Hospital stay in patients admitted for acute bipolar manic episodes prescribed quetiapine immediate or extended release: a retrospective non-interventional cohort study (HOME)

BMC Psychiatry

Antonello Bellomo²  Esteban Medina¹  Miguel Angel Gonzalez³  Miriam Moreno-Manzanaro¹  Domingo Gonzalez⁶  Murad Atmaca⁵  Andreas Reif⁷  Oğuz Karamustafalıoğlu⁴ 

[1] AstraZeneca Farmaceutica Spain, Madrid, Spain;Department of Clinical and Experimental Sciences, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy;Quintiles, Parque Empresarial Cristalia, Madrid, Spain;Department of Psychiatry, Şişli Etfal Teaching and Research Hospital, Istanbul, Turkey;Department of Psychiatry, Firat University School of Medicine, Elazig, Turkey;Assertive Outreach, Birmingham & Solihull Mental Health Trust, Birmingham, UK;Department of Psychiatry, Psychosomatics and Psychotherapy, Head Psychiatric Neurobiology and Bipolar Disorder Program, University of Würzburg, Würzburg, Germany

关键词: Length of stay;    Hospitalisation;    Quetiapine;    Acute mania;    Bipolar disorder;   

Others  :  1123369
DOI  :  10.1186/s12888-014-0246-3

 received in 2013-08-21, accepted in 2014-08-19,  发布年份 2014

【 摘 要 】

Background

Bipolar manic episodes often require hospital admission to ensure patient safety. The antipsychotic quetiapine is a common treatment for bipolar mania and is available in immediate release (IR) and extended release (XR) formulations; however, outcomes in patients receiving these different formulations have not been directly compared in an acute hospital setting.

Methods

We conducted a multinational, observational, retrospective cohort study to describe and compare hospital stay in patients admitted for an acute bipolar manic episode treated with quetiapine IR or XR from 1 October 2009–1 October 2010. The primary outcome measure was comparison of length of stay (LOS) using zero-truncated negative binomial regression.

Results

In total, 1230 patients were included (659 in the IR cohort; 571 in the XR cohort). The median LOS (interquartile range) was 18.0 days (12.0, 28.0) in the IR cohort and 20.0 days (12.0, 34.0) in the XR cohort, respectively. LOS was not significantly associated with quetiapine formulation irrespective of whether or not clinical characteristics were taken into account (p = 0.820 and p = 0.386, respectively). Overall, 84.2% and 84.4% of patients in the IR and XR cohorts, respectively, had not previously used quetiapine; of these patients, 78.7% and 68.9% received one total daily dose, and 14.4% and 23.9% received dose titration. Over half of patients received antipsychotic monotherapy (53.1% and 58.3% in the IR and XR cohorts, respectively) and most received a daily quetiapine dose ≥ 400 mg (64.9% and 71.8%, respectively, for quetiapine monotherapy and 59.9% and 80.3%, respectively, for combination treatment).

As a secondary outcome, multivariate analysis was used to identify other factors that affect LOS. Factors associated with a longer hospital stay included public funding versus private, maximum number of new medications administered, did not receive lithium and did not receive anxiolytics, sedatives/hypnotics (all p < 0.0001). Factors associated with a shorter hospital stay included presence of drug/alcohol abuse, living accompanied and having a psychiatric medical history (all p < 0.05).

Conclusions

LOS was not found to be associated with quetiapine formulation. However, most patients received only one total daily dose of quetiapine without dose titration, which was unexpected and contrary to current recommendations.

