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Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period: focus on mood stabilizers

Walpoth-Niederwanger, Michaelaa; Kemmler, Georga; Grunze, Heinzb; Weiss, Ulrikea; Hörtnagl, Christinea; Strauss, Roberta; Blasko, Imricha; Hausmann, Armanda

International Clinical Psychopharmacology:
doi: 10.1097/YIC.0b013e328356ac92
Original Articles
Abstract

The increasing number of pharmacological treatment options for bipolar disorder seems to be paralleled by the number of evidence-based guidelines published previously. The aim of this study was to systematically examine the adherence to published guidelines and any change in prescription habits over time in a psychiatric hospital setting. This is a retrospective study of 531 bipolar in patients who were consecutively admitted to the Department for Psychiatry and Psychotherapy in Innsbruck. Their complete medical histories were evaluated for psychotropic medications, with a special focus on mood stabilizers (MSs). To compare the use of individual MSs or combinations with other psychotropic medications in two preselected observation periods (1999–2003 and 2004–2007), we used Fisher’s exact test. Overall, the proportion of patients receiving at least one MS increased significantly from 1999–2003 to 2004–2007 (74.1 vs. 83.1%, P=0.011). Among the individual MSs, valproate was used most frequently in both time periods, showing a significant increase (P<0.001). Prescriptions of quetiapine (P<0.001) and lamotrigine (P=0.033) increased significantly, carbamazepine showed a significant decrease (P<0.001). Prescriptions of lithium and olanzapine decreased without reaching significance. The significant increase in the prescription of MS reflects the increasing awareness and implementation of recent evidence-based medicine guidelines into clinical practice. Clinical decision making, usually made on the basis of individual clinical experience, should always be reevaluated using periodically updated evidence-based medicine guidelines.

Author Information

aDepartment of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria

bInstitute of Neuroscience, Academic Psychiatry, Newcastle General Hospital, Newcastle University, Newcastle upon Tyne, UK

Correspondence to Michaela Walpoth-Niederwanger, MD, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria Tel: +43 512 504 23636; fax: +43 512 504 3628; e-mail: michaela.walpoth@i-med.ac.at

Received January 17, 2012

Accepted June 6, 2012

© 2012 Lippincott Williams & Wilkins, Inc.