Use of injectable antipsychotics in bipolar I disorder



Comment by Diane McIntosh, BSc Pharmacy, MD, FRCPC – Vancouver, British Columbia

Among the many clinical challenges in the management of bipolar I disorder, the need for effective treatments that maintain symptomatic remission and promote long-term adherence is paramount. Depending on the study population and the methodology employed, up to 60% of patients diagnosed with bipolar disorder do not adhere to treatment recommendations (Colom et al. Bipolar Disord 2005;7(suppl 5):24-31). A recent study reported that patients with bipolar disorder missed doses a mean of three days in the preceding week (Levin et al. J Nerv Ment Dis 2017;205:182-187). Treatment nonadherence is a major risk factor for relapse, readmission to hospital and suicidality (Rascati et al. Psychiatr Serv 2011;62:1032-1040) and is associated with higher rates of work absenteeism and disability (Bagalman et al. J Occup Environ Med 2010;52:478-485). Read More

‘Seduced by significance” – the p-value controversy


The past decade has seen numerous criticisms of statistical methodology in biomedical research, fuelled in part by a ‘reproducibility crisis’ – the concern that many supposedly significant results cannot be replicated. The latest salvo was an editorial recently published in the Journal of the American Medical Association (Ioannidis JPA. JAMA 2018;319:1429-1430). Read More

Comorbidity – a publishing phenomenon


2018Research into comorbidity has expanded exponentially in recent years, with over 55,000 papers published in the medical literature over the past seven years, according to a new analysis of the Web of Science database of biomedical publications (Catala-Lopez et al. PLoS One 2018;13:e0189091). The literature search terms included “comorbidity”, in which there is another medical condition in addition to an index disease; as well as the emerging “multimorbidity”, a more patient-centric term in which no index disease is defined and all conditions are viewed with equal importance. Several neologisms have been coined less successfully, such as “multipathology”, “polymorbidity”, “polipathology”, and “pluripathology”. Read More

Vortioxetine: Improved work productivity in adults with major depression



Comment by Dr. Pratap Chokka, Edmonton, Alberta

Antidepressant therapies have traditionally been evaluated for their effect on symptoms of depression and anxiety. However, symptomatic improvements may not result in functional gains in areas such as work performance and productivity, activities of daily living and quality of life. In the latest iteration of the Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder (MDD), functional recovery was recognized as a priority in the treatment of MDD in both the acute and maintenance phases of the disease (Lam et al. Ann Clin Psychiatry 2015;27:142-149). The group concluded that there was a need for evidence-based interventions that demonstrated an improvement in patient functioning. Read More