Effect of long acting injectable antipsychotics on course and hospitalizations in bipolar disorder – a naturalistic mirror image study

Abstract

Purpose

To determining whether the addition of a long-acting injectable antipsychotic (LAI-AP) has a positive effect on prognosis in bipolar disorder.

Materials and methods

Medical records of patients with bipolar disorder who were using LAI-AP at least for one year in the community mental health center (CMHC) until March 2020 were investigated. Comparisons were made between the period of one year before and after the initiation of LAI-AP. Hospital admission was the primary outcome. Residual symptom severity and functionality were evaluated with Personal and Social Performance Scale (PSP), Young Mania Rating Scale (YMRS), and Beck Depression Inventory (BDI).

Results

There were 197 patients with bipolar disorder who were attending to the CMHC and 17 of them were under maintenance treatment with LAI-AP for at least one year. The LAI-APs used were aripiprazole (n = 8), paliperidone (n = 5) and risperidone (n = 4). Duration of illness was 13.5 ± 8.02 years and duration of LAI-AP treatment was 24.8 ± 22.74 months (median: 18). During the one-year period after the LAI-AP initiation, there were fewer days spent in hospital (2.5 ± 5.68 vs. 15.5 ± 20.59 days, p = .026) and the number of hospitalizations was lower than the year before the LAI-AP use (0.1 ± 0.39 vs. 0.9 ± 1.24 hospitalizations, p = .013). During the recovery period with LAI antipsychotics, there were mild residual symptoms presented with mean PSP (70.2), YMRS (1.7) and BDI (7.6) scores.

Conclusion

LAI-AP use may have positive effect on course for selected patients with a long history of bipolar disorder.

Keywords:

• Bipolar disorder
• long-acting injection
• maintenance treatment

Disclosure statement

The authors report no potential conflicts of interest.

Additional information

Notes on contributors

Eren Yıldızhan

Eren Yıldızhan, M.D. has graduated from Istanbul University, Medical Faculty of Cerrahpaşa in 2007 and completed his residency in psychiatry in 2012 in Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. He has been a researcher and clinical supervisor since 2015 in this hospital. He was also clinical consultant in Bağcılar Meydan Community Mental Health Center between 2019-2020.

Eda Uzun

Eda Uzun, M.D. has been resident in Psychiatry in Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery since 2018. She was graduated from İstanbul Atatürk Science High School in 2010. She studied medicine at Istanbul University, Medical Faculty of Cerrahpaşa between 2010-2016.

Nesrin Buket Tomruk

Nesrin Buket Tomruk, M.D. is a psychiatrist at Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. She is one of the founders of “modified electroconvulsive therapy unit” in this hospital in 2007. She has experience in psychopharmacology, perinatal psychiatry, treatment refractory patients.

All authors (EY, EU, NBT) contributed to planning, design and presentation of the results. EY EU and NBT did the literature search. EY and EU performed the data collection. EY conducted the statistical analysis. EY and EU wrote the initial report, EY conducted the writing and submission of the manuscript with critical contributions from EU and NBT. All authors (EY, EU, NBT) contributed and approved the revisions and the final manuscript.