Acta Scientific Medical Sciences (ISSN: 2582-0931)

Research Article Volume 4 Issue 3

A Double-Blind Comparison Between Lithium and Third Generation Antipsychotic

Saeed Shoja Shafti*

Full Professor of Psychiatry, University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Tehran, Iran

*Corresponding Author: Saeed Shoja Shafti, Full Professor of Psychiatry, University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Tehran, Iran.

Received: January 20, 2020; Published: February 11, 2020

×

Abstract

Background: While prescription of lithium has been limited in recent years due to its adverse effects and necessity for frequent laboratory tests, second generation antipsychotics (SGAs) are introduced as helpful medications for acute and maintenance treatment of bipolar disorder. To compare lithium with aripiprazole in a group of patients with diagnosis of acute mania was the objective of the present trial.

Methods: A total of 30 male inpatients with diagnosis of bipolar I disorder were entered into a four-week, double-blind study for random assignment to lithium carbonate (800 - 1200 mg/day) or aripiprazole (20 - 30 mg/day) (n =15 in each group). While Manic State Rating Scale (MSRS) was the main outcome measure in the present assessment, other scales such as Bech-Rafaelsen Mania Scale (BRMS), Schedule for Assessment of Insight (SAI) and Clinical Global Impressions-Global Improvement scale (CGI-G) have been used as secondary outcome measures.

Results: At the end of assessment and in comparison with baseline frequency and intensity of symptoms reduced significantly in both groups (p < 0.05), improvement was significantly more remarkable by lithium compared with aripiprazole (p < 0.01). Also, while CGI-G demonstrated significant improvement by both of them (p < 0.04 for aripiprazole and p < 0.002 for lithium), BRMS and SAI showed significant amelioration only in the lithium group (p < 0.001and p < 0.000, respectively).

Conclusion: Though both aripiprazole and lithium were helpful in the improvement of manic symptoms, treatment with lithium was more advantageous.

Keywords: Bipolar Disorder; Acute Mania; Lithium; Aripiprazole

×

References

  1. American Psychiatric Association (APA). “Diagnostic and Statistical Manual of Mental Disorders”. 5th ed. Washington, DC: American Psychiatric Association (2013): 123-132.
  2. Neel Burton, Psychiatry, 2nd Edition, John Wiley and Sons Ltd, Oxford, UK (2010): 89-120.
  3. Bouchra O., et al. “Screening of the unrecognized bipolar disorders among outpatients with recurrent depressive disorder: a cross-sectional study in psychiatric hospital in Morocco”. Pan African Medical Journal 27 (2017): 247. 
  4. Brown R., et al. “Aripiprazole alone or in combination for acute mania”. The Cochrane Database of Systematic Reviews 12 (2013): CD005000. 
  5. Tohen M and Vieta E. “Antipsychotic agents in the treatment of bipolar mania”. Bipolar Disord 11.2 (2009): 45-54. 
  6. Sayyaparaju KK., et al. “When to start aripiprazole therapy in patients with bipolar mania”. Neuropsychiatric Disease and Treatment 10 (2014): 459-470. 
  7. Dhillon S. “Aripiprazole: a review of its use in the management of mania in adults with bipolar I”. Disorder Drugs 72.1 (2012): 133-162. 
  8. Tsai AC., et al. “Aripiprazole in the maintenance treatment of bipolar disorder: a critical review of the evidence and its dissemination into the scientific literature”. PLOS Medicine 8.5 (2011): 100-114.
  9. Vieta E., et al. “Assessment of safety, tolerability and effectiveness of adjunctive aripiprazole to lithium/valproate in bipolar mania: a 46-week, open-label extension following a 6-week double-blind study”. Current Medical Research and Opinion 26.6 (2010): 1485-1496. 
  10. McKeage K. “Aripiprazole: a review of its use in the treatment of manic episodes in adolescents with bipolar I disorder”. CNS Drugs 28.2 (2014): 171-183. 
  11. Keck PE., et al. “Aripiprazole monotherapy in the treatment of acute bipolar I mania: a randomized, double-blind, placebo- and lithium-controlled study”. Journal of Affective Disorders 112.1-3 (2009): 36-49.
  12. El-Mallakh RS., et al. “A 40-week double-blind aripiprazole versus lithium follow-up of a 12-week acute phase study (total 52 weeks) in bipolar I disorder”. Journal of Affective Disorders 136.3 (2012): 258-266. 
  13. Kumar A., et al. “Atypical antipsychotics for psychosis in adolescents”. The Cochrane Database of Systematic Reviews 15.10 (2013): CD009582. 
  14. Beigel A., et al. “The Manic-State Rating Scale: Scale Construction, Reliability, and Validity”. Archives of General Psychiatry 25 (1971): 256-262.
  15. Bech P., et al. “The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale”. Acta Psychiatrica Scandinavica 59.4 (1979): 420-430.
  16. David AS. “Insight and Psychosis”. British Journal of Psychiatry 156 (1990): 798-808.
  17. Clinical Global Impressions, "ECDEU Assessment manual for psychopharmacology, Guy W, ed, Rockville: U.S Department of Health, Education, and Welfare, DHEW Publication NO. (ADM) (1976): 76-338.
  18. Neel Burton, Psychiatry, 2nd Edition, John Wiley and Sons Ltd, Oxford, UK (2010): 89-120.
  19. Cornelius Katona., et al. “Psychiatry at a Glance, 5th Edition”. John Wiley and Sons Ltd, Oxford, UK (): 24-25. 
  20. Yildiz A., et al. “Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials”. Neuropsychopharmacology 36.2 (2011): 375-389.
  21. Yatham LN., et al. “Efficacy of aripiprazole versus placebo as adjuncts to lithium or valproate in relapse prevention of manic or mixed episodes in bipolar I patients stratified by index manic or mixed episode”. Journal of Affective Disorders 147.1-3 (2013): 365-372. 
  22. McIntyre RS. “Aripiprazole for the maintenance treatment of bipolar I disorder: A review”. Clinical Therapeutics 32.1 (2010): 33-38. 
  23. Yatham LN. “A clinical review of aripiprazole in bipolar depression and maintenance therapy of bipolar disorder”. Journal of Affective Disorders 128.1 (2011): 21-28. 
  24. Harrison P., et al. “Lecture Notes: Psychiatry, 10th Edition”. Wiley-Blackwell, United Kingdom (2010): 100-101.
  25. Shoja Shafti S. “Olanzapine vs. lithium in management of acute mania”. Journal of Affective Disorders 122 (2010): 273-276.
  26. Shoja Shafti S and Shahveisi B. “Comparison Between Lithium and Valproate in the Treatment of Acute Mania”. Journal of Clinical Psychopharmacology 28.6 (2008): 718-720.
×

Citation

Citation: Saeed Shoja Shafti. “A Double-Blind Comparison Between Lithium and Third Generation Antipsychotic". Acta Scientific Medical Sciences 4.3 (2020): 01-08.



Member In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for March Issue
    The last date for submission of articles for regular Issues is February 29, 2020.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US