Background
Population | N | Guidelines | % Concordance | |
---|---|---|---|---|
Unutzer et al. 2000 [30] | Out-patients | 1246 BD | Expert consensus panel | 83% |
Lim et al. 2001 [24] | In-patients | 1421 BDI | Expert consensus panel | Manic with psychotic features: 38% without: 16%; Depressive with psychotic features: 31%; without: 17% |
Simon et al. 2004 [31] | Out-patients | 665 BDI + 239 BDII | Several guidelines | BDI: 65.4% BDII: 52.7% |
Kilbourne et al. 2005 [32] | In- and out-patients | 2316 BDI | APA and Department of Veterans Affairs | Bipolar specific MS: 74.6% Any MS or neuroleptics second generation: 84.4% |
Farrelly et al. 2006 [33] | Out-patients | 224 mood episodes in 84 BD I and II | British Association for Psychopharmacology | Manic: 81% Depressive: 64% Mixed: 62% |
Dennehy et al. 2007 [29] | Out-patients | 469 BDI 198 BDII | Several guidelines | Depressive: 83.4% Hypomanic/manic: 81.9% Mixed: 81.8% |
Bush et al. 2007 [34] | In- and out-patients | 2644 BDI | Several guidelines | 67% |
Arvilommi et al. 2007 [25] | In- and out-patients | BDI – 90 BDII- 101 | Several guidelines | BDI: 55.6% BDII: 30.7% |
Smith et al. 2008 [27] | In-patients | 23 BD | Expert consensus panel | 52% in naturalistic settings, increased to 75% after intervention |
Bauer et al. 2009 [28] | 306 (87% BDI) | Department of Veterans Affairs | 50%-60% at index hospitalization in collaborative model; declined to 30%-40% after two years | |
Altinbas et al. 2011 [26] | Out-patients | 263 depressive episodes in 142 patients (131 BDI) | Turkish Psychiatric Association Guidelines for Bipolar Disorder | Severity of the episode: Mild: 29.%; Moderate or severe without psychosis: 27.4%; severe with psychos: 87.5% |
Methods
Sample
Diagnostic and clinical assessment
Criteria: adherence to treatment guidelines
Data analysis
Results
Characteristics of the sample
Prevalence of psychotropic prescriptions by type of BD
Bipolar I disorder (N = 32) | Bipolar II disorder (N = 81) | Total | Daily dosage min–max | |
---|---|---|---|---|
N (%) | N (%) | N (%) | Mg | |
Lithium
|
20 (62.5)
|
15 (18.5)
*
|
35 (31.0)
| 300–1950 |
Anticonvulsants
|
10 (31.3)
|
36 (44.4)
†
|
46 (40.7)
| |
Valproate | 3 (9.4) | 14 (17.3) | 17 (15) | 250–2000 |
Carbamazepine | 1 (3.1) | 0 | 1 (0.9) | 600 |
Lamotrigine | 6 (18.8) | 13 (16) | 19 (16.8) | 50–500 |
Gabapentin | 1 (3.1) | 6 (7.4) | 7 (6.2) | 300–1600 |
Topiramate | 1 (3.1) | 9 (11.1) | 10 (8.8) | 25–200 |
Levetiracetam | 0 | 1 (1.2) | 1 (0.9) | 250 |
Antidepressants
|
17 (53.1)
|
54 (66.7)
†
|
71 (62.8)
| |
SSRIs | 7 (21.9) | 27 (33.3) | 34 (30.1) | |
Citalopram | 4 (12.5) | 10 (12.3) | 14 (12.4) | 20–80 |
Escitalopram | 1 (3.1) | 12 (14.8) | 13 (11.5) | 5–40 |
Fluoxetine | 1 (3.1) | 1 (1.2) | 2 (1.8) | 20 |
Fluvoxamine | 1 (3.1) | 0 | 1 (0.9) | 200 |
Paroxetine | 0 | 2 (2.5) | 2 (1.8) | 40–60 |
Sertraline | 0 | 2 (2.5) | 2 (1.8) | 100–200 |
SNRI | 9 (28.1) | 13 (16.0) | 22 (19.5) | |
Duloxetine | 0 | 1 (1.2) | 1 (0.9) | 60 |
Venlafaxine | 9 (28.1) | 12 (14.8) | 21 (18.6) | 75–300 |
Moclobemide | 0 | 1 (1.2) | 1 (0.9) | 600 |
Antidepressants Tricyclic | 1 (3.1) | 5 (6.2) | 6 (5.3) | |
Amitriptyline | 1 (3.1) | 4 (4.9) | 5 (4.4) | 10–100 |
Trimipramine | 0 | 1 (1.2) | 1 (0.9) | 50 |
Other antidepressants | 6 (18.8) | 27 (33.3) | 33 (29.2) | |
Bupropion | 2 (6.3) | 13 (16.0) | 15 (13.3) | 100–450 |
Mirtazapine | 0 | 4 (4.9) | 4 (3.5) | 7.5–60 |
Trazodone | 5 (15.6) | 13 (16.0) | 18 (15.9) | 50–200 |
Anxiolytics benzodiazepines
|
10 (31.3)
|
16 (19.8)
†
|
26 (23.0)
| |
Neuroleptics
|
18 (56.3)
|
33 (40.7)
†
|
51 (45.1)
| |
Neuroleptics first generation | 2 (6.3) | 4 (4.9) | 6 (5.3) | |
Methotrimeprazine | 1 (3.1) | 4 (4.9) | 5 (4.4) | 10–125 |
Trifluoperazine | 1 (3.1) | 0 | 1 (0.9) | 3 |
Neuroleptics second generation | 17 (53.1) | 30 (37.0) | 47 (41.6) | |
Olanzapine | 7 (21.9) | 6 (7.4) | 13 (11.5) | 2.5–20 |
Quetiapine | 8 (25.0) | 18 (22.2) | 26 (23.0) | 12.5–450 |
Risperidone | 2 (6.3) | 8 (9.9) | 10 (8.8) | 0.5–2.00 |
Stimulants – methylphenidate | 0 | 1 (1.2) | 1 (0.9) | 5 |
Hypnotics – Zopiclone | 0 | 5 (6.2) | 5 (4.4) | 3.75–30 |
No psychotropics | 0 | 8 (90.0) | 8 (7.0) |
Psychotropic medications administered by nature of mood episodes
Bipolar I disorder (N = 32) | Bipolar II disorder (N = 81) | |||||
---|---|---|---|---|---|---|
Hypomania | Depression | Euthymia | Hypomania | Depression | Euthymia | |
N = 7 | N = 18 | N = 7 | N = 18 | N = 47 | N = 16 | |
N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | |
Lithium | 4 (57.1) | 11 (61.1) | 5 (71.4) | 3 (16.7) | 8 (17.0) | 4 (25.0) |
Anticonvulsants | 2 (28.6) | 5 (27.8) | 3 (42.9) | 7 (38.9) | 25 (53.2) | 4 (25.0) |
Antidepressants | 3 (42.9) | 13 (72.2) | 1 (14.3) | 10 (55.6) | 34 (72.3) | 10 (62.5) |
Neuroleptics | 3 (42.9) | 11 (61.1) | 4 (57.1) | 7 (38.9) | 20 (42.6) | 6 (37.5) |
First generation | 0 | 1 (5.6) | 1 (14.3) | 1 (5.6) | 3 (6.4) | 0 |
Second generation | 3 (42.9) | 11 (61.1) | 3 (42.9) | 6 (33.3) | 18 (38.3) | 6 (37.5) |
Benzodiazepines | 0 | 7 (38.9) | 3 (42.9) | 3 (16.7) | 8 (17.0) | 5 (31.3) |
At least one MS or AAP in therapeutic range* | 7 (100) | 15 (83.3) | 5 (71) | 8 (44.4) | 26 (55.3) | 6 (37.5) |
At least one psychotropic drug | 7 (100) | 18 (100) | 7 (100) | 16 (88.9) | 44 (93.6) | 13 (81.3) |
Prescriptions concordant with CANMAT guidelines
Bipolar I disorder (N = 32) | Bipolar II disorder (N = 81) | ||||||
---|---|---|---|---|---|---|---|
Hypomania | Depression | Euthymia | Hypomania | Depression | Euthymia | Total | |
