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This podcast series provides a brief discussion on real-world issues in the diagnosis and treatment of bipolar disorder in patients shared by primary care and mental health care professionals. Each podcast also discusses treatment with ziprasidone.
Podcast 1:
Differential diagnosis of major depressive disorder or bipolar disorder in primary care and the complexity of the mixed-episode patient
Podcast 2:
Patients may want or need to switch medications; maximizing efficacy with ziprasidone in manic or mixed episodes
Podcast 3:
Metabolic issues in bipolar disorder
Podcast 4:
Drug treatment expectations in manic and mixed episodes of bipolar disorder
Click the "Listen | Download" tabs below to listen to the Podcasts in your default player. To save them to your local computer for playback on an I-pod or similar device, please right click the tab and select "Save target as..." from the menu.
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Differential diagnosis of major depressive disorder or bipolar disorder in primary care and the complexity of the mixed-episode patient
Copresented by:
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Robert L. Grieco, MD |
Trinity Family Practice |
Beaver Falls, PA |
Coauthor: The Other Depression: Bipolar Disorder |
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Paul E. Keck, MD |
Professor of Psychiatry and Neuroscience |
Department of Psychiatry |
University of Cincinnati College of Medicine |
Cincinnati, OH |
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Your feedback is important to us. After you listen to this podcast, please click here to fill out a brief survey to help us provide you with the most current and relevant information to you and your practice. |
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Patients may want or need to switch medications; maximizing efficacy with ziprasidone in manic or mixed episodes
Copresented by:
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Robert L. Grieco, MD |
Trinity Family Practice |
Beaver Falls, PA |
Coauthor: The Other Depression: Bipolar Disorder |
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Paul E. Keck, MD |
Professor of Psychiatry and Neuroscience |
Department of Psychiatry |
University of Cincinnati College of Medicine |
Cincinnati, OH |
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Your feedback is important to us. After you listen to this podcast, please click here to fill out a brief survey to help us provide you with the most current and relevant information to you and your practice. |
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Objectives:
- Provide information on increasing awareness of how bipolar disorder presents in primary care settings, proper diagnosis, and ways to treat manic and mixed episodes
- Give practical information on recognizing, monitoring, and mitigating metabolic disturbances in patients being treated for bipolar disorder
- Help give insight into expected timing and nature of outcomes of drug treatment for bipolar disorder
- Garber AJ, Johnson DL, Krauss RM, et al. J Clin Psychiatry 2005;66:790-798.
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 QTc 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.
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