Pointers for boosting prophylactic bipolar treatment reported

By Eleanor McDermid, Senior medwireNews Reporter

Patients with newly diagnosed bipolar disorder who have not previously used psychiatric drugs or have short hospital admissions should be targeted for prophylactic treatment, say researchers.

Louise Scheen (Karolinska Institutet, Stockholm, Sweden) and colleagues found that these patients were at an increased risk of not receiving prophylactic treatment, in the face of recommendations that all newly diagnosed bipolar disorder patients should be given such therapy.

In all, 72.2% of the 31,770 patients in the nationwide study had started on a mood stabiliser or antipsychotic drug within 3 months of receiving a bipolar disorder diagnosis. The rate of prophylactic drug use rose only slightly by 1 year after diagnosis, to 79.2%. The rate of prophylactic drug use was higher among patients diagnosed during hospital admission than those diagnosed as outpatients, especially during the first 3 months.

On multivariate analysis, previous use of mood stabilising or antipsychotic drugs was a strong predictor of their use within 3 months of diagnosis, increasing this likelihood by 24% among inpatients and 78% among outpatients. Being in a mixed or depressive state, relative to an unspecified state, at diagnosis also increased both groups’ chances of receiving prophylactic treatment.

More than two-thirds of the patients had previous psychiatric hospitalisations or outpatient visits and had been prescribed psychiatric drugs, with two-thirds receiving an antidepressant, a quarter an antipsychotic and 11% lithium.

Scheen et al note that the age at diagnosis was relatively high in their cohort, at 39.8 years, probably reflecting diagnostic delays. In this case, the lack of prophylactic medication at diagnosis for more than a quarter of the patients may be “in many cases adding to an already substantial treatment delay, despite previous contact with psychiatric care”, they write in the Journal of Affective Disorders.

Among inpatients, longer durations of hospital stay increased their chances of receiving prophylactic medication, by 1.86-fold for stays of 7 to 28 days and 2.18-fold for 28 days or longer, relative to a stay of less than 7 days. Among outpatients, being in a manic or hypomanic state halved the likelihood of being prescribed prophylactic medication.

This latter finding probably reflects “the difficulty of managing manic patients in outpatient care,” say the researchers, adding that this implies a need “for inpatient care to facilitate proper treatment”.

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