Trial registration

Trial registration: NCT01239589 webcite

【 授权许可】

   
2014 Karamustafalioglu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington DC; 2000.
• [2]Revicki DA, Matza LS, Flood E, Lloyd A: Bipolar disorder and health-related quality of life: review of burden of disease and clinical trials. Pharmacoeconomics 2005, 23:583-594.
• [3]The World Health Report, 2001. New Understanding, New Hope Geneva, Switzerland, Mental Health; 2001.
• [4]Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MB: Course of illness and maintenance treatments for patients with bipolar disorder. J Clin Psychiatry 1995, 56:5-13.
• [5]Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jönsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J, et al.: Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011, 21:718-779.
• [6]Pini S, de Queiroz V, Pagnin D, Pezawas L, Angst J, Cassano GB, Wittchen HU: Prevalence and burden of bipolar disorders in European countries. Eur Neuropsychopharmacol 2005, 15:425-434.
• [7]Connolly KR, Thase ME: The clinical management of bipolar disorder: a review of evidence-based guidelines.Prim Care Companion CNS Disord 2011, 13. doi:10.4088/PCC.10r01097.
• [8]Vieta E, Langosch JM, Figueira ML, Souery D, Blasco-Colmenares E, Medina E, Moreno-Manzanaro M, Gonzalez MA, Bellivier F: Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd). Int J Neuropsychopharmacol 2013, 16:1719-1732.
• [9]Al Jurdi RK, Dixit LA, Sajatovic M: Role of extended release quetiapine in the management of bipolar disorders. Neuropsychiatr Dis Treat 2010, 6:29-35.
• [10]Janicak PG, Rado JT: Quetiapine for the treatment of acute bipolar mania, mixed episodes and maintenance therapy. Expert Opin Pharmacother 2012, 13:1645-1652.
• [11]Järbrink K, Locklear J, Hayflinger D: The impact of once-daily quetiapine fumarate on length of hospitalisation in patients with mental illness. Eur Neuropsychopharmacol 2009, 19:S578.
• [12]The SAS System, Version 9.2. Cary. SAS Institute Inc, NC; 2009.
• [13]Lieberman PB, Wiitala SA, Elliott B, McCormick S, Goyette SB: Decreasing length of stay: are there effects on outcomes of psychiatric hospitalization? Am J Psychiatry 1998, 155:905-909.
• [14]Martin-Carrasco M, Gonzalez-Pinto A, Galan JL, Ballesteros J, Maurino J, Vieta E: Number of prior episodes and the presence of depressive symptoms are associated with longer length of stay for patients with acute manic episodes. Ann Gen Psychiatry 2012, 11:7. BioMed Central Full Text
• [15]Priest RG, Fineberg N, Merson S, Kurian T: Length of stay of acute psychiatric inpatients: an exponential model. Acta Psychiatr Scand 1995, 92:315-317.
• [16]Cheng IC, Liao SC, Lee MB, Tseng MM: Predictors of treatment response and length of stay for inpatients with major depression. J Formos Med Assoc 2006, 106:903-910.
• [17]Pettit JW, Averill PM, Wassef AA, Gruber NP, Schneider L: Ratings of early major depressive disorder symptom change during a brief psychiatric hospitalization. Psychiatr Q 2005, 76:33-48.
• [18]Creed F, Tomenson B, Anthony P, Tramner M: Predicting length of stay in psychiatry. Psychol Med 1997, 27:961-966.
• [19][www.nice.org.uk/guidance/CG38] webcite Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care. In NICE Clinical Guideline. 2006. .
• [20]Perlis RH, Ostacher MJ, Goldberg JF, Miklowitz DJ, Friedman E, Calabrese J, Thase ME, Sachs GS: Transition to mania during treatment of bipolar depression. Neuropsychopharmacology 2010, 35:2545-2552.
• [21]Valenti M, Pacchiarotti I, Bonnin CM, Rosa AR, Popovic D, Nivoli AM, Goikolea JM, Murru A, Undurraga J, Colom F, Vieta E: Risk factors for antidepressant-related switch to mania. J Clin Psychiatry 2012, 73:e271-e276.
• [22]Rosa AR, Cruz N, Franco C, Haro JM, Bertsch J, Reed C, Aarre TF, Sanchez-Moreno J, Vieta E: Why do clinicians maintain antidepressants in some patients with acute mania? Hints from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM), a large naturalistic study. J Clin Psychiatry 2010, 71:1000-1006.
• [23]Bonafede M, Locklear J, Wahlqvist W, Fajutrao L, Szamosi J, Pan K, Eriksson H: PMH72 the impact of once-daily extended-release quetiapine fumarate (Quetiapine XR) on length of hospitalisation of patients with acute bipolar mania. Value Health 2011, 14:A300.
• [24]Gonzalez-Pinto AM, Dardennes R, de Zelicourt M, Lopez P, Oliveros RG, Vieta E, Barbeito S, Echevarria E, Fagnani F: In-patient care costs of patients with bipolar I disorder: a comparison between two European centers. J Affect Disord 2010, 121:152-155.
• [25]Douzenis A, Seretis D, Nika S, Nikolaidou P, Papadopoulou A, Rizos EN, Christodoulou C, Tsopelas C, Mitchell D, Lykouras L: Factors affecting hospital stay in psychiatric patients: the role of active comorbidity. BMC Health Serv Res 2012, 12:166. BioMed Central Full Text
• [26]Zhang J, Harvey C, Andrew C: Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry 2011, 45:578-585.
• [27]Fan AH, Frye MA, Hassell SJ, Hwang S, Kiriakos L, Mintz J, Gitlin MJ, Altshuler LL: Increased suicidality in mania complicated by alcoholism. Psychiatry (Edgmont) 2007, 4:34-39.
• [28]Keck PE Jr, McElroy SL, Strakowski SM, West SA, Sax KW, Hawkins JM, Bourne ML, Haggard P: 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Am J Psychiatry 1998, 155:646-652.
• [29]Vieta E, Sanchez-Moreno J: Acute and long-term treatment of mania. Dialogues Clin Neurosci 2008, 10:165-179.