Symptoms predicting remission after divalproex augmentation with olanzapine in partially nonresponsive patients experiencing mixed bipolar I episode: a post-hoc analysis of a randomized controlled studyReportar como inadecuado




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BMC Research Notes

, 3:276

First Online: 02 November 2010Received: 16 June 2010Accepted: 02 November 2010DOI: 10.1186-1756-0500-3-276

Cite this article as: Houston, J.P., Gatz, J.L., Degenhardt, E.K. et al. BMC Res Notes 2010 3: 276. doi:10.1186-1756-0500-3-276

Abstract

BackgroundRating scale items in a 6-week clinical trial of olanzapine versus placebo augmentation in patients with mixed bipolar disorder partially nonresponsive to ≥14 days of divalproex monotherapy were analyzed to characterize symptom patterns that could predict remission. At baseline, the two treatment groups were similar.

FindingsFactor analysis with Varimax rotation was performed post hoc on baseline items of the 21-Item Hamilton Depression Rating Scale HDRS-21 and Young Mania Rating Scale YMRS. Backwards-elimination logistic regression ascertained factors predictive of protocol-defined endpoint remission HDRS-21 score ≤ 8 and YMRS score ≤ 12 with subsequent determination of optimally predictive factor score cutoffs.

Factors for Psychomotor activity YMRS items for elevated mood, increased motor activity, and increased speech and HDRS-21 agitation item and Guilt-Suicidality HDRS-21 items for guilt and suicidality significantly predicted endpoint remission in the divalproex+olanzapine group. No factor predicted remission in the divalproex+placebo group. Patients in the divalproex+olanzapine group with high pre-augmentation psychomotor activity scores ≥10 were more likely to remit compared to those with lower psychomotor activity odds ratio OR = 3.09, 95% confidence interval CI = 1.22-7.79, and patients with marginally high Guilt-Suicidality scores ≥2 were less likely to remit than those with lower scores OR = 0.37, 95% CI = 0.13-1.03. Remission rates for divalproex+placebo vs. divalproex+olanzapine patients with high psychomotor activity scores were 22% vs. 45% p = 0.08 and 33% vs. 48% p = 0.29 for patients with low Guilt-Suicidality scores.

ConclusionsPatients who were partially nonresponsive to divalproex treatment with remaining high vs. low psychomotor activity levels or minimal vs. greater guilt-suicidality symptoms were more likely to remit with olanzapine augmentation.

Trial RegistrationClinicalTrials.gov; http:-clinicaltrials.gov-ct2-show-NCT00402324?term=NCT00402324andrank=1, Identifier: NCT00402324

List of abbreviationsCGI-S Clinical Global Impressions of Severity

95% CI 95% confidence interval

DPX divalproex

HDRS-21 21-Item Hamilton Depression Rating Scale

NPV negative predictive value

OLZ olanzapine

PLA placebo

PPV positive predictive value

YMRS Young Mania Rating Scale.

Electronic supplementary materialThe online version of this article doi:10.1186-1756-0500-3-276 contains supplementary material, which is available to authorized users.

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Autor: John P Houston - Jennifer L Gatz - Elisabeth K Degenhardt - Hassan H Jamal

Fuente: https://link.springer.com/







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