N = 7 | N = 18 | N = 7 | N = 18 | N = 47 | N = 16 | N = 113 | |
Follows guidelines strictly
|
4 (57.1%) |
8 (44.4%) |
4 (57.1%) |
3 (16.7%) |
29 (61.7%) |
4 (25.0%) |
52 (46.0%) |
First line treatment | 4 (57.1%) | 5 (27.8%) | 3 (42.9%) | 3 (16.7%) | 0 | 1 (6.3%) | 16 (14.2%) |
Second line treatment | 0 | 1 (5.6%) | 1 (14.3%) | 0 | 14 (29.8%) | 3 (18.8%) | 19 (16.8%) |
Third line treatment | 0 | 2 (11.1%) | 0 | 0 | 15 (31.9%) | 0 | 17 (15.0%) |
Polypharmacy with at least one treatment recommended in guidelines
|
0
|
7 (38.9%) |
1 (14.3%) |
1 (5.6%) |
14 (29.8%) |
2 (12.5%) |
25 (22.1%) |
No treatment following the guidelines
|
3 (42.9%) |
3 (16.7%) |
2 (28.6%) |
14 (77.8%) |
4 (8.5%) |
10 (62.5%) |
36 (31.9%) |
Bipolar I disorder with no treatment concordant with guidelines (N = 8) | Bipolar II disorder with no treatment concordant with guidelines (N = 28) | ||||||
---|---|---|---|---|---|---|---|
Hypomania | Depression | Euthymia | Hypomania | Depression | Euthymia | Total | |
N = 3 | N = 3 | N = 2 | N = 14 | N = 4 | N = 10 | N = 36 | |
No psychotropics | 0 | 0 | 0 | 2 | 3 | 3 | 8 (22.2%) |
Antidepressants without any mood stabilizer | 0 | 1 | 0 | 5 | - | 5 | 11 (30.6%) |
Antidepressants in hypomania | 3 | - | - | 5 | - | - | 8 (22.2%) |
Low dosage of treatment | 0 | 2 | 2 | 1 | 1 | 1 | 7 (19.4%) |
Other prescriptions of psychotropics, not following guidelines | 0 | 0 | 0 | 1 | 0 | 1 | 2 (5.6%) |
Factors associated with the prescription of at least one treatment concordant with guidelines by type and dosage of the medication
Variable | At least one treatment concordant with guidelines N (%) | N | Degree of freedom | Χ2
| P |
---|---|---|---|---|---|
Sex | |||||
Man | 26 (66.7%) | 39 | 1 | 0.06 | 0.81 |
Woman | 51 (68.9%) | 74 | |||
Previous hospitalizations | |||||
Yes | 41 (77.4%) | 53 | 1 | 3.91 | 0.05 |
No | 36 (60.0%) | 60 | |||
Type of bipolar disorder | |||||
Type I | 24 (75.0%) | 32 | 1 | 0.97 | 0.32 |
Type II | 53 (65.4%) | 81 | |||
Nature of the current mood episode | |||||
Hypomanic | 8 (32.0%) | 25 | |||
Depressive | 58 (89.2%) | 65 | 2 | 32.7 | 0.001 |
Euthymic | 11 (47.8%) | 23 | |||
Comorbid anxiety disorder (current) | |||||
Present | 19 (67.9%) | 28 | 1 | 0.001 | 0.97 |
Absent | 58 (68.2%) | 85 | |||
Comorbid substance use disorder (current) | |||||
Present | 15 (53.6%) | 28 | 1 | 3.64 | 0.06 |
Absent | 62 (72.9%) | 85 | |||
Variable
|
Mean (SD) |
N
|
t-test
|
P
| |
Age (mean ± SD) | |||||
Treatment – concordant | 39.8 ± 11.3 | 77 | 1 | 1.58 | 0.18 |
Treatment – not concordant | 36.3 ± 10.7 | 36 | |||
Age at onset (mean ± SD) | |||||
Treatment – concordant | 22.4 ± 8.0 | 77 | 1 | 1.72 | 0.09 |
Treatment – not concordant | 25.5 ± 9.0 | 36 |