PATTERNS OF PSYCHOTROPIC DRUG PRESCRIPTION BEFORE AND AFTER EVALUATION IN A SPECIALIZED OUTPATIENT PROGRAM FOR BIPOLAR DISORDERS G.Michalopoulos, J-M. Aubry, M.Gex-Fabry Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland

Introduction/Aim Efficient treatment of patients with bipolar disorders (BD) depends on early diagnosis, taking into account the time course of the disorder, the symptom overlap with other conditions and the high rates of comorbidity. Adherence to published treatment guidelines is challenging in these disorders. To evaluate psychotropic medication in patients presenting for a thorough clinical evaluation in a specialized outpatient program for BD, and compare prescription patterns at admission and discharge, with reference to international guidelines.

Method We conducted a retrospective chart review for 250 patients who entered our program in Geneva, Switzerland, during the period January July A majority of patients were referred by private psychiatrists (42%) or general practitioners or internists (26%) for an expert evaluation of a suspected or complex BD. Most patients had three interviews with trained nurses, psychologists and psychiatrists, which included a semi-structured diagnostic interview (MINI) and rating scales (MADRS or YMRS, HCL-32, MDQ, Borderline questionnaire, sleep questionnaire,CTQ.

Results BD was confirmed in 56% (140/250) of the sample; 16% (39/250) bipolar I, 30% (76/250) bipolar II and 10% (25/250) not otherwise specified. A majority of bipolar I and II patients were euthymic (52%) during the evaluation period, 40% were depressed and 8% had a hypomanic or mixed episode. Comorbidity was 23% with anxiety disorders, 34% with (several) addictions (26% for alcool) and 42% with personality disorders (18% Borderline and 23% others personality disorders). Before evaluation, prescribed medication for BDI and II patients included mood stabilizers for 48%, antipsychotics for 44%, antidepressants for 44%, and benzodiazepines for 43%. After evaluation, proportions significantly increased to 89% for mood stabilizers and 59% for antipsychotics, but significantly decreased to 17% for benzodiazepines. Antidepressant prescription remained stable after discharge at 44%: 59% of patients with major depressive episodes, 35% for euthymic and 33% for hypomanic or in mixed episode. Prescription did not significantly differ in bipolar I and II patients, except for more frequent exposure to antipsychotic medication in bipolar I, both before and after evaluation. Complex polypharmacy (i.e., ≥ 4 psychotropic drugs) was frequent both before (19%) and after evaluation (28%).

Conclusion/Discussion Increased prescription of mood stabilizers and antipsychotics is in keeping with international guidelines, which recommend them as first-line options for maintenance treatment of BD, either in monotherapy or in combination. Antidepressant prescription at discharge remained frequent in bipolar depression, despite controversy about their effectiveness. The high rate of complex polypharmacy raises concerns about adverse events and poor treatment adherence in bipolar patients who often present with comorbid conditions. Specialized clinical evaluation might help providing bipolar patients with rational treatment, in line with most recent guidelines.

Comorbidities

Psychotropics in BDI and II patients ADMISSIONDISCHARGE

Antidepressants prescription in BDI and II ADMISSIONDISCHARGE