Maintenance treatment received by patients with bipolar I and II disorders--a naturalistic prospective study.
BACKGROUND
We investigated the adequacy of maintenance phase pharmacotherapy received by psychiatric in- and outpatients with bipolar I or II disorder, including patients both with and without a clinical diagnosis of bipolar disorder (BD).


METHODS
In the Jorvi Bipolar Study (JoBS), a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities, we studied the adequacy of pharmacological treatment received by 154 patients during the first maintenance phase after index episode. Information on treatments prescribed during the follow-up was gathered in interviews and from psychiatric records.


RESULTS
Of the patients with a maintenance phase in follow-up, adequate maintenance treatment was received by 75.3% for some time, but by only 61.0% throughout the maintenance phase and for 69.3% of the time (783/1129 patient months) indicated. Uninterrupted adequate maintenance treatment received was most strongly independently associated with having a clinical diagnosis of BD; other associations included inpatient treatment, rapid cycling and not having a personality disorder.


CONCLUSIONS
Adequacy of dosage, duration or serum concentrations were not estimated. Findings represent an upper limit for adequate treatment within the cohort.


CONCLUSIONS
Provision or continuity of maintenance treatment was found to be compromised in more than one-third of BD patients during their first follow-up maintenance phase. As expected, clinical diagnosis of BD has a decisive role in determining adequacy of maintenance treatments. However, also rapid cycling may facilitate provision of adequate maintenance treatment, whereas outpatients and those with comorbid personality disorders may be disadvantaged subgroups.
Arvilommi
Petri
P
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Suominen
Kirsi
K
Mantere
Outi
O
Leppämäki
Sami
S
Valtonen
Hanna M
HM
Isometsä
Erkki
E
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077213:Lamotrigine; D016651:Lithium Carbonate / Q000008:administration & dosage / Q000009:adverse effects; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D000078330:Oxcarbazepine; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D015363:Quinolones / Q000008:administration & dosage / Q000009:adverse effects; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects
D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D014227:Triazines; D001569:Benzodiazepines; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine; D000077213:Lamotrigine; D000078330:Oxcarbazepine