title: A randomized open comparison of long-acting injectable risperidone and treatment as usual for prevention of relapse, rehospitalization, and urgent care referral in community-treated patients with rapid cycling bipolar disorder.
abstract: OBJECTIVE
  To compare adjunctive long-acting injectable risperidone plus treatment as usual (RLAI+TAU) versus TAU alone for relapse, rehospitalization, and urgent care events in patients with bipolar disorder in routine care settings.
  
  
  METHODS
  This was a 12-month randomized open comparison of RLAI+TAU (n = 20) and TAU alone (n = 25) in adults with rapid cycling, Mini International Neuropsychiatric Interview-confirmed bipolar I/II disorder and 4 or more illness relapses in the preceding 12 months. Clinical outcome was assessed every 2 weeks using the Longitudinal Interval Follow-up Evaluation instrument. Psychopathology and quality of life were assessed monthly using the Young Mania Rating Scale, Montgomery-Asberg Depression Rating Scale, Quick Inventory of Depressive Symptoms-Self Report 16 and Quality of Life, Enjoyment, and Satisfaction Questionnaire. Relapse was defined using symptom severity, necessary clinical adjustment of medications, and urgent care referrals. Relapse rates and duration were calculated per person per year of follow-up. All treatments were provided by community-based clinicians.
  
  
  RESULTS
  There were no significant between-groups differences in the total number or duration of relapse events (any cause) or in the number of manic or depressive relapses. Thirteen of 14 urgent care events (hospitalization, emergency department visit, intensive outpatient, or respite care referral) occurred with TAU alone (92.3%). Urgent care referral (P < 0.04) and necessary medication change rates (P = 0.01) were significantly lower in the RLAI+TAU group. There were no significant between-groups differences in the duration of follow-up, hospitalization rates, or psychopathology over time.
  
  
  CONCLUSIONS
  Rates of any-cause relapse may not differ significantly between RLAI+TAU and TAU alone; however, RLAI may reduce the need for urgent care referrals or the frequency of medication adjustments to prevent relapse in community-treated patients with rapid cycling bipolar disorder. Additional investigation is warranted.
authors: Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA. william.v.bobo@vanderbilt.edu
authors: William V
authors: WV
authors: Bobo
authors: Richard A
authors: RA
authors: Epstein
authors: Alan
authors: A
authors: Lynch
authors: Tynya D
authors: TD
authors: Patton
authors: Nicholas A
authors: NA
authors: Bossaller
authors: Richard C
authors: RC
authors: Shelton
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D003153:Community Health Services / Q000379:methods / Q000639:trends*; D003692:Delayed-Action Preparations; D004632:Emergency Medical Services / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007267:Injections; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000639:trends*; D018967:Risperidone / Q000008:administration & dosage*; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D018967:Risperidone