Pharmacotherapy for acute mania and disconcordance with treatment guidelines: bipolar mania pathway survey (BIPAS) in mainland China

BMC Psychiatry

Yiru Fang⁴  Jingping Zhao³  Xin Yu⁵  Zhenghui Yi⁴  Weihong Lu⁴  Yong Wang⁴  Daihui Peng⁴  Jia Huang⁴  Chengmei Yuan⁴  Chen Zhang⁴  Jun Chen⁴  Zhiguo Wu⁴  Mengjuan Xing⁴  Wu Hong⁴  Keming Gao¹  Zuowei Wang² 

[1]Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA

[2]Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai 200083, P. R. China

[3]Mental Health Institute,The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P. R. China

[4]Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P. R. China

[5]Institute of Mental Health, Peking University, Beijing 100191, P. R. China

关键词: Guidelines;    Treatment;    Pharmacotherapy;    Mania;    Bipolar disorder;   

Others  :  1123527
DOI  :  10.1186/1471-244X-14-167

 received in 2014-01-29, accepted in 2014-06-03,  发布年份 2014

【 摘 要 】

Background

With the recent attention to evidence-based medicine in psychiatry, a number of treatment guidelines for bipolar disorders have been published. This survey investigated prescribing patterns and predictors for guideline disconcordance in the acute treatment of a manic and mixed episode across mainland China.

Methods

The pharmacological treatments of 2828 patients with a recent hypomanic/manic episode or mixed state were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments.

Results

The most common pattern of pharmacological treatments for an acute manic or mixed episode was a mood stabilizer plus an atypical antipsychotic (n = 1345, 47.6%), and the rate of guideline-disconcordant treatments was 11.1%. The patients who were treated in general hospitals were more likely to receive guideline-disconcordant treatments than those who were treated in psychiatric hospitals, with an OR of 1.84 (95% CI 1.44-2.36). Similarly, the patients with a mixed episode at study entry were more likely to receive guideline-disconcordant treatments than those with a manic episode, with an OR of 1.69 (95% CI 1.22-2.35). In contrast, the patients with a longer duration of disease (>5 years) were less likely to receive guideline-disconcordant treatments than those with a short duration, with an OR of 0.47 (95% CI 0.36-0.60).

Conclusions

In mainland China, the disconcordance with treatment guidelines for a most recent acute manic or mixed episode was modest under naturalistic conditions. The higher risk for disconcordance in general hospitals than in psychiatric hospitals suggests that special education based on treatment guidelines to practitioners in general hospitals is necessary in order to reduce the risk for disconcordant treatments.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

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