At discharge 778 of patients with mixed states and 857 of patients with depressive state were considered responders with regard to the MADRS scores reduction of MADRS scores of at least 50 ID: 275871
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Similarly, a statistically significant MADRS reduction over time was found (F=156.2, p<0.0005). Depressive patients improved more than patients presenting with mixed episodes (p=0.01). For MADRS scores reduction, no difference between high (>800 mg/day) and low (<800 mg/day) quetiapine groups could be seen (p=0.7). At discharge, 77.8% of patients with mixed states, and 85.7% of patients with depressive state were considered responders with regard to the MADRS scores (reduction of MADRS scores of at least 50%).With regard to tolerance, a “yes or no binary variable” (defined as chart notification of side effect), no differences in reported side effects between the low (<800 mg/day) and the high (<800 mg/day) quetiapine dose group were found (p=0.8). A logistic regression was performed to attempt to classify quetiapine doses (high vs. low) with the following candidate predictors: episode type, sex, MAS scores at entry. An overall percentage of 74% of the cases were correctly classified. The R2 Nagelkerke statistic showed that 49% of the variation in the outcome variable was explained by the model. Only episode type (p=0.02) was a significant predictor of quetiapine group whereas sex and MAS scores at admission were not. Compared to those with mixed episodes, patients with manic symptoms were less likely to be in the high dose category (O.R=0.19 and IC [0.04; 0.80]).LimitationsOpen-label, retrospective design.Observation period was limited to the hospitalization period.ConclusionsThe present study confirms quetiapine efficiency and tolerability in the treatment of bipolar episodes, even at doses >800 mg, and found a link between mixed episodes and quetiapine doses. Particularly, mixed episodes seem to respond well to quetiapine, but mostly at higher dosages than for pure manic episodes.Quetiapine dosage >800 mg/day is predicted by mixed episodes.ReferencesVieta E et al. Quetiapine monotherapy for mania associated with bipolar disorder: combined analysis of two international, double-blind, randomised, placebo-controlled studies. Curr Med Res Opin 2005, 21: 923-934.Bowden CL et al. A randomized, double-blind, placebo-controlled efficacy and safety study of quetiapine or lithium as monotherapy for mania in bipolar disorder. J Clin Psychiatry 2005, 66: 111-121.McIntyre RS et al. Quetiapine or haloperidol as monotherapy for bipolar mania--a 12-week, double-blind, randomised, parallel-group, placebo-controlled trial. Eur Neuropsychopharmacol 2005, 15: 573-585.Sachs G et al. Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study. Bipolar Disord 2004, 6: 213-223.Yatham LN et al. Quetiapine versus placebo in combination with lithium or divalproex for the treatment of bipolar mania. J Clin Psychopharmacol 2004, 24: 599-606.Calabrese JR et al. A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 2005, 162: 1351-1360.Bech P. The Bech-Rafaelsen Mania Scale in clinical trials of therapies for bipolar disorder: a 20-year review of its use as an outcome measure. CNS Drugs 2002, 16: 47-63.Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979, 134: 382-389.AknoledgementStudy supported by AstraZeneca Pharmaceuticals
IntroductionQuetiapine was found to be efficacious in the treatment of acute mania, as monotherapy1-3 or in combination with other mood stabilisers4,5 at doses up to 800 mg/day, and at doses of up to 600 mg/day as monotherapy for the treatment of bipolar depression6. The aim of this retrospective study was to investigate the efficacy, tolerability and clinical reasons for the use of high doses (>800 mg/day) of quetiapine, in routine clinical practice, in a sample of inpatients with bipolar disorder (BPD) and schizoaffective disorder (SA).MethodsData are based on a systematic chart review of all adult inpatients with BPD or SA, who received quetiapine treatment for a major mood episode between December 1999 and February 2005 in the mood and anxiety disorder treatment unit of the University Psychiatric Department of Lausanne.These charts also included the assessment of manic and depressive symptoms on admission and at discharge using the Bech-Rafaelsen Mania Scale (MAS)7, and the Montgomery-Asberg Depression Rating Scale (MADRS)8, respectively.ResultsNinety four charts were analysedANOVA for repeated measures, to test the evolution of MAS and MADRS, revealed a statistically significant MAS scores reduction between admission and discharge (F=171.4, p<0.0005); with greater reductions seen in MAS scores for manic episodes than mixed episodes (p=0.03). For MAS score reductions, no difference between high (>800 mg/day) and low (<800 mg/day) quetiapine groups was found (p=0.9). At discharge, 81.8% of patients with mixed states, and 70.7% of patients with mania were considered responders with regard to the MAS (reduction of MAS scores of at least 50%).
Quetiapine Dosage in Bipolar Disorder Episodes: A Retrospective Chart Review
Yasser Khazaal
1
, Anne Chatton
1, Martin Preisig2, Daniele Zullino11Division of Substance Abuse, University Hospitals of Geneva2Department of Psychiatry, University Hospitals of Lausanne
Service d’abus de substances
Département de Psychiatrie