Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

364 R. W. Baker et al.initiation of mood-stabilizer treatment did not necessarily antedate starting quetiapineor placebo. Patients were randomized to 3 weeks of adjunctive treatment withquetiapine 200–800 mg/day (n ¼ 91) or placebo (n ¼ 100); significantly greaterimprovement in YMRS from baseline occurred in the adjunctive quetiapine group(44% reduction) than in the placebo group (32%) (P ¼ 0.021). Response, defined as50% or greater YMRS improvement, was more common in patients taking adjunctivequetiapine (54.9%) than placebo (32.6%, P ¼ 0.005). Montgomery-Asbergdepression ratings improved from baseline in both groups (25% reduction onquetiapine versus 20% on placebo, difference not significant) and the number ofpatients with treatment-emergent depression also did not differ significantlybetween groups (quetiapine 17%, placebo 14%). Unfortunately, the report doesnot shed light on subgroup efficacy; the authors do not mention whether improvementis consistent irrespective of presence of psychosis, and both rapid-cyclingpatients and those in current mixed episodes were excluded from the trial. Dropoutrate did not differ significantly between placebo-treated (51%) and quetiapinetreatedpatients (39%) for this 3-week adjunctive-treatment study. Changes inextrapyramidal symptom ratings (Simpson-Angus and Barnes Akathisia scales)were modest and apparently did not differ between the groups.ZiprasidoneAt this writing, one double-blind trial of ziprasidone in bipolar disorder has beenreported (Keck et al., 2003a). This 3-week, placebo-controlled study in patients withacute manic or mixed episodes found superior YMRS improvement on ziprasidone80–160 mg/day (46% reduction, n ¼ 131) than on placebo (29%, n ¼ 64)(P