Academic journal article Current Psychiatry

Bipolar Depression Diagnosis: Confounding Factors

Academic journal article Current Psychiatry

Bipolar Depression Diagnosis: Confounding Factors

Article excerpt

INDICATIONS AND USAGE

LATUDA Is indicated for treatment of major depressive episodes associated with bipolar I disorder (bipolar depression) as monotherapy and as adjunctive therapy with lithium or valproate. The efficacy of LATUDA was established in a 6-week monotherapy study and a 6-week adjunctive therapy study with lithium or valproate In adult patients with bipolar depression. The effectiveness of LATUDA for longer-term use, that is, for more than 6 weeks, has not been established in controlled studies. Therefore, the physician who elects to use LATUDA for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. The efficacy of LATUDA in the treatment of mania associated with bipolar disorder has not been established.

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older. In patients of all ages who are started on antidepressant therapy, monitor closely for worsening, and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber. LATUDA is not approved for use in patients under the age of 18 years.

Bipolar disorder often coexists with other psychiatric disorders, which may confound diagnosis as symptoms between disorders overlap, necessitating a thorough screening to clarify root causes and, as in the case presented on the following page (S2), arrive at the correct diagnosis of bipolar I disorder. (1)

Ruling Out Psychiatric Comorbidities

As reported in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial, the most prevalent psychiatric comorbidities are anxiety disorders (which include, but are not limited to, generalized anxiety disorder, social anxiety disorder, and obsessive compulsive disorder) and substance use disorders.2 Other psychiatric comorbidities include attention deficit disorder and eating disorders. (2)

In STEP-BD, the total number of comorbid psychiatric disorders was examined, as well; 72% of patients met the criteria for at least 1 psychiatric comorbid disorder, 20% for 2 psychiatric comorbid disorders, 15% for 3 psychiatric comorbid disorders, and 17% for 4 or more psychiatric comorbid disorders. (2)

Therefore, to ensure prompt, appropriate intervention for patients with bipolar disorder, clinicians must demonstrate diagnostic vigilance in order to come to an accurate diagnosis. (2)

Screening Tools

Because confounding symptoms can be present among patients with bipolar disorder, clinicians should be familiar with various screening tools used to assess and rule out other conditions, as well as those used to confirm a diagnosis of bipolar disorder. For example, to better assess an individual's symptoms of anxiety, one of the most prevalent comorbid conditions as mentioned above, Spitzer and colleagues developed a 7-item generalized anxiety disorder scale (GAD-7). (3) This self-report scale scores 7 items of anxiety from 0 to 3 for a total score between 0 and 21.

Other tools commonly used to confirm a diagnosis of bipolar disorder are the Patient Health Questionnaire-9 item (PHQ-9), (4) which screens for symptoms of depression, and the Mood Disorder Questionnaire (MDQ), (5) which screens for bipolar disorder in the presence of euthymia or depression. As with all screening tools, a positive or negative screen should be confirmed by further clinical evaluation and before any treatment is considered.

LATUDA: A Treatment Option for Bipolar Depression

The efficacy of Latuda[R] (lurasidone HCl) was established in a 6-week monotherapy study and a 6-week adjunctive therapy study with lithium or valproate in adult patients with bipolar depression. …

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