Does Insight Affect the Efficacy of Antipsychotics in Acute Mania? An Individual Patient Data Regression Meta-Analysis

Carlijn C M Welten, Maarten W J Koeter, Tamar D Wohlfarth, Jitschak G Storosum, Wim van den Brink, Christine C Gispen-de Wied, Hubert G M Leufkens, Damiaan A J P Denys

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Patients having an acute manic episode of bipolar disorder often lack insight into their condition. Because little is known about the possible effect of insight on treatment efficacy, we examined whether insight at the start of treatment affects the efficacy of antipsychotic treatment in patients with acute mania. We used individual patient data from 7 randomized, double-blind, placebo-controlled registration studies of 4 antipsychotics in patients with acute mania (N = 1904). Insight was measured with item 11 of the Young Mania Rating Scale (YMRS) at baseline and study endpoint 3 weeks later. Treatment outcome was defined by (a) mean change score, (b) response defined as 50% or more improvement on YMRS, and (c) remission defined as YMRS score less than 8 at study endpoint. We used multilevel mixed effect linear (or logistic) regression analyses of individual patient data to assess the interaction between baseline insight and treatment outcomes. At treatment initiation, 1207 (63.5%) patients had impaired or no insight into their condition. Level of insight significantly modified the efficacy of treatment by mean change score (P = 0.039), response rate (P = 0.033), and remission rate (P = 0.043), with greater improvement in patients with more impaired insight. We therefore recommend that patients experiencing acute mania should be treated immediately and not be delayed until patients regain insight.

Original languageEnglish
Pages (from-to)71-6
Number of pages6
JournalJournal of Clinical Psychopharmacology
Volume36
Issue number1
DOIs
Publication statusPublished - Feb 2016

Keywords

  • Acute Disease
  • Adult
  • Antipsychotic Agents
  • Bipolar Disorder
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Randomized Controlled Trials as Topic
  • Regression Analysis
  • Treatment Outcome
  • efficacy
  • Meta-Analysis

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