Paliperidone palmitate depot in the long-term treatment of psychotic bipolar disorder : A case series

Objectives: The treatment of bipolar disorder (BD) cannot be limited to the remission of acute phases but includes the long-term treatment in order to prevent relapses, poor outcome, and chronicity. The purpose of this article is to present 3 cases of severe psychotic bipolar patients treated with monthly injection of paliperidone pamoate. Methods: Three poor-compliant severe psychotic BD patients were initiated to paliperidone palmitate (100–150 mg monthly), and they were followed up for 12 months. Young Mania Rating Scale and Hamilton Depression Rating Scale were administered at baseline and during monthly follow-up visits. Results: None of patients presented recurrences or relapses during the 12-month follow-up period. The patients did not develop adverse effects or significant changes in metabolism. Conclusions: These preliminary results indicate that paliperidone palmitate (100–150 mg monthly) may be a therapeutic option for long-term treatment of psychotic BD, particularly for poor-compliant severe patients. These results have to be confirmed in double-blind studies with bipolar patients not necessarily belonging to psychotic subtype.