To Evaluate the Efficiency and Safety of Quetiapine Fumarate in the Treatment of Acute Manic Patients With Bipolar Disorder.

This is an interventional treatment trial for Bipolar Disorder focused on measuring CCMD-3,, CRF,, EPS,, GCP,, ICH,, ITT,, LOCF,, MADRS,, PANSS,, YMRS., Acute, manic, patients, with, bipolar, disorder Read More

Inclusion Criteria:

• Written informed consent for study participation, signed by the patient's legal guardian
• Aged between 18 and 65 (inclusive)
• Is hospitalized in a psychiatric unit with an acute manic episode of bipolar disorder defined by CCMD-3 criteria i.e. [31.2] bipolar disorder whose current status is mania without psychotic symptom or [31.3] bipolar disorder whose current status is mania with psychotic symptom
• Both at screening and at randomization (Day 1), had a YMRS total score of at least 20
• Be able to understand and comply with the requirements of the study, judged by the investigator

Exclusion Criteria:

• Manic index episode judged to be the direct physiological consequence of a medical condition or treatment.

• These conditions included:

  • degenerative neurological conditions (e.g. Parkinson's disease, Huntington's disease),
  • cerebrovascular disease (e.g., stroke),
  • metabolic conditions (e.g., Vitamin B12 deficiency),
  • autoimmune conditions (e.g., systemic lupus erythematosus),
  • viral or other infections (e.g., hepatitis, mononucleosis, human immunodeficiency),
  • certain cancers.
• Manic index episode judged to be the direct physiological effect of a substance of abuse, including intoxication with or withdrawal from alcohol, amphetamine and related substances, cocaine, sedatives, hypnotics, or anxiolytics; intoxication with hallucinogens, inhalants, opioids, or phencyclidine and related substances.
• Patients who met CCMD-3 criteria for rapid cycling: at least 4 episodes of a mood disturbance in the previous 12 months that meet criteria for a hypomanic/manic or nonmajor depression/depression, or mixed episode
• Known intolerance or lack of response to quetiapine or valproate, as judged by the investigator
• Known or suspected hypersensitivity to quetiapine or valproate
• Known lack of response to clozapine
• Use of clozapine within 28 days before randomization (Day 1)
• Women in pregnancy or lactation, or female of childbearing potential without appropriate birth control measures
• Substance or alcohol dependence (except for nicotine dependence), as defined in CCMD-3, within 1 month before randomisation (Day 1).
• Continuous daily use of benzodiazepines during the month preceding screening.
• Receipt of electroconvulsive therapy (ECT) within 30 days prior to randomisation (Day 1).
• Use of antidepressant(s) during the screening period (Day -7 to Day 1) or within a period of 5 half-lives of the drug(s) prior to randomisation (Day 1).
• Use of long-acting anti-psychotic medication within 30 days prior to randomisation (Day 1)
• Thyroid-stimulating hormone concentration more than 10% above the upper limit of the normal range, regardless of treatment for hypothyroidism or hyperthyroidism.
• Use of any potent cytochrome P450 3A4 inhibitors in the 14 days preceding randomization (Day 1), e.g., ketoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, troleandomycin, indinavir, nelfinavir, ritonavir, and saquinavir.
• Use of potent cytochrome P450 inducers (e.g. Phenytoin, carbamazepine, barbiturates, rifampin, glucocorticoids, St. John's Wort) in the 14 days preceding randomisation (Day 1).
• Renal, cardiovascular, hepatic, haematological, endocrine, congestive heart failure, or other disease or clinical finding that was unstable or in the opinion of the investigator would be negatively affected by study medication or that would affect study medication.

• Patients with diabetes mellitus (DM) fulfilling one of the following criteria:

  • Unstable DM defined as enrolment HbA1c > 8.5%
  • Admitted to hospital for treatment of DM or DM related illness in past 12 weeks
  • Not under care of physician responsible for patient's DM care
  • Physician responsible for patient's DM care has not indicated that patient's DM is controlled
  • Physician responsible for patient's DM care has not approved patient's participation in the study
  • Has not been on the same dose of oral hypoglycaemic drug(s) and/or diet for the 4 weeks prior to randomisation. For thiazolidinediones (glitazones) this period should not be less than 8 weeks
  • Taking insulin whose daily dose on one occasion in the past 4 weeks has been more than 10% above or below their mean dose in the preceding 4 weeks
• Participation in another clinical study within 4 weeks of randomisation (Day 1).
• Lack of response in previous systemic treatment with lithium and/or quetiapine.
• Medical conditions that would affect absorption, distribution, metabolism or excretion of study treatment.
• An absolute neutrophil count (ANC) of < 1.5 x 109/L