Utilization of Valproate: Extent of Inpatient Use in the New York State Office of Mental Health
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Objective: To describe the extent and type of use of valproate among hospitalized psychiatric patients. Method: A database containing patient information and drug prescription information for every in-patient within the adult civil facilities of the New York State Office of Mental Health was queried. Results: In 1994, 2,888 of 18,668 in-patients received valproate (15.5%). In 1996, 4,247 of 12,444 in-patients received valproate (34.1%). In 1996, approximately 50% of all patients diagnosed as bipolar or schizoaffective, and 28% of all patients diagnosed with schizophrenia, received valproate. Once started on valproate, over 90% remained on it after 2 weeks, with no difference found in the discontinuation rates between valproic acid or divalproex sodium at the end of the initial 14 day period. Patients received valproate for approximately two-thirds of their hospital stay, at a mean dose of 1400 mg/day. 95% also received concomitant antipsychotics, and 20% received concomitant lithium. Use of lithium and carbamazepine was less in 1996 than in 1994, but the magnitude of this change was much less than the increase in utilization of valproate. Conclusions: From 1994 to 1996 valproate use has more than doubled, and it is being used widely in patients with schizophrenia, an off-label indication for which there is only anecdotal support in the literature. Given the lack of difference in early discontinuation rates, there are probably no dramatic differences in side effects for the two preparations of valproate.
- Bowden CL, Brugger AM, Swann AC, et al: Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 271: 918-924, 1994.
- Gerner RH, Stanton A: Algorithm for patient management of acute manic states: lithium, valproate or carbamazepine? Journal of Clinical Psychopharmacology 12(suppl): 57S-63S, 1992.
- Chou JCY: Recent advances in treatment of acute mania. Journal of Clinical Psychopharmacology 11: 3-21, 1991.
- Freeman MP, Stoll AL: Mood stabilizer combinations: A review of safety and efficacy. Am J Psychiatry 155(1): 12-21, 1998.
- Heninger GR, Charney DS, Sternberg DE: Lithium carbonate augmentation of antidepressant treatment. Archives General Psychiatry 40: 1335-1342, 1983.
- Wassef A, Watson DJ, Morrison P, et al. Neuroleptic-valproic acid combination in treatment of psychotic symptoms: a three-case report. Journal of Clinical Psychopharmacology 9: 45-48, 1989.
- Sheard MH, Marini JL, Bridges CI, et al: The effect of lithium on impulsive aggressive behavior in man. American Journal of Psychiatry 133: 1409-1413, 1976.
- Luchins DL: Carbamazepine in violent non-epileptic schizophrenics. Psychopharmacology Bulletin 20: 569-571, 1984.
- Citrome L: The use of lithium, carbamazepine, and valproic acid in a state operated psychiatric hospital, Journal of Pharmacy Technology 11(2): 55-59, 1995.
- Abbott Laboratories: Depakote and Depakene product information in Physicians' Desk Reference, 52nd Edition. Medical Economics Company, Montvale, NJ, 1998. Pages 421-434.
- Wilder BJ, Karas BJ, Penry JK, et al: Gastrointestinal tolerance of divalproex sodium. Neurology 33(6): 808-811, 1983.
- Keck PE: The use of divalproex. J Clin Psychiatry Monograph 15(4): 18-19, 1997.
- Wilder BJ, Karas BJ, Hammond EJ, et al: Twice-daily dosing of valproate with divalproex. Clin Pharmacol Ther 34(4): 501-504, 1983.
- Schaff MR, Fawcett J, Zajecka JM: Divalproex sodium in the treatment of refractory affective disorders. J Clin Psychiatry 54(10): 380-384, 1993.
- Kastner T, Friedman DL, Plummer AT, et al: Valproic acid for the treatment of children with mental retardation and mood symptomatology. Pediatrics 86(3): 467-472, 1990.
- Kastner T, Finesmith R, Walsh K: Long-term administration of valproic acid in the treatment of affective symptoms in people with mental retardation. J Clin Psychopharmacology 13(6): 448-451, 1993.
- Shah BS, Ratner H: Anti-convulsant drugs, smoking, and body weights in psychiatric in-patients. New York State Journal of Medicine 93(1): 16-17, 1993.
