Pattern of Pharmacotherapy by Episode Types for Patients With Bipolar Disorders and Its Concordance With Treatment Guidelines
Authors
Ji Hyun Baek ; Kyooseob Ha ; Lakshimi N. Yatham ; Jae Seung Chang ; Tae Hyon Ha ; Hong Jin Jeon ; Kyung Sue Hong ; Sung Man Chang ; Yong Min Ahn ; Hyun Sang Cho ; Eunsoo Moon ; Boseok Cha ; Jung Eun Choi ; Yeon Ho Joo ; Eun Jeong Joo ; Se Young Lee ; Yunseong Park
Citation
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY, Vol.34(5) : 577-587, 2014
This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.