Sébastien Brodeur1, Hugo Terrisse2, Arnaud Pouchon1, Ophelia Godin3, Bruno Aouizerate4, Valerie Aubin5, Frank Bellivier6, Raoul Belzeaux7, Thierry Bougerol1, Philippe Courtet8, Caroline Dubertret9, Sebastien Gard4, Emmanuel Haffen10, Chantal Henry11, Marion Leboyer3, Emilie Olié8, Paul Roux12, Ludovic Samalin13, Raymund Schwan14, Bruno Etain6, Jean-Luc Bosson2, Mircea Polosan15. 1. Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, Grenoble , T. Bougerol, B. Fredembach, A. Suisse, S. Brodeur, A. Pouchon, and M. Polosan, France. 2. TIMC-IMAG, University Grenoble Alpes, France. 3. AP-HP, DHU PePSY, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, Créteil ; S. Hotier, A. Pelletier, N. Drancourt, JP. Sanchez, E. Saliou, C. Hebbache, J. Petrucci, L. Willaume and E. Bourdin. 4. Hôpital C. Perrens, Centre Expert Trouble Bipolaire, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, B. Antoniol, A. Desage, S. Gard, A. Jutant, K. Mbailara, I. Minois, and L. Zanouy, France. 5. Centre Hospitalier Princesse Grace, Monaco, V. Aubin, I. Cussac, M.A Dupont, J. Loftus, and I. Medecin, Monaco. 6. AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, F. Bellivier, M. Carminati, B. Etain, E. Marlinge, M. Meyrel, France. 7. Pôle de Psychiatrie, addictologie et pédopsychiatrie, Hôpital Sainte Marguerite, Marseille , R. Belzeaux, N. Correard, F. Groppi, A. Lefrere, L. Lescalier., E. Moreau, J. Pastol, M. Rebattu, B. Roux and N. Viglianese, France. 8. Département d'Urgence et Post Urgence Psychiatrique, CHRU Montpellier, Montpellier , C. Abettan, L. Bardin, A. Cazals, P. Courtet, B. Deffinis, D. Ducasse, M. Gachet, A. Henrion, E. Martinerie, F. Molière, B. Noisette, E. Olié and G. Tarquini, France. 9. AHPH, Departement de Psychiatrie, Hopital Louis Mourier, Colombes, France, C. Dubertret, N. Mazer, C. Portalier, Monaco. 10. Service de psychiatrie, CHU de Besançon, laboratoire de Neurosciences, Université de Franche-Comté, E. Haffen, France. 11. Université Paris Descartes, Pôle Hospitalo-Universitaire Paris 15ème, GHU, Centre Hospitalier Sainte Anne, France. 12. Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'adultes, Le Chesnay, A. M. Galliot, I. Grévin, A. S. Cannavo, N. Kayser, C. Passerieux, and P. Roux; Service de Psychiatrie, France. 13. CHU de Clermont Ferrand, Pôle de Psychiatrie, Clermont Ferrand : Service de Psychiatrie de l'adulte B, Centre Expert Trouble Bipolaire, CHU de Clermont-Ferrand, Clermont-Ferrand, France , PM. Llorca, L. Samalin, L., C. Moreau, D. Lacelle, S.Pires, C. Doriat, and O. Blanc, France. 14. Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandœuvre Les Nancy ; R. Cohen, Raymond Schwan, J. P. Kahn, M. Milazzo, and O. Wajsbrot-Elgrabli, France. 15. Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, Grenoble , T. Bougerol, B. Fredembach, A. Suisse, S. Brodeur, A. Pouchon, and M. Polosan, France. Electronic address: MPolosan@chu-grenoble.fr.
Abstract
BACKGROUND: Despite thorough and validated clinical guidelines based on bipolar disorders subtypes, large pharmacological treatment heterogeneity remains in these patients. There is limited knowledge about the different treatment combinations used and their influence on patient outcomes. We attempted to determine profiles of patients based on their treatments and to understand the clinical characteristics associated with these treatment profiles. METHODS: This multicentre longitudinal study was performed on a French nationwide bipolar cohort database. We performed hierarchical agglomerative clustering to search for clusters of individuals based on their treatments during the first year following inclusion. We then compared patient clinical characteristics according to these clusters. RESULTS: Four groups were identified among the 1795 included patients: group 1 ("heterogeneous" n = 1099), group 2 ("lithium" n = 265), group 3 ("valproate" n = 268), and group 4 ("lamotrigine" n = 163). Proportion of bipolar 1 disorder, in groups 1 to 4 were: 48.2%, 57.0%, 48.9% and 32.5%. Groups 1 and 4 had greater functional impact at baseline and a less favorable clinical and functioning evolution at one-year follow-up, especially on GAF and FAST scales. LIMITATIONS: The one-year period used for the analysis of mood stabilizing treatments remains short in the evolution of bipolar disorder. CONCLUSIONS: Treatment profiles are associated with functional evolution of patients and were not clearly determined by bipolar subtypes. These profiles seem to group together common patient phenotypes. These findings do not seem to be influenced by the duration of disease prior to inclusion and neither by the number of treatments used during the follow-up period.
BACKGROUND: Despite thorough and validated clinical guidelines based on bipolar disorders subtypes, large pharmacological treatment heterogeneity remains in these patients. There is limited knowledge about the different treatment combinations used and their influence on patient outcomes. We attempted to determine profiles of patients based on their treatments and to understand the clinical characteristics associated with these treatment profiles. METHODS: This multicentre longitudinal study was performed on a French nationwide bipolar cohort database. We performed hierarchical agglomerative clustering to search for clusters of individuals based on their treatments during the first year following inclusion. We then compared patient clinical characteristics according to these clusters. RESULTS: Four groups were identified among the 1795 included patients: group 1 ("heterogeneous" n = 1099), group 2 ("lithium" n = 265), group 3 ("valproate" n = 268), and group 4 ("lamotrigine" n = 163). Proportion of bipolar 1 disorder, in groups 1 to 4 were: 48.2%, 57.0%, 48.9% and 32.5%. Groups 1 and 4 had greater functional impact at baseline and a less favorable clinical and functioning evolution at one-year follow-up, especially on GAF and FAST scales. LIMITATIONS: The one-year period used for the analysis of mood stabilizing treatments remains short in the evolution of bipolar disorder. CONCLUSIONS: Treatment profiles are associated with functional evolution of patients and were not clearly determined by bipolar subtypes. These profiles seem to group together common patient phenotypes. These findings do not seem to be influenced by the duration of disease prior to inclusion and neither by the number of treatments used during the follow-up period.
Authors: Romain Icick; Ingrid Melle; Bruno Etain; Margrethe Collier Høegh; Sébastien Gard; Sofie R Aminoff; Marion Leboyer; Ole A Andreassen; Raoul Belzeaux; Chantal Henry; Thomas D Bjella; Jean-Pierre Kahn; Nils Eiel Steen; Frank Bellivier; Trine Vik Lagerberg Journal: Front Psychiatry Date: 2022-05-03 Impact factor: 5.435