Rapid antipsychotic response with ziprasidone predicts subsequent acute manic/mixed episode remission.
OBJECTIVE
To assess rapid antipsychotic efficacy with oral ziprasidone monotherapy in bipolar acute manic/mixed episodes with psychotic features, and predictive value of rapid antipsychotic response for subsequent acute manic/mixed episode remission.


METHODS
Pooled analysis of two 3-week, randomized, double-blind, placebo-controlled trials of ziprasidone (40-160mg/d) in inpatients with bipolar I disorder, and a current manic or mixed episode, with (n=152) or without (n=246) psychotic features. Psychosis improvement was evaluated by change in SADS-C psychosis score (sum of delusions, hallucinations, and suspiciousness items). Rapid antipsychotic response (>or=50% decrease in SADS-C psychosis score by Day 4) and acute manic episode response and remission (endpoint >or=50% MRS decrease, and a MRS score <or=12, respectively) were analyzed.


RESULTS
Significantly greater antipsychotic effects were observed by Day 4 with ziprasidone treatment (vs. placebo) and the magnitude of improvement increased significantly with time, in all subjects, in the subgroup of all psychotic subjects, and psychotic subjects with low baseline agitation (p<0.05). Rapid antipsychotic response predicted subsequent acute manic episode remission independent of ziprasidone or placebo treatment received (p<0.001, ROC AUC=0.71) with significant improvement in accuracy of MRS remission prediction when compared to models using early changes in MRS score alone (p=0.01).


CONCLUSIONS
Post hoc analysis, use of 3 SADS-C psychosis items to assess psychosis.


CONCLUSIONS
The predictive value of rapid (Day 4) improvement in psychotic symptoms for subsequent (Day 21) remission of acute manic/mixed symptoms may facilitate enhanced therapeutics, in view of the current practice of brief hospitalization for patients with acute manic/mixed episodes with psychotic features.
Ketter
Terence A
TA
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5723, USA. tketter@stanford.edu
Agid
Ofer
O
Kapur
Shitij
S
Loebel
Antony
A
Siu
Cynthia O
CO
Romano
Steven J
SJ
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001714:Bipolar Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D055502:Secondary Prevention; D013844:Thiazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone