Comparative Efficacy of Typical and Atypical Antipsychotics as Add-On Therapy to Mood Stabilizers in the Treatment of Acute Mania. [CME]
J Clin Psychiatry 2001;62:975-980
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Typical antipsychotics are commonly used in combination
with mood stabilizers for acute mania. Although typical antipsychotics are effective,
they have undesirable side effects such as induction of depressive symptoms
and tardive dyskinesia. Atypical antipsychotics have more favorable side effect
profiles, and recent evidence shows their efficacy in treating mania. Apart
from a previous small study that compared risperidone with typical neuroleptics
as add-on therapy to mood stabilizers, no studies to date have directly compared
atypical antipsychotics with typical antipsychotics as add-on therapy to mood
stabilizers in a clinically relevant, naturalistic setting.
Method: This study is a chart review of all patients with DSM-IV-defined
bipolar disorder, current episode mania (N = 204), admitted to the University
of British Columbia Hospital during a 30-month period. Patients were separated
into 3 groups according to the medications used: (1) mood stabilizer and typical
antipsychotic, (2) mood stabilizer and atypical antipsychotic, and (3) combination:
mood stabilizer plus a typical antipsychotic, then switched to mood stabilizer
plus risperidone or olanzapine within 1 week. The atypical group was further
subdivided into risperidone and olanzapine subgroups. Outcome was measured using
Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I)
ratings generated by review of clinical information in the chart.
Results: Patients treated with typical antipsychotics were more
severely ill at admission and at discharge than those treated with atypical
antipsychotics. Patients in the atypical (p < .005) and combination (p <
.05) groups showed significantly greater clinical improvement at discharge than
patients treated with typical antipsychotics. This difference was also significant
in the subset of patients with psychotic features (p < .03). Risperidone
and olanzapine were associated with fewer extrapyramidal side effects than were
typical antipsychotics (risperidone vs. typical antipsychotics, c2 = 8.72, p
< .01; olanzapine vs. typical antipsychotics, c2 = 16.9, p < .001).
Conclusion: Due to their superior effectiveness and side effect
profile when compared with typical antipsychotics, atypical antipsychotics are
an excellent choice as add-on therapy to mood stabilizers for the treatment
of patients with mania.