .001), cyclothymic/irritable/hy-perthymic temperaments (p = <= .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and de-pressive mixed features (p = .003) differed between TEM+cases vs. TEM-controls. Upon multinomial logisticregression, the accounted psychopathological features correctly classified as much as 88.6% of TEM+cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns].Specifically, lithium [B = - 2.385; p = .001], SGAs [B = - 2.354; p = .002] predicted lower rates of TEM+incontrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixedfeatures did not [B = 1.267; p = ns].Limitations: Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias andBerkson's biases. Permissive operational criterion for TEM. Relatively small sample size.Conclusions: Cyclothymic temperament and mixed depression discriminated TEM+between TEM-cases, al-though only lithium and the SGAs reliably predicted TEM+/-grouping. Larger-sampled/powered longitudinalreplication studies are warranted to allow fi rm conclusions on the matter, ideally contributing to the identifi-cation of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.
Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants
Veronese N;
2018
Abstract
Background: Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carrysignificant burden in the clinical management of bipolar depression, whereas the use of antidepressants raisesboth efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlatesof TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients.Methods: Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-IIdepressed outpatients exposed to antidepressants.Results: Second-generation antipsychotics (SGA) (p = .005), lithium (<= .001), cyclothymic/irritable/hy-perthymic temperaments (p = <= .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and de-pressive mixed features (p = .003) differed between TEM+cases vs. TEM-controls. Upon multinomial logisticregression, the accounted psychopathological features correctly classified as much as 88.6% of TEM+cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns].Specifically, lithium [B = - 2.385; p = .001], SGAs [B = - 2.354; p = .002] predicted lower rates of TEM+incontrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixedfeatures did not [B = 1.267; p = ns].Limitations: Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias andBerkson's biases. Permissive operational criterion for TEM. Relatively small sample size.Conclusions: Cyclothymic temperament and mixed depression discriminated TEM+between TEM-cases, al-though only lithium and the SGAs reliably predicted TEM+/-grouping. Larger-sampled/powered longitudinalreplication studies are warranted to allow fi rm conclusions on the matter, ideally contributing to the identifi-cation of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
