Transcript than for BP II

MAnagement of biPolar disease in
INtercontinental reGion: MAPING
Preliminary results
P.M Llorca, M.M Jalal Uddin,
S.A Ahmadi Abhari, F Nacef,
V Mishyiev, D Aizenberg, L
Melas-melt, I Sedeki
Disclosures
• P-M Llorca
– Advisory board: Astra-Zeneca, Janssen, Lilly, Lundbeck, Otsuka, Roche,
Takeda
– Involvement in clinical trials for: Amgen, Astra-Zeneca, Lundbeck,
Roche, Sunovion
– Educational grants for research, honoraria and travel support for
activities as a consultant/advisor and lecturer/faculty member for
pharmaceutical companies: Astra-Zeneca, Bristol Myers Squibb, Eli
Lilly, Janssen, Lundbeck, Otsuka, Roche, Sanofi, Servier
• MaPing Study was funded by Sanofi
Rationale of the study / selection of patients
• MAPING study aims to
provide information on the
management of patients
with BD in everyday
practice, across 6 different
countries (Bangladesh,
Egypt, Iran, Israel, Tunisia
and Ukraine)
• International, multicenter,
non-interventional, crosssectional registry in bipolar
patients
• Selection of physicians
– 90 sites were randomly
selected from a preestablished list from
Bangladesh, Egypt, Iran,
Israel, Tunisia and Ukraine (in
psychiatric hospitals, general
hospitals or community).
• Selection of patients
– Clinicians at each site
screened all their consecutive
eligible patients (BD, DSM-IV
criteria), during a period of 8
months.
Main variables collected
• Patient’s characteristics:
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age
sex
educational level
professional status
degree of disability
alcohol and other substance abuse
medical history
associated psychiatric diseases
family history of psychiatric diseases
• Pharmacological treatment used:
– ongoing or prescribed
• Psychiatric hospitalizations
during the last 12 months
• Disease characteristics:
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time from first diagnosis
nature of first diagnosis
time from start of Bipolar Disorder
type of Bipolar Disorder
episodes during the last 12 months
presence of psychotic symptoms
characteristics of mood disorders
social, familial and occupational
dysfunction during the last two
months
Results
Physicians’ characteristics :
- 85 psychiatrists
- Mean age 50.6 ± 8.2 years (21.4 ±
8.3 years of practice).
- Male 77.5%
- Median number of BP seen per
month : 90
- International guidelines used :
- very frequently: 49.4%
- from time to time: 48.3%
Description of the studied population
Socio-demographic aspects
• Mean age : 37.9 ± 13.2 years
• 52.8% male - 47.2% female
• 47.6% married (n=562)
• Living in an urban area:
69.3%(n=818)
• 79.6% of patients had a
secondary or higher level of
education
• 53.4% of patients were
unemployed (n=630)
• For 47.0% (n=296)
unemployment was due to a
work disability.
• 13.6% of patients (n=161)
were in part-time
employment due to their
bipolar disorder.
• For patients in full-time or
part-time employment:
– 54.8% of patients had taken
sick leave during the past 12
months, with a median
duration of 35 days (range: 2365)
Description of the studied population
Disease characteristics
• 72.2% were diagnosed as
BP I
• 25.7% were diagnosed as
BP II
• Median time from initial
diagnosis was 80 months
(range: 0 – 608)
• 64.4% of patients were
diagnosed before the age
of 30
• Predominant initial
diagnoses:
– ‘Major depressive disorder’
36.4%
– ‘Other: bipolar disorder’ :
20.1%
• 80.8% of patients
experienced 1 to 3
episodes in the last
12 months (predominant
polarity of episodes
‘Maniac’ : 65.9%)
Description of the studied population
History of treatments
• 44.4% of patients received antidepressants at initial diagnosis
(SSRIs: 67.2%)
• 29.7 % of patients received anticonvulsants at initial diagnosis
• 67.2% of patients received antipsychotic drugs at initial diagnosis
– first generation drugs: 51.1%
– second generation drugs: 51.6%
(‘Major depressive disorder’ and ‘Other: bipolar disorder’ were the
predominant initial diagnoses : 36.4% and 20.1% respectively)
• 30 % of patients received anxiolytics at initial diagnosis
• From the 63.8% patients who received a previous antidepressant:
– 46.1% experienced manic or hypomanic switches
– 30.3% experienced irritability
– 29.6% experienced mood lability
Description of the studied population
Current symptoms
• 69.9% of patients presented at least one current symptom of mania
• The most frequent current symptoms of mania reported were:
– ‘Feeling unusually ‘high’ and optimistic or extremely irritable’ : 52.7% of
patients
– ‘Sleeping very little, but feeling extremely energetic’: 50.8% of patients
• 45.0% reported current symptoms of bipolar depression
• The most frequently reported were:
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‘Sleep problems’: 30.9% of patients
‘Feeling hopeless, sad, or empty’: 28.2% of patients
‘Fatigue or loss of energy’: 26.8% of patients
‘Concentration and memory problems’: 26.3% of patients
Description of the studied population
Functioning
• Global assessment of functioning during the last two
months (GAF):
– Social, familial and occupational dysfunction during the
last 2 months was moderate with a mean score of 54.7 ±
19.7.
