Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2024 Mar 1;103(9):e37270. doi: 10.1097/MD.0000000000037270.
Bipolar disorder is a complex mental illness. Pharmacological therapy, including antipsychotics and mood stabilizers, is the primary treatment approach for manic episode. The study aimed to analyze prescribing patterns over a 14-year period for patients with bipolar mania discharged from a psychiatric hospital in Taiwan. Patients with bipolar mania discharged from the study hospital between 2006 and 2019 (n = 2956) were included in the analysis. Prescribed drugs for the treatment of manic episode, included mood stabilizers (i.e., lithium, valproate, carbamazepine) and any antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs). Monotherapy, simple polypharmacy, and complex polypharmacy were also examined. Simple polypharmacy was defined as being prescribed 2 different bipolar drugs (lithium, valproate, carbamazepine, and any antipsychotics), while complex polypharmacy at least 3 bipolar drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The prescription rates of valproate, SGAs, and complex polypharmacy significantly increased over time, whereas the prescription rates of any mood stabilizers, FGAs, and simple polypharmacy significantly decreased. Prescription rates of lithium and monotherapy did not significantly change. The study highlights the shifts in prescribing practices for bipolar mania. SGAs were prescribed more while FGAs declined, likely due to SGAs' favorable properties. Complex polypharmacy increased, reflecting the complexity of treating bipolar disorder. Long-term outcomes of these changes require further research.
双相情感障碍是一种复杂的精神疾病。药物治疗，包括抗精神病药和心境稳定剂，是治疗躁狂发作的主要方法。本研究旨在分析台湾一家精神病院出院的躁狂症患者 14 年来的处方模式。该研究分析了 2006 年至 2019 年期间从研究医院出院的 2956 例双相躁狂症患者。用于治疗躁狂发作的处方药物包括心境稳定剂（即锂盐、丙戊酸盐、卡马西平）和任何抗精神病药（即第二代和第一代抗精神病药；SGAs 和 FGAs）。还检查了单药治疗、简单联合用药和复杂联合用药。简单联合用药定义为开了 2 种不同的双相药物（锂盐、丙戊酸盐、卡马西平、和任何抗精神病药），而复杂联合用药至少开了 3 种双相药物。使用 Cochran-Armitage 趋势检验分析每种处方模式的时间趋势。丙戊酸盐、SGAs 和复杂联合用药的处方率随时间显著增加，而任何心境稳定剂、FGAs 和简单联合用药的处方率显著下降。锂盐和单药治疗的处方率没有显著变化。本研究强调了双相躁狂症治疗中处方模式的转变。SGAs 的处方量增加，而 FGAs 的处方量下降，可能是因为 SGAs 具有有利的特性。复杂联合用药增加，反映了治疗双相情感障碍的复杂性。这些变化的长期结果需要进一步研究。
