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Bipolar disorders: from remission to maintenance
Vieta Eduard
Annals of General Psychiatry , 2006, DOI: 10.1186/1744-859x-5-s1-s26
Melhorando o desfecho do transtorno bipolar usando estratégias n?o farmacológicas: o papel da psicoeduca??o
Colom, Francesc;Vieta, Eduard;
Revista Brasileira de Psiquiatria , 2004, DOI: 10.1590/S1516-44462004000700011
Abstract: the present paper addresses the efficacy of psychoeducation and related strategies in bipolar disorders. recently, several randomised clinical trials have shown the efficacy of psychological interventions -namely identification of prodromal signs, cognitive-behavioral therapy, psychoeducation and family-focused interventions- as a prophylactic add-on to medication. all these studies are presented hereby, together with the pioneer studies in the field. there are several topics that every psychoeducational program should include to ensure its usefulness, and they will be summarized in twelve points. roughly, psychoeducation should contain general information about bipolar illness, compliance enhancement elements, teaching on early recognition of relapses and lifestyle regularity issues. nowadays, several treatment guidelines include psychoeducation as a crucial prophylactic tool. clinicians should be aware of this and start performing psychoeducation in their everyday clinical practice.
Efficacy and safety of aripiprazole in the treatment of bipolar disorder: a systematic review
Konstantinos N Fountoulakis, Eduard Vieta
Annals of General Psychiatry , 2009, DOI: 10.1186/1744-859x-8-16
Abstract: A systematic Medline and repositories search concerning the usefulness of aripiprazole in bipolar disorder was performed, with the combination of the words 'aripiprazole' and 'bipolar'.The search returned 184 articles and was last updated on 15 April 2009. An additional search included repositories of clinical trials and previous systematic reviews specifically in order to trace unpublished trials. There were seven placebo-controlled randomised controlled trials (RCTs), six with comparator studies and one with add-on studies. They assessed the usefulness of aripiprazole in acute mania, acute bipolar depression and during the maintenance phase in comparison to placebo, lithium or haloperidol.Aripiprazole appears effective for the treatment and prophylaxis against mania. The data on bipolar depression are so far negative, however there is a need for further study at lower dosages. The most frequent adverse effects are extrapyramidal signs and symptoms, especially akathisia, without any significant weight gain, hyperprolactinaemia or laboratory test changes.The treatment of bipolar illness started with lithium and Frederik Lange in the late 19th century [1]; later John Cade in 1949 [2-4] and Mogens Schou with Poul Christian Baastrup in the 1970s established its effectiveness [5-10]. Its long-term effects are still a matter of debate [11]. Anticonvulsants are also considered to be useful in the treatment of bipolar illness. In spite of what many clinicians believe, there is no class effect for this group in bipolar disorder, since only valproate carbamazepine and lamotrigine have strong data support. The use and usefulness of antidepressant agents in bipolar disorder (BD) is controversial. Guidelines suggest their cautious use and always in combination with an antimanic agent [12]. This is because antidepressants are believed to induce switching to mania or hypomania [13-16], mixed episodes [17] and rapid cycling, while research suggests that the use of antimanic agents
Amisulpride plus valproate vs haloperidol plus valproate in the treatment of acute mania of bipolar I patients: a multicenter, open-label, randomized, comparative trial
Pierre Thomas,Eduard Vieta for the SOLMANIA study group
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Pierre Thomas1, Eduard Vieta2 for the SOLMANIA study group1Department of Psychiatry, Fontan Hospital CHRU Lille, University of Lille 2, France; 2Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, SpainAbstract: The primary objective of this study was to compare the effectiveness of combination treatment of valproate and amisulpride with that of valproate and haloperidol in bipolar I disorder. Adult inpatients with a current manic episode fulfilling DSM-IV-TR diagnostic criteria for bipolar type I disorder were included. Patients were randomized to amisulpride (400–800 mg/day) or haloperidol (5–15 mg/day) for 3 months and all received valproate. The primary effectiveness criterion was the percentage of responders (defined by a decrease of ≥50% of the Y-MRS) in patients completing the study. Safety was evaluated by adverse event reporting, determination of extrapyramidal function and clinical examination. Sixty-two patients were randomized to receive valproate-amisulpride, and 61 to receive valproate-haloperidol. At study end, responder rates were 72.6% in the amisulpride group and 65.5% in the haloperidol group. Remission rates were 83.9% and 89.7%, respectively. At study end, neither response rates nor remission rates differed significantly between groups. Treatment-emergent adverse events occurred significantly (p = 0.009) more frequently in the haloperidol group (86.4%) than in the amisulpride group (66.1%). In conclusion, the valproate–amisulpride combination was as effective as the valproate – haloperidol combination in bipolar I patients, with a better safety profile.Keywords: amisulpride, valproate, haloperidol, clinical trial, mania, bipolar disorder
Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis
Konstantinos N Fountoulakis, Xenia Gonda, Eduard Vieta, Frank Schmidt
Annals of General Psychiatry , 2009, DOI: 10.1186/1744-859x-8-27
Abstract: A systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted.The meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively).The data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.The treatment of bipolar disorder (BD) is difficult since the illness itself is complex [1-7]. In the BD clinical picture, psychotic features are a very frequent manifestation although they are not considered to constitute a core feature of the disorder. Delusions are relatively more common than hallucinations. However, it is reported that unipolar-depressed patients who later 'convert' to BD over time, as well as bipolar depressives, manifest more frequently psychotic features and pathological (psychotic) guilt [8,9]. Additionally, within the BD patient group it has been suggested (but not proven) that those patients with a history of psychotic symptoms suffer from a greater impairment regarding the neuropsychological performance especially concerning verbal memory and executive function [10,11].Psychotic featu
Class effect of pharmacotherapy in bipolar disorder: fact or misbelief?
Konstantinos N Fountoulakis, Xenia Gonda, Eduard Vieta, Zoltan Rihmer
Annals of General Psychiatry , 2011, DOI: 10.1186/1744-859x-10-8
Abstract: We reviewed the available treatment data from randomized controlled trials (RCTs) and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD) (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression).From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania) and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics.The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.In the last decade there were important developments in our understanding of bipolar disorder (BD), as well as its treatment. From a historical point of view, since Hippocrates from antiquity to Emil Kraepelin in the early 20th century, manic depressive illness has been established as a nosological entity (and separate from schizophrenia) on the basis of heredity, longitudinal follow-up and a supposed favorable outcome. However, recently there was important insight into the illness with the description and definition of subtypes (BD-I to BD-VI) [1-3].This dramatically changed the perceived epidemiology of the disorder. Although earlier stu
Long term lithium therapy: a neuroprotective or neurotoxic factor? A systematic review of existing data
Fountoulakis Konstantinos,Vieta Eduard,Bouras Constantin,Notaridis Grigorios
Annals of General Psychiatry , 2006, DOI: 10.1186/1744-859x-5-s1-s329
Anticonvulsants in the treatment of aggression in the demented elderly: an update
Amann Benedikt,Pantel Johannes,Grunze Heinz,Vieta Eduard
Clinical Practice and Epidemiology in Mental Health , 2009, DOI: 10.1186/1745-0179-5-14
Abstract: Introduction Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. Methods Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. Results To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. Conclusion So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.
Treatment guidelines for bipolar disorder: a critical review
Fountoulakis Konstantinos,Vieta Eduard,Sαnchez-Moreno José,Kaprinis Stergios
Annals of General Psychiatry , 2006, DOI: 10.1186/1744-859x-5-s1-s327
Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder
Konstantinos N Fountoulakis, Eduard Vieta, Melina Siamouli, Marc Valenti, Stamatia Magiria, Timucin Oral, David Fresno, Panteleimon Giannakopoulos, George S Kaprinis
Annals of General Psychiatry , 2007, DOI: 10.1186/1744-859x-6-27
Abstract: This article summarizes the current status of our knowledge and practice of its treatment.It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling.The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.The term 'bipolar disorder' (BD) is the contemporary label used for what is widely known as manic depressive illness, and was described for the first time by Hippocrates and Areteus. In modern times, Falret defined it as an illness in 1851. Today, two types are officially recognized, bipolar disorder type I and type II (BD-I and BD-II), and combined they account for a 3.7% prevalence rate or higher [1,2]. Both types constitute disabling conditions. Treatment aims to the resolution of symptoms, the restoration of psychosocial functioning and the prevention of relapses.When collect
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