Uploaded on

Its study of comparison of valproate & lithium published in BJP.

Its study of comparison of valproate & lithium published in BJP.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
339
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
8
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Dept of Psychiatry Presentor- Dr. Nilesh BasarkarModerator- Dr. C Pinto , Dr. J P Rawat Dr. Malay Dave
  • 2. Valproate v. Lithium in the treatment of Bipolar disorder in clinical practice The British Journal of Psychiatry 2011 Lars Vedel Kessing Gunnar Hellmund John R. Geddes Guy M. Goodwin Per Kragh Andersen
  • 3. Introduction Bipolar disorder – Complex heterogeneous recurrent episodic illness.Valproate – most commonly used mood stabilizer.
  • 4. Aims and ObjectivesTo compare the effect of Valproate V. Lithium for treatment in Bipolar disorder in clinical practice.
  • 5. MethodologyObservational Cohort Study in DenmarkDiagnosed cases of Bipolar disorderOn Valproate or LithiumPeriod – 1995 - 2006
  • 6. Exclusion criteria• Anti depressants• Anti psychotics• Anti convulsants other than Valproate at the time of study
  • 7. Analysis was adjusted for• Gender ( M / F )• Age group – all age in 5 year interval , upto 24years, 25-29, 30- 34, etc. upto 60-64, 65+• Purchase of Anti depressants, Anti psychotics or Anti convulsants prior to purchase of Lithium or Valproate• Previous hospital admissions
  • 8. Analysis were carried out for four sub populations• Bipolar disorder – current episode Depression Hypo manic or Manic Mixed Remission
  • 9. ObservationGender distribution and age at first purchase of Lithium and Valproate seen to be indistinguishable .
  • 10. Risk of Psychiatric Hospital admission n Total HR Depression Mania/Mixed Total Total Valproate Valproate 719 1.33 1.32 1.29 Lithium Lithium 3549 1 1 1Depression Valproate 758 1.87 1.13 1.62 Lithium 106 1 1 1 Mania Valproate 1176 1.24 1.81 1.23 Lithium 274 1 1 1 Mixed Valproate 281 1.44 2.44 1.59 Lithium 82 1 1 1Remission Valproate 468 1.15 1.08 0.55 Lithium 78 1 1 1
  • 11. Cumulative incidence curves for risk of hospital admission
  • 12. Risk of switch to or add on of another psychotropic n HR Total Valproate 290 1.86 Lithium 1555 1Depression Valproate 50 2.52 Lithium 317 1 Manic Valproate 104 2.11 Lithium 535 1 Mixed Valproate 28 1.90 Lithium 118 1Remission Valproate 47 1.46 Lithium 257 1
  • 13. Cumulative incidence curves for the risk ofswitch to / add on of another psychotropic
  • 14. ConclusionOverall rate of hospital admissions switch on add on to another Psychotropic was increased for Valproate .Lithium is superior to Valproate.
  • 15. Take home messageUse of Lithium hampered by side effects Renal Complications Pregnancy Endocrine Neurological Cardiovascular Dermatological.