Impact of First Generation Antipsychotics in the Long Term Outcome of Bipolar Disorder, A Community-Based Naturalistic Follow-Up Study, Butajira, Ethiopia
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Date
2013-01
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Addis Ababa University
Abstract
Background: Bipolar disorder is one of the most severe forms of mental disorders,
and is clinically characterized by profound mood swings. Bipolar disorder is an
episodic condition requiring long-term, often life-long, treatment to control acute
symptoms and stabilize mood. Despite recommendations by some treatment
guidelines to avoid use of first generation antipsychotics(FGAs) in maintenance
treatment of bipolar disorder, their use is highly prevalent especially in resource
limited countries like Ethiopia.
Objective: To assess the impact of the long term use of FGAs in the course and
outcome of bipolar I disorder.
Methods: The Longitudinal Interval Follow-up Evaluation(LIFE) chart was used to
collect detailed psychosocial, psychopathologic and treatment outcome information.
Results: Among the study participants who were at risk for relapse, 86.5% had
experienced relapse during their follow-up. Duration on daily FGAs dose ≥ 300mg
Chlorpromazine(CPZ) equivalents was significantly associated with relapse rate in
bipolar I disorder. While FGAs use did not predict remission and overall functioning
improvement, remission was negatively associated with duration of treatment on
daily FGAs dose ≥ 300mg CPZ equivalents. Furthermore, duration on FGAs
significantly increased the risk for EPS. On the other hand, FGAs use did not predict
suicidality in bipolar I patients.
iv
Conclusion: Findings from the current study suggest that benefits of the long term
use of FGAs in bipolar disorder are doubtful. Therefore, providing access to
effective medications such as mood stabilizers may be relevant next steps to
optimize the outcome of bipolar disorder in settings where FGAs are widely used.
Key words: First generation antipsychotics, bipolar disorder, maintenance
treatment, prophylaxis, outcome, Ethiopia
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Keywords
First generation antipsychotics;Bipolar disorder, Maintenance treatment, prophylaxis, outcome, Ethiopia