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Effects of Lithium Combined with Second-Generation Antipsychotics for the Treatment of Manic Episodes in Patients with Bipolar Disorder: A Naturalistic Study in China

Authors Liu Y, Liang J, Xia Q, Zhou X, Xie X

Received 7 July 2020

Accepted for publication 8 October 2020

Published 4 November 2020 Volume 2020:16 Pages 2623—2632

DOI https://doi.org/10.2147/NDT.S270596

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Yuping Ning


Yang Liu,1,2,* Jun Liang,2,* Qingrong Xia,2 Xin Zhou,1 Xuefeng Xie1

1Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei 230032, Anhui, People’s Republic of China; 2Department of Pharmacy, Hefei Fourth People’s Hospital, Hefei 230000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xuefeng Xie
Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, People’s Republic of China
Tel/Fax +86 551 65172137
Email xiexuefeng@ahmu.edu.cn

Objective: To explore the therapeutic effects of lithium combined with second-generation antipsychotics (SGAs) of quetiapine, clozapine, olanzapine, and risperidone for the treatment of manic episodes in patients with bipolar disorder (BD) to guide the selection of medications.
Methods: We examined the case data of patients with BD who experienced manic episodes and were hospitalized in a Class 3A Psychiatric Hospital in Anhui Province from January 2015 to October 2019. The enrolled patients were rated using the Bech–Rafaelsen Mania Rating Scale (BRMS) before and after treatment, and relevant adverse effects were monitored.
Results: Analysis of the collected case data of 182 patients showed significant differences in the BRMS scores on admission and at discharge of patients treated with lithium combined with each SGA. The chi-square test showed no obvious difference in the final therapeutic effects of lithium combined with each of the four SGAs (χ2 = 7.365, P = 0.146). However, there were differences in the incidence of adverse effects (χ2 = 10.604, P = 0.014) and remission rate after 2 weeks of treatment (χ2 = 10.174, P = 0.017). Logistic regression analysis revealed that the incidence of adverse effects was related to the length of stay in hospital and clozapine treatment. The remission rate after 2 weeks was associated with the length of stay in hospital, clozapine treatment, and age of onset.
Conclusion: Lithium combined with SGAs (quetiapine, clozapine, olanzapine, and risperidone) effectively improves the manic symptoms of patients with BD who experience manic episodes. Lithium combined with quetiapine for the treatment of bipolar manic episode has advantages with respect to the speed of effective and incidence of adverse effects.

Keywords: bipolar mania, atypical antipsychotic, mood stabilizers, remission rate

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