title: Mania in the Nordic countries: patients and treatment in the acute phase of the EMBLEM study.
abstract: In bipolar disorder, mood stabilizers and second-generation antipsychotics have a central role in pharmacotherapy. There are, however, substantial differences in how the treatment is realized in different countries. The aim of this paper was to compare the treatment of acute mania in the Nordic countries with other European countries during the first 12 weeks of the EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) study. Adult patients with bipolar disorder were enrolled within standard course of care as in/outpatients if they initiated/changed oral medication with antipsychotics, anticonvulsants or lithium for treatment of acute mania. Five hundred and thirty European psychiatrists including 23 Nordic psychiatrists enrolled 3459 patients including 79 Nordic patients eligible for analysis using the same study methods assessing demographics, psychiatric history, clinical status, functional status and pharmacological treatment. Psychiatric status at inclusion measured by the Young Mania Rating Scale (YMRS) and the Clinical Global Impression-Bipolar Disorder (CGI-BP) were similar in the Nordic and European patient groups, which is surprising as 73% of the Nordic patients compared with 38% of the European patients were inpatients. In the Nordic group of patients, more patients were living independently. Before inclusion in the study more patients in the Nordic group had combination therapy, but after inclusion in the study the prescription pattern of psychopharmacy was similar in the Nordic and the European patient groups. This study indicated differences in admission patterns, patient social functioning and medical treatment in the Nordic patients compared with the European patients.
authors.affiliation: Gentofte Psychiatric Centre, Niels Andersensvej 65, Hellerup DK-2900, Denmark. jela@geh.regionh.dk
authors.forename: Jens Knud
authors.initials: JK
authors.lastname: Larsen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Porsdal
authors.forename: Trond F
authors.initials: TF
authors.lastname: Aarre
authors.forename: Hannu J
authors.initials: HJ
authors.lastname: Koponen
authors.forename: Jorma
authors.initials: J
authors.lastname: Aarnio
authors.forename: Ole Kristian
authors.initials: OK
authors.lastname: Kleivenes
mesh_terms: D000208:Acute Disease; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003718:Denmark; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005060:Europe; D005260:Female; D005387:Finland; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment; D012959:Socioeconomic Factors
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate