Comparison of Functioning, Quality of Life, and Cognition between Lithium and Sodium Valproate Combination Therapy and Sodium Valproate Monotherapy in Euthymic Bipolar Patients: A Cross-sectional Study

Abstract

Introduction: The combination of lithium and valproate is the most recommended treatment for relapse prevention in Bipolar Affective Disorder (BPAD) after the failure of monotherapy. If it is proven that functioning, quality of life and cognitive functioning in bipolar patients on a sodium valproate and lithium combination are better than those on valproate monotherapy, this could further encourage the use of combination therapy. Aim: To compare the functioning, quality of life and cognitive functioning of euthymic bipolar patients on lithium and sodium valproate combination therapy with those on sodium valproate monotherapy. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Outpatient Department, Institute of Mental Health, Madras Medical College, Chennai, Tamil Nadu, India, from March 2017 to July 2017. A total of 80 patients were included in the study. Forty euthymic bipolar disorder patients on a lithium and sodium valproate combination for at least a year were chosen as group 1. Forty euthymic bipolar patients on sodium valproate monotherapy for at least a year were chosen as group 2. Socio-demographic details and clinical characteristics of both groups were collected. The Global Assessment of Functioning (GAF) scale and the World Health Organisation Quality of Life Brief (WHOQoL-BREF) version scale were applied to both groups. Cognitive assessment using the Frontal Assessment Battery (FAB), Trail Making Test-A (TMT-A) and Trail Making Test-B (TMT-B) was conducted. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 20.0. An independent t-test was used to compare quality of life and cognitive variables, as well as, the number of episodes post-treatment between the two groups. A Chi-square test was used to compare functioning between the two groups. Results: The mean±Standard Deviation (SD) age of onset in group 1 was 26.73±5.77 years and in group 2 was 27.03±6.49 years. There were 22 (55%) males and 18 (45) females in group 1 and, 20 (50) males and 20 (50) females in group 2. There were no statistical differences in socio-demographic characteristics between both groups (p-value>0.05). Functioning and quality of life were significantly better in the combination therapy group (p-value ≤0.01). Cognitive variables like FAB score, and time taken to complete TMT-A and TMT-B in seconds showed no significant differences (p-value>0.05). By independent t-test, the reduction in episodes of bipolar illness after treatment was found to be greater in group 1 (p-value=0.006). Conclusion: The functioning, quality of life and effectiveness of treatment for those euthymic bipolar patients on lithium and sodium valproate combination therapy were found to be better than those on valproate monotherapy alone. There was no significant change in cognitive functioning between the two groups.

Keywords

• frontal assessment battery
• global assessment of functioning
• major depressive disorder
• mania
• trail making test
• young mania rating scale