Abstract
We investigated trends over a decade in the prescription of lithium, antiepileptics, and antipsychotic agents at discharge for patients hospitalised for acute mania. We conducted a retrospective review of medical records for 165 inpatients with acute mania who had been hospitalised in Cerrahpaşa Faculty of Medicine, Department of Psychiatry during 2001–2002 and 2011–2012. Among 165 patients, prescription of olanzapine at discharge increased from 3 to 46 % (p < 0.001), while prescription of haloperidol decreased from 55 to 21 % (p < 0.001). Use of other atypical antipsychotics did not change significantly (risperidone decreased from 14 to 11 %, p = 0.5; quetiapine increased from 10 to 16 %, p = 0.2). Use of valproate, carbamazepine, and lithium did not change significantly. Use of electroconvulsive therapy in acute mania decreased by half from 27 to 13 % (p = 0.02). Typical antipsychotics alone or in combination with antiepileptics were the most common treatment regimen at discharge at 2001–2002; while 10 years later, they had been largely replaced by lithium or antiepileptics combined with second generation antipsychotics. Antipsychotic agents remained to be an important component of acute treatment of mania in our practice.
Similar content being viewed by others
References
Angst J, Sellaro R: Historical perspectives and natural history of bipolar disorder. Biological Psychiatry 48:445–57, 2000.
Baldessarini RJ: Treatment research in bipolar disorder: issues and recommendations. CNS Drugs 16:721–9, 2002.
Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J: Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatric Services 58:85–91, 2007.
Berk M, Ichim L, Brook S: Olanzapine compared to lithium in mania: a double-blind randomized controlled trial. International Clinical Psychopharmacology 14:339–343, 1999.
Bonnin CM, Martinez-Aran A, Torrent C, Pacchiarotti I, Rosa AR, Franco C, Murru A, Sanchez-Moreno J, Vieta E: Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term, follow-up study. Journal of Affective Disorders 121:156–160, 2010.
Buoli M, Serati M, Altamura AC: Is the combination of a mood stabilizer plus an antipsychotic more effective than mono-therapies in long-term treatment of bipolar disorder? A systematic review. Journal of Affective Disorders 152–154:12–18, 2014.
Calabrese JR, Keck PE Jr, Macfadden W, Minkwitz M, Ketter TA, Weisler RH, Cutler AJ, McCoyR, WilsonE, Mullen J: A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. American Journal of Psychiatry 162:1351–1360, 2005.
Centorrino F, Ventriglio A, Vincenti A, Talamo A, Baldessarini RJ: Changes in medication practices for hospitalized psychiatric patients: 2009 versus 2004. Human Psychopharmacology 25:179–186, 2010.
Cipriani A, Barbui C, Salanti G, Rendell J, Brown R, Stockton S, Purgato M, Spineli LM, Goodwin GM, Geddes JR: Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 378:1306–15, 2011.
Cipriani A, Rendell J, Geddes JR: Olanzapine in the long-term treatment of bipolar disorder: a systematic review and meta-analysis. Journal of Psychopharmacology 24:1729–1738, 2010.
Geddes JR, Miklowitz DJ: Treatment of bipolar disorder. Lancet 381:1672–1682, 2013.
Ghaemi SN, Katzow JJ: The use of quetiapine for treatment-resistant bipolar disorder: a case series. Annals of Clinical Psychiatry 11:137–140, 1999.
Goikolea JM, Colom F, Torres I, Capapey J, Valenti M, Undurraga J, Grande I, Sanchez-Moreno J, Vieta E: Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol. Journal of Affective Disorders 144:191–198, 2013.
Goodwin FK: Manic-depressive illness. Oxford University Press, New York, 1990.
Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D: Suicide risk in bipolar disorder during treatment with lithium and divalproex. Journal of the American Medical Association 290:1467–1473, 2003.
Goodwin GM, Bowden CL, Calabrese JR, Grunze H, Kasper S, White R, Greene P, Leadbetter R: A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. Journal of Clinical Psychiatry 65:432–41, 2004.
Goodwin GM; Consensus Group of the British Association for Psychopharmacology: Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 23:346–88, 2009.