- Stein DJ, Simeon D, Frenkel M, et al: An open trial of valproate in borderline personality disorder. J Clin Psychiatry 56(11): 506-510, 1995.
- Wilcox JA: Divalproex sodium as a treatment for borderline personality disorder. Annals of Clinical Psychiatry 7(1): 33-37, 1995.
- Kahn D, Stevenson E, Douglas CJ: Effect of sodium valproate in three patients with organic brain syndromes. Am J Psychiatry 145(8): 1010-1011, 1988.
- Mazure CM, Druss BG, Cellar JS: Valproate treatment of older psychotic patients with organic mental syndrome and behavioral dyscontrol. J American Geriatrics Society 40(9): 914-916, 1992.
- Mellow AM, Solano-Lopez C, Davis S: Sodium valproate in the treatment of behavioral disturbance in dementia. J Geriatric Psychiatry and Neurology 6: 205-209, 1993.
- Lott AD, McElroy SL, Keys MA: Valproate in the treatment of behavioral agitation in elderly patients with dementia. J Neuropsychiatry 7(3): 314-319, 1995.
- Hass S, Vincent K, Holt J, et al: Divalproex: A possible treatment alternative for demented, elderly aggressive patients. Annals of Clinical Psychiatry 9(3): 145-147, 1997.
- McElroy SL, Keck PE, Pope HG: Sodium valproate: its use in primary psychiatric disorders. J Clinical Psychopharmacology 7(1): 16-24, 1987.
- McElroy SL, Keck PE, Pope HG, et al: Valproate in psychiatric disorders: Literature review and clinical guidelines. J Clinical Psychiatry 50(suppl 3): 23-29, 1989.
- Keck PE, McElroy SL, Strakowski SM: New developments in the pharmacologic treatment of schizoaffective disorder. J Clin Psychiatry 57(suppl 9): 41-48, 1996.
- Linnoila M, Viukari M, Hietala O: Effect of sodium valproate on tardive dyskinesia. Br J Psychiatry 129: 114-119, 1976.
- Fisk GG, York SM: The effect of sodium valproate on tardive dyskinesia-revisited. Br J Psychiatry 150: 542-546, 1987.
- Roy-Byrne PP, Ward NG, Donnelly PJ: Valproate in anxiety and withdrawal syndromes. J Clin Psychiatry 50(suppl 3): 44-48, 1989.
- Primeau F, Fontaine R, Beauclair L: Valproic acid and panic disorder. Can J Psychiatry 35: 248-250, 1990.
- Keck PE, McElroy SL, Friedman LM: Valproate and carbamazepine in the treatment of panic and post-traumatic stress disorders, withdrawal states, and behavioral dyscontrol syndromes. J Clin Psychopharmacology 12(1): 36S-41S, 1992.
- Donovan SJ, Susser ES, Nunes EV, et al: Divalproex treatment of disruptive adolescents: a report of 10 cases. J Clinical Psychiatry 56(1): 12-15, 1997.
- Morinigo A, Martin J, Gonzalez S, et al: Treatment of resistant schizophrenia with valproate and neuroleptic drugs. Hillside J Clin Psychiatry 11(2): 199-207, 1989.
- Mattes JA: Valproic acid for nonaffective aggression in the mentally retarded. J Nervous and Mental Disease 180: 601-602, 1992.
- Wroblewski BA, Joseph AB, Kupfer J, et al: Effectiveness of valproic acid on destructive and aggressive behaviors in patients with acquired brain injury. Brain Injury 11(1): 37-47, 1997.
- Alam MY, Klass DB, Luchins DJ, et al: Effectiveness of divalproex sodium, valproic acid and carbamazepine in aggression (poster). NCDEU 35th Annual Meeting, 1995.
- Wilcox J: Divalproex sodium in the treatment of aggressive behavior. Annals of Clinical Psychiatry 6(1): 17-20, 1994.
- Citrome L, Levine J, Allingham B: Utilization of depot neuroleptic medication in psychiatric inpatients, Psychopharmacology Bulletin 32(3): 321-326, 1996.
- Levine J, Citrome L, Allingham B: An effectiveness study comparing oral and depot neuroleptic medications. Psychopharmacology Bulletin 33(3): 476, 1997.
- Utilization of Valproate: Extent of Inpatient Use in the New York State Office of Mental Health
Volume 69, Issue 4 , pp 283-300
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links