Comparison and Assessment of Prescribing Pattern of Psychotropic Agents in Bipolar Affective Disorder with Mania and Depression
Abstract
INTRODUCTION: Bipolar disorder is a recurring chronic disorder characterized by mood, state, and energy fluctuations. Individuals differ in symptoms, course, severity, and response to treatment. It is critical to know the current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder.
Primary Objective: To compare and assess the prescribing pattern of psychotropic agents in bipolar affective disorder with mania and depression in a tertiary care teaching hospital.
Secondary Objectives:
- Determination of risk and cofactors associated with Bipolar Disorder
- Assessment of treatment modalities
DESIGN: Prospective observational study
RESULTS: The most commonly prescribed drug combination was Mood stabilizer + Antipsychotics + Benzodiazepine combination, 5(33.3%) in bipolar depression and9(60.0%) in bipolar mania. A very small percentage of patients(6.7%) received ECT. The most commonly prescribed drug was valproic acid (Mood stabilizer), 7(46.7%) in bipolar depression and 14(93.3%) in bipolar mania.
CONCLUSION: According to the data, Mood stabilizers were found to be the most commonly prescribed drug. Combination treatments are prevalent, reflecting the complexity of managing bipolar disorder. Although various genetic and environmental risk factors are identified, the attributable risk of individual elements is often less.
KEYWORDS: Bipolar disorder, Mania, Depression, Valproic acid
Keywords:
Bipolar disorder, Depression, ManiaDOI
https://doi.org/10.22270/jddt.v12i5-S.5702References
Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. The Lancet. 2016 Apr 9; 387(10027):1561-72. https://doi.org/10.1016/S0140-6736(15)00241-X
Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, Mitchell PB, Centorrino F, Risser R, Baker RW, Evans AR. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Archives of general psychiatry. 2003 Nov 1; 60(11):1079-88. https://doi.org/10.1001/archpsyc.60.11.1079
Malhi GS, Adams D, Lampe L, Paton M, O'connor N, Newton LA, Walter G, Taylor A, Porter R, Mulder RT, Berk M. Clinical practice recommendations for bipolar disorder. Acta Psychiatrica Scandinavica. 2009 May; 119:27-46 https://doi.org/10.1111/j.1600-0447.2009.01383.x
Belmaker RH. Bipolar Disorder. New England Journal of Medicine. 2004 Jul 29; 351(5):476-86. https://doi.org/10.1056/NEJMra035354
Phillips ML, Kupfer DJ. Bipolar disorder diagnosis: challenges and future directions. The Lancet. 2013 May 11; 381(9878):1663-71. https://doi.org/10.1016/S0140-6736(13)60989-7
Bauer M, Pfennig A. Epidemiology of bipolar disorders. Epilepsia. 2005 Jun; 46: 8-13. https://doi.org/10.1111/j.1528-1167.2005.463003.x
Anderson IM, Haddad PM, Scott J. Bipolar disorder. Bmj. 2012 Dec 27; 345. https://doi.org/10.1136/bmj.e8508
Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. The Lancet. 2002 Jan 19; 359(9302):241-7. https://doi.org/10.1016/S0140-6736(02)07450-0
Hilty DM, Leamon MH, Lim RF, Kelly RH, Hales RE. A review of bipolar disorder in adults. Psychiatry. 2006 Sep.
Goldberg JF, Harrow M, eds. Bipolar Disorders: Clinical Course and Outcome. Washington, DC: American Psychiatric Press, 1999.
Goodnick PJ, ed. Mania: Clinical and Research Perspectives. Washington, DC: American Psychiatric Press, 1998.
American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002; 159:1-50.
Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, Leon AC, Rice JA, Keller MB. The long-term natural history of the weekly symptomatic status of bipolar I disorder.Archives of general psychiatry. 2002 Jun 1; 59(6):530-7. https://doi.org/10.1001/archpsyc.59.6.530
Bauer MS, Simon GE, Ludman E, Unützer J. 'Bipolarity' in bipolar disorder: distribution of manic and depressive symptoms in a treated population. The British Journal of Psychiatry. 2005Jul; 187(1):87-8. https://doi.org/10.1192/bjp.187.1.87
Rihmer Z, Kiss K. Bipolar disorders and suicidal behaviour. Bipolar Disorders. 2002 Sep; 4:21-5. https://doi.org/10.1034/j.1399-5618.4.s1.3.x
Morriss R, Yang M, Chopra A, Bentall R, Paykel E, Scott J. Differential effects of depression and mania symptoms on social adjustment: prospective study in bipolar disorder. Bipolar disorders. 2013 Feb; 15(1):80-91. https://doi.org/10.1111/bdi.12036
Shah N, Grover S, Rao GP. Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry. 2017 Jan; 59(Suppl 1):S51. https://doi.org/10.4103/0019-5545.196974
Psycho social treatment ref-(Swartz HA, Swanson J. Psychotherapy for bipolar disorder in adults: a review of the evidence. Focus. 2014 Jul; 12(3):251-66. https://doi.org/10.1176/appi.focus.12.3.251
Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Australian & New Zealand Journal of Psychiatry. 2019 Jul; 53(7):609-23. https://doi.org/10.1177/0004867419839139
Levine J, Chengappa KR, Brar JS, Gershon S, Yablonsky E, Stapf D, Kupfer DJ. Psychotropic drug prescription patterns among patients with bipolar I disorder. Bipolar Disorders. 2000 Jun; 2(2):120-30. https://doi.org/10.1034/j.1399-5618.2000.020205.x
Vega P, Barbeito S, De Azúa SR, Martínez-Cengotitabengoa M, González-Ortega I, Saenz M, González-Pinto A. Bipolar disorder differences between genders: special considerations for women. Women's Health. 2011 Nov; 7(6):663-76. https://doi.org/10.2217/WHE.11.71
Benazzi F. Bipolar II disorder family history using the family history screen: findings and clinical implications. Comprehensive psychiatry. 2004 Mar 1; 45(2): 77-82. https://doi.org/10.1016/j.comppsych.2003.12.003
Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: a brief review. Medicina. 2019 Aug; 55(8):403. https://doi.org/10.3390/medicina55080403
Johnson SL. Life events in bipolar disorder: towards more specific models. Clinical psychology review. 2005 Dec 1; 25(8):1008-27. https://doi.org/10.1016/j.cpr.2005.06.004
Lin D, Mok H, Yatham LN. Polytherapy in bipolar disorder. CNS drugs. 2006 Jan; 20(1):29- 42. https://doi.org/10.2165/00023210-200620010-00003
Trivedi JK, Sareen H, Yadav VS, Rai SB. Prescription pattern of mood stabilizers for bipolar disorder at a tertiary health care centre in north India. Indian journal of psychiatry. 2013 1Apr; 55(2):131. https://doi.org/10.4103/0019-5545.111449
Walpoth-Niederwanger M, Kemmler G, Grunze H, Weiss U, Hörtnagl C, Strauss R, Blasko I, Hausmann A. Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period: focus on mood stabilizers. International clinical psychopharmacology. 2012 Sep 1; 27(5):256-66. https://doi.org/10.1097/YIC.0b013e328356ac92
Lim PZ, Tunis SL, Edell WS, Jensik SE, Tohen M. Medication prescribing patterns for patients with bipolar I disorder in hospital settings: adherence to published practice guidelines. Bipolar Disorders. 2001 Aug; 3(4):165-73. https://doi.org/10.1034/j.1399-5618.2001.30401.x
Hayes J, Prah P, Nazareth I, King M, Walters K, Petersen I, Osborn D. Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995-2009. PloS one. 2011 Dec 7; 6(12):e28725. https://doi.org/10.1371/journal.pone.0028725
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