Greil W, Haberle A, Haueis P, Grohmann R, Russmann S: Pharmacotherapeutic trends in 2231 psychiatric inpatients with bipolar depression from the International AMSP Project between 1994 and 2009. Journal of Affective Disorders 136:534–42, 2012.
Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Moller HJ, Kasper S.: The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World Journal of Biological Psychiatry 10:85–116, 2009.
Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170:205–228, 1997.
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 6:e28725, 2011.
Hooshmand F., Miller S, Dore J, Wang PW, Hill SJ, Portillo N, Ketter TA: Trends in pharmacotherapy in patients referred to a bipolar specialty clinic, 2000-2011. Journal of Affective Disorders 155:283–287, 2014.
Malempati RN: Aripiprazole adjunct treatment in bipolar I or II disorder, depressed state: a 2-year clinical study. Journal of Nervous and Mental Disease 203:58–64, 2015.
McElroy SL, Keck PE Jr: Pharmacologic agents for the treatment of acute bipolar mania. Biological Psychiatry 48:539–57, 2000.
Medda P, Toni C, Perugi G: The mood-stabilizing effects of electroconvulsive therapy. Journal of ECT 30:275–82, 2014.
Mohammad O, Osser DN: The psychopharmacology algorithm project at the Harvard South Shore Program: an algorithm for acute mania. Harvard Review of Psychiatry 22:274–294, 2014.
Mukherjee S, Sackeim HA, Schnur DB: Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience. The American Journal of Psychiatry 151:169–176, 1994.
Ogawa Y, Tajika A, Takeshima N, Hayasaka Y, Furukawa TA: Mood stabilizers and antipsychotics for acute mania: a systematic review and meta-analysis of combination/augmentation therapy versus monotherapy. CNS Drugs 28: 989–1003, 2014.
Segal J, Berk M, Brook S: Risperidone compared with both lithium and haloperidol in mania: a double-blind randomized controlled trial. Clinical Neuropharmacology 21:176–180, 1998.
Sernyak MJ, Griffin RA, Johnson RM, Pearsall HR, Wexler BE, Woods SW: Neuroleptic exposure following inpatient treatment of acute mania with lithium and neuroleptic. American Journal of Psychiatry 151:133–135, 1994.
Smith LA, Cornelius V, Warnock A, Tacchi MJ, Taylor D: Acute bipolar mania: a systematic review and meta-analysis of co-therapy vs. monotherapy. Acta Psychiatrica Scandinavica 115:12–20, 2007.
Srivastava S, Ketter TA, Clinical relevance of treatments for acute bipolar disorder: balancing therapeutic and adverse effects. Clinical Therapeutics 33:B40–B48, 2011.
Walpoth-Niederwanger M, Kemmler G, Grunze H, Weiss U, Hortnagl 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 27:256–266, 2012.
Wang Z, Gao K, Hong W, Xing M, Wu Z, Chen J, Zhang C, Yuan C, Huang J, Peng D, Wang Y, Lu W, Yi Z, Yu X, Zhao J, Fang Y: Pharmacotherapy for acute mania and disconcordance with treatment guidelines: bipolar mania pathway survey (BIPAS) in mainland China. BMC Psychiatry 14:167, 2014.
WHO: The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, World Health Organization, 1992.
Wolfsperger M, Greil W, Rossler W, Grohmann R: Pharmacological treatment of acute mania in psychiatric in-patients between 1994 and 2004. Journal of Affective Disorders 99:9–17, 2007.
Yang M, Barner JC, Lawson KA, Rascati KL, Wilson JP, Crismon ML, Worchel J, Mascarenas CA: Antipsychotic medication utilization trends among Texas veterans: 1997-2002. Annals of Pharmacotherapy 42:1229–1238, 2008.
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen, WA, Berk M: Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorder 15:1–44, 2013.
Acknowledgments
This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Arıkan, M.K., Poyraz, C.A., Baş, A. et al. Changing Trends in Treatment of Acute Mania: Experience of a Tertiary Centre Over a Decade. Psychiatr Q 87, 305–313 (2016). https://doi.org/10.1007/s11126-015-9388-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11126-015-9388-9