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Supplements to The Journal of Family Practice and Current Psychiatry

	Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine
	Challenges in recognition, clinical management, and treatment of bipolar disorder at the interface of psychiatric medicine and primary care
	Mood Disorder Questionnaire (Read Only)

Faculty:

Henry Chung, MD
Larry Culpepper, MD, MPH
Jeffrey N. De Wester, MD
Robert L. Grieco, MD
Neil S. Kaye, MD
Mack Lipkin, MD
Sherryl J. Rosen, APRN, BC

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Objectives:

• Provide information that can make a difference in increasing awareness of bipolar disorder and how it presents in primary care and psychiatric settings¹
• Offer insight into ways for primary care providers and mental health providers to collaborate to optimize outcomes for shared patients²

1. Garber AJ, Johnson DL, Krauss RM, et al. J Clin Psychiatry 2005;66:790-798.
2. Griswold KS, Pessar LF. Am Fam Physician 2000;62:1343-1353, 1357-1358.

Please click here to see ziprasidone full prescribing information. By clicking this link, you selected to read information for medical professionals.

Ziprasidone is indicated for the treatment of acute manic or mixed episodes associated with bipolar disorders with or without psychotic symptoms.

Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Ziprasidone is not approved for the treatment of patients with dementia-related psychosis.

Ziprasidone is contraindicated in patients with a known history of QT prolongation, recent acute myocardial infarction, or uncompensated heart failure, and should not be used with other QT-prolonging drugs. Ziprasidone has a greater capacity to prolong the QT_c interval than several antipsychotics. In some drugs, QT prolongation has been associated with torsade de pointes, a potentially fatal arrhythmia. In many cases this would lead to the conclusion that other drugs should be tried first.

As with all antipsychotic medications, a rare and potentially fatal condition known as neuroleptic malignant syndrome (NMS) has been reported with ziprasidone. NMS can cause hyperpyrexia, muscle rigidity, diaphoresis, tachycardia, irregular pulse or blood pressure, cardiac dysrhythmia, and altered mental status. If signs and symptoms appear, immediate discontinuation, treatment, and monitoring are recommended.

Prescribing should be consistent with the need to minimize tardive dyskinesia (TD), a potentially irreversible dose- and duration-dependent syndrome. If signs and symptoms appear, discontinuation should be considered since TD may remit partially or completely.

Hyperglycemia-related adverse events, sometimes serious, have been reported in patients treated with atypical antipsychotics. There have been few reports of hyperglycemia or diabetes in patients treated with ziprasidone, and it is not known if ziprasidone is associated with these events. Patients treated with an atypical antipsychotic should be monitored for symptoms of hyperglycemia.

Precautions include the risk of rash, orthostatic hypotension, and seizures.

The most common adverse events associated with ziprasidone in bipolar mania were somnolence, extrapyramidal symptoms, dizziness, akathisia, and abnormal vision.

In short-term schizophrenia trials, the most commonly observed adverse events associated with ziprasidone at an incidence of
5% and at least twice the rate of placebo were somnolence and respiratory tract infection.

In short-term schizophrenia clinical trials, 10% of ziprasidone-treated patients experienced a weight gain of 7% of body weight vs 4% for placebo.