Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice
AUTOR(ES)
Goi, Pedro D., Bücker, Joana, Vianna-Sulzbach, Mireia, Rosa, Adriane R., Grande, Iria, Chendo, Ines, Sodré, Leonardo A., Kauer-Sant'Anna, Marcia, Silveira, Leonardo, Kunz, Mauricio, Ceresér, Keila M., Gama, Clarissa S., Massuda, Raffael
FONTE
Rev. Bras. Psiquiatr.
DATA DE PUBLICAÇÃO
12/05/2015
RESUMO
Objectives:Staging models for medical diseases are widely used to guide treatment and prognosis. Bipolar disorder (BD) is a chronic condition and it is among the most disabling disorders in medicine. The staging model proposed by Kapczinski in 2009 presents four progressive clinical stages of BD. Our aim was to evaluate pharmacological maintenance treatment across these stages in patients with BD.Methods:One hundred and twenty-nine subjects who met DSM-IV criteria for BD were recruited from the Bipolar Disorders Program at Hospital de Clínicas de Porto Alegre, Brazil. All patients were in remission. The subjects were classified according to the staging model: 31 subjects were classified as stage I, 44 as stage II, 31 as stage III, and 23 as stage IV.Results:Patterns of pharmacological treatment differed among the four stages (p = 0.001). Monotherapy was more frequent in stage I, and two-drug combinations in stage II. Patients at stages III and IV needed three or more medications or clozapine. Impairment in functional status (Functioning Assessment Short Test [FAST] scale scores) correlated positively with the number of medications prescribed.Conclusions:This study demonstrated differences in pharmacological treatment in patients with stable BD depending on disease stage. Treatment response can change with progression of BD. Clinical guidelines could consider the staging model to guide treatment effectiveness.
Documentos Relacionados
- Valproate in Bipolar Disorder: Case Examples From a Family Practice
- Staging in bipolar disorder: one step closer to precision psychiatry
- Staging and neuroprogression in bipolar disorder: a systematic review of the literature
- Tratamento farmacológico do transtorno bipolar : as evidências de ensaios clínicos randomizados
- Perspectives on the pharmacological treatment of bipolar disorder