Insights into real-world treatment of cluster headache through a large Italian database: prevalence, prescription patterns, and costs.

Objective: This study aimed at estimating the treated cluster headache (CH) prevalence and describing prescription patterns and direct costs paid by the Italian National-Health-System.Methods: Through the ReS database (healthcare administrative data collection of a large sample of the Italian population), adults in treatment for CH (acute therapy with sumatriptan/subcutaneous or oxygen, associated with preventive therapy with verapamil or lithium) were selected. A cross-sectional analysis described the prevalence of CH-treated subjects repeated annually in 2013-2017. A longitudinal analysis of patients selected in 2013-2015 and followed for 2 years provided the prescription patterns.Results: The annual prevalence of CH-treated patients increased from 6.4×100,000 adults in 2013 to 6.7 in 2017. In 2013-2015, 570 patients (80.7% M; mean age 46) treated for CH were found. In 50.4%, the identifying CH treatment was sumatriptan/subcutaneous+verapamil. During follow-up, >1/3 changed the preventive drug and interruption was the most frequent modification, although acute treatments were still prescribed. The mean annual cost/patient ranged from €2,956 to €2,267; pharmaceuticals expenditure represented the 56.4% and 57.3%, respectively.Conclusions: This study showed an important unmet need among CH patients, carrying a high economic burden that should be considered in the evaluation of the impact of incoming therapies (e.g. Calcitonin-Gene-Related-Peptide antibodies).

Can lithium salts prevent depressive episodes in the real world?

To critically examine the effectiveness of lithium in preventing depressive symptoms (mixed and depressive episodes) in real life settings, taking into account adherence to drug treatment and its implications for the clinical costs of the disease. Overall, 72 patients with bipolar disorder initially treated with lithium carbonate were included and followed-up for 10 years. Patients were assessed every 8 weeks for morbidity and alcohol/drug consumption. Patients with good adherence to lithium had fewer episodes with depressive features than poor adherers (B = 2.405, p = 0.046) and also fewer manic and hypomanic episodes (B = 2.572; p < 0.001), after controlling for confounders. Time to relapse into a depressive or mixed episode and into a manic or hypomanic episode was shorter in patients with poor adherence. The costs of the 1.95 ±â€¯2.38 (mean ±â€¯standard deviation) admissions of adherent patients through the 10 years of follow-up were €10,349, while the costs of the 6.25 ±â€¯4.92 admissions of non-adherent patients were €44,547. In clinical practice settings, long-term lithium salts seem to have a preventive effect on depressive symptoms.

The new lithium clinic.

Until the early 1950s, no effective pharmacological treatment existed for bipolar affective disorder. By the early 1960s, specialty clinics were being set up to dispense lithium carbonate to bipolar patients. By the late 1980s, a new body of knowledge was influencing the perception of bipolar disorder and how the disease should be treated. The authors' lithium clinic from 1974 has grown and evolved from a lithium blood level monitoring model into a comprehensive care model with polypharmacy, psychoeducation, rehabilitation, cognitive therapy, social rhythm therapy, and employment counseling as well as a staff of 2 part-time psychiatrists and 1 clinical psychologist. This service delivery model may benefit both treatment and research in bipolar disorder. The evolution of psychopharmacological and psychosocial knowledge in treating bipolar illness has been integrated into our clinic. Case vignettes are presented to illustrate these points. The comparative cost of this model is discussed.

Long-term therapy with lithium in a private practice clinic: a naturalistic study.

OBJECTIVE: To document the effectiveness and vicissitudes of treating 14 bipolar patients with lithium carbonate over a combined 300 years, and an average of 21 years/patient. METHODS: Chart review of the narrative and laboratory studies of these 14 patients ranging in duration from 12 to 29 years. RESULTS: Lithium stabilized these bipolar patients over these periods. Only three patients required hospitalization, one because lithium was slowly tapered at her request after 6 years of mood stability, another because of non-compliance, and a third because of co-morbid alcohol abuse. One patient attempted suicide after lithium was tapered off. However, in some patients, there were serious side-effects necessitating lithium discontinuation. CONCLUSIONS: Controlled studies in psychopharmacology are obviously preferred to open-label or naturalistic case studies. However, controlled studies are rarely conducted over long periods, and practice-related naturalistic research can be of value, albeit anecdotal and without the use of structured rating scales. In this paper, we are reporting on 14 patients seen consistently by one psychiatrist. These patients were functional and productive at work and in family life. The patients suffered brief hypomanic or depressive episodes. Although several patients experienced serious side-effects, lithium was continued with stable mood, while the side-effects were managed in collaboration with other specialists.

The impact of the discovery of lithium on psychiatric thought and practice in the USA and Europe.

The discovery of lithium has had a major impact on modern psychiatry. By launching the psychopharmacology revolution, lithium forced psychiatrists to become more adept at diagnosis. Lithium research has also provided a window into secular changes in bipolar illness which adversely impact response, produced pharmacoeconomic data on the social costs of psychiatric illness, and played a role in the birth of patient-run advocacy movements. In addition, the development of lithium has demonstrated the closely intertwined purposes of clinical and basic research, and the continued importance of research in the clinical setting.

Decision model for the acute treatment of mania.

Decision making in psychiatric diagnosis and treatment has not been evaluated systematically. The authors present a model for treatment of an acute manic episode using a decision analysis software program. Six treatment options were put into the model: lithium, valproate, carbamezepine, electroconvulsive therapy, clonazepam, and neuroleptics. Each treatment was evaluated on three factors, efficacy, tolerability, and cost, using data from the literature and pharmacy and billing information. Output from the computer program identified three top choices among the six options: valproate, carbamazepine, and lithium, with valproate emerging as the first choice using the data we inputted.