2 results
Impact of Cariprazine on Weight and Blood Pressure in Bipolar I Depression: A Real-World Study Using Electronic Medical Records
- Christoph U. Correll, François Laliberté, Guillaume Germain, Sean D. MacKnight, Huy-Binh Nguyen, Mousam Parikh, Sally W. Wade, Andrew J. Cutler
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 216
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Introduction
Patients with a severe mental illness such as bipolar I disorder (BP-I) have a higher prevalence of obesity and related metabolic comorbidities than the general population. This study evaluated the impact of cariprazine on weight and blood pressure in patients with BP-I depression using electronic medical records (EMRs) from a nationally representative database.
MethodsAnalyses were based on data from EMRs in the Symphony Health’s Integrated Dataverse® from March 2015 to October 2018. Patients ≥18 years of age with ≥2 cariprazine fills (first dispensing=index date) and clinical activity for ≥12 months pre-index (baseline) and ≥1 month post-index were included. Patients also had a diagnosis of BP-I depression at their most recent episode prior to cariprazine initiation. The on-treatment period spanned from the index date to the earliest of cariprazine discontinuation, a switch to another atypical or long-acting injectable antipsychotic, end of clinical activity, or end of data. Metabolic outcomes of interest were weight and blood pressure (systolic and diastolic). For each outcome, patients were required to have ≥1 measurement in both the baseline and on-treatment periods. Linear trajectories during those periods were estimated using mixed-effects models; 95% confidence intervals (CIs) were calculated using non-parametric bootstrap procedures.
ResultsIn total, 1702 patients who met study eligibility criteria had ≥1 weight measurement recorded in the baseline and on-treatment periods; of these patients, 178 had bipolar I depression as their most recent episode. Patients gained an average of 2.43 kg/year during the baseline period and 0.60 (95% CI: -1.97, 3.70) kg/year during the on-treatment period. Analyses of blood pressure change (n=179) showed that cariprazine had neutral effects over the on-treatment period. Patients’ systolic blood pressure increased at 1.12 mmHg/year during baseline and decreased at -0.63 (95% CI: -3.59, 2.25) mmHg/year during the on-treatment period. For diastolic blood pressure, increases of 0.25 mmHg/year during baseline and 0.44 (95% CI: -1.65, 2.16) mmHg/year during the on-treatment period were observed.
ConclusionsAlthough patient weight was increasing prior to cariprazine initiation, a neutral weight trajectory was seen with long-term cariprazine treatment among those with a most recent BP-I depression episode. Cariprazine also had minimal impact on systolic or diastolic blood pressure. Overall, these findings are consistent with prior short- and long-term studies showing that cariprazine has a neutral weight and metabolic profile.
FundingAbbVie
Characterizing the Impact of Stigma From the Perspective of Bipolar Disorder Patients: Results From a Social Listening Study
- Thais Moreira, Collette Eccleston, Kiren Patel, Christine Varley, Huy-Binh Nguyen
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 232
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- Article
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- You have access Access
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Background
Bipolar disorder (BP) is a chronic and recurrent psychiatric disorder characterized by manic/hypomanic and depressive episodes with or without mixed features. Despite high levels of functional disability associated with BP, internal and external stigma can create barriers to successful recovery. This retrospective, observational social listening study was conducted to understand how stigma-related terms correlated with discussion of therapeutic interventions and psychosocial domains associated with functional recovery in unprompted, online conversations by self-identified bipolar disorder patients.
MethodsA comprehensive search was performed for publicly available, online conversations posted on forums, blogs, message boards, and the social media platforms Facebook and YouTube between 1/1/2019 and 9/30/2021. Digital interactions of anonymous self-identified BP-diagnosed patients were analyzed to identify associations between common themes and sentiments related to BP and stigma. An index value (baseline=100) was calculated based on the expected correlation between the rate that a stigma-related concept was used in BP conversation versus general online conversation. An index value >100 indicated higher correlation than statistically expected; index values <100 indicated lower correlation than expected.
ResultsA total of 257,964 conversations from 30,710 patients with BP were identified for analysis (mean, 8.4 BP-I posts per individual/year). The most prevalent stigma-related terms in patient conversations were guilt (6.9%), frustrated/discouraged (1.8%), shame (1.1%), and exhaustion (1.1%). Stigma-related terms over-indexed in conversations attributed to bipolar patients (e.g., guilt=708, denial=563, embarrassment=480); stigma-related terms were also over-indexed in relapse-related conversations (e.g., stressed=184, shame=141, and frustrated/discouraged=124). Social/familial topics (47.2%) were discussed as often as medical/psychological interventions (48.7%) and medication (42.8%). Medical intervention-related conversations were not highly correlated with stigma, except in areas of insurance/disability. Stigma-related terms were over-indexed in conversations related to social/familial relationships (e.g., isolation/loneliness=134, guilt=132), and jobs/school (e.g., embarrassment=190, stigma=184, overwhelmed=154, shame=142, isolation/loneliness=140).
ConclusionThese analyses describe the pattern by which stigma appears in patient perceptions of psychosocial and medical/therapeutic domains. Stigma significantly associates with psychosocial domains related to functional recovery, but not with patient perceptions of therapeutic interventions. Thus, stigma may act as a barrier between symptomatic remission and functional recovery. The patient-provider therapeutic alliance represents a trusted channel and an opportunity through which patients should be supported in overcoming stigma-related barriers to functional recovery.
FundingAbbVie