Determinants of voluntary vs. involuntary admission in bipolar disorder and the impact of adherence.
BACKGROUND
Treatment adherence plays a pivotal role in hospitalisation in bipolar disorder (BD). We examined the impact of adherence and pharmacological variables on involuntary vs. voluntary admission on a sample of inpatients from the European Mania in Bipolar Longitudinal Evaluation of Medication study (EMBLEM).


METHODS
1374 inpatients with an acute manic or mixed episode of BD participated in this observational study on clinical, functional and economic outcomes of pharmacological treatment. We analysed data at the time of study inclusion, and the primary outcome measure was admission status (voluntary vs. involuntary admission).


RESULTS
The strongest baseline factor of admission status was adherence whereby patients' adherence was significantly associated with admission when treated with atypical antipsychotics or lithium as monotherapy. Adherence with typical antipsychotics was not significantly associated with admission status.


CONCLUSIONS
These results emphasise the crucial role of treatment adherence for admission status and, within the context of a naturalistic study, some advantage of atypical over typical antipsychotics on admission in acute mania of BD.
Schuepbach
D
D
Psychiatric University Hospital Zurich, Zurich, Switzerland. daniel.schuepbach@puk.zh.ch
Novick
D
D
Haro
J M
JM
Reed
C
C
Boeker
H
H
Noda
S
S
Angst
J
J
Hell
D
D
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D010054:Brief Psychiatric Rating Scale; D017723:Drug Utilization Review / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D014836:Volition
D014150:Antipsychotic Agents