Functional consequences of the disease
Relation to symptoms
• Functioning (GAF score)
was statistically
significantly worse when:
– Current manic symptoms
were experienced:
• 51.0 ± 19.0 versus 56.0 ±
18.9 for depression
symptoms (p<0.001)
– Patients with a symptom of
mania had a more
negative perception of
social functioning than
patients without mania
• Symptoms of depression
were not correlated with
the GAF score except for
‘Thoughts of death or
suicide’ (50. 0± 20.0 versus
55.3 ± 19.6, p=0.005)
Functional consequences of the disease
Symptoms
• The total number of current symptoms
(either mania or depression) was significantly
negatively correlated to the GAF Score
The more symptoms experienced by the patients
the lower the GAF score
Functional consequences of the disease
Time before diagnosis and episodes
• Time between initial diagnosis
and bipolar disorder diagnosis
was poorly correlated with GAF
score (Spearman correlation
coefficient of 0.055, p = 0.060):
• Median times were longer in
patients with a high GAF score
(1.5 years and 2.8 years for
patients with median GAF score
81-90 and 91-100, respectively)
than in patients with low GAF
score (0.6 year and 0.9 year for
patients with median GAF score
1-10 and 11-20, respectively).
• Functioning (GAF score) was
statistically significantly worse
when:
– the number of episodes that
occurred in the last 12 months was
higher than or equal to 4 (46.1 ±
19.0 versus 55.3 ± 19.6, p<0.001)
– at least one psychiatric
hospitalization occurred in the last
12 months (59.6 ± 18.7 versus 49.3
± 19.5 for one hospitalization and
47.8 ±18.9 for multiple
hospitalizations p<0.001)
Functional consequences of the disease
• Important impact of manic symptoms
• Impact of suicidality
• Impact of the number of symptoms
• Impact of the number of episodes
Current symptoms and current treatment
• Symptoms of mania were
associated with:
– a statistically significant increase in
antipsychotic drug prescription
(e.g. from 78.7% to 91.2% for
‘unrealistic, or grandiose beliefs
about one’s abilities or powers’)
– Patients who reported ‘Racing
thoughts: jumping quickly from
one idea to the next’, ‘Sleeping
very little, but feeling extremely
energetic’ or ‘Impaired judgment
and impulsiveness’ received more
mood stabilizers than others
(respectively 90.0% versus 83.2%,
88.6% versus 82.6% and 88.1%
versus 83.9%)
– a decrease in antidepressant drug
prescription (from 44.6% to 21.9%)
• Depression symptoms were
associated with
– a significant increase in
antidepressant drug prescription
(e.g. from 21.5% to 73.3% for
‘hopelessness, sadness or
emptiness feelings’)
– a decrease in antipsychotic drug
prescription (apart from ‘Feelings
of worthlessness or guilt’,
‘Thoughts of death or suicide’ and
‘Irritability’)
Current symptoms and treatment
• Antidepressants are largely used for bipolar
depression in our sample
• Second Generation Antipsychotics and Mood
stabilizers are the most prescribed for manic
symptoms
– The difference of use between those two classes
remains difficult to describe
BP I vs BP II
Time between initial diagnosis and bipolar disorder
# P-value, Wilcoxon-Mann-Whitney test (Two-sided).
* P-value, Chi-square test
The average time from initial diagnosis to bipolar disorder diagnosis was shorter
for BP I patients (median time of 0.8 year) than for BP II (median time of 2.2 years)
BP I vs BP II
Functioning
• BP I patients had a lower GAF score than BP II patients:
53.8 ± 20.0 versus 56.9 ± 18.5 (p = 0.017):
– BP I patients suffered from more social, familial and
occupational dysfunction in the last two months
• Work status and productivity:
– no statistically difference between BP I and BP II.
Work productivity
by bipolar disorder
type
BP I vs BP II
Treatments
• BP II patients tended to receive more antidepressants than
BP I patients: 58.1% versus 27.8%
– SSRIs remained the most common antidepressant for BP II
(80.1%) and BDI (76.4%)
• BP I patients tended to receive more antipsychotics
(87.7%) than BP II patients (72.3%)
– Second generation antipsychotic were received by more
patients suffering from BDII than BDI (91.8% versus 75.9%).
• BP I patients tended to receive more anxiolytics (54.8%)
than BP II patients (41.3%)
– Benzodiazepines were the most commonly used anxiolytic for
both bipolar disorders (98.6% for BDII and 96.8% for BDI)
BP I vs BP II
• BP II is less recognized compared to BP I
• BP I have more important functional
consequences in all the domains
• BP II received more AD (SSRIs) and more SGA