title: Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period:  focus on mood stabilizers.
abstract: The increasing number of pharmacological treatment options for bipolar disorder seems to be paralleled by the number of evidence-based guidelines published previously. The aim of this study was to systematically examine the adherence to published guidelines and any change in prescription habits over time in a psychiatric hospital setting. This is a retrospective study of 531 bipolar in patients who were consecutively admitted to the Department for Psychiatry and Psychotherapy in Innsbruck. Their complete medical histories were evaluated for psychotropic medications, with a special focus on mood stabilizers (MSs). To compare the use of individual MSs or combinations with other psychotropic medications in two preselected observation periods (1999-2003 and 2004-2007), we used Fisher's exact test. Overall, the proportion of patients receiving at least one MS increased significantly from 1999-2003 to 2004-2007 (74.1 vs. 83.1%, P=0.011). Among the individual MSs, valproate was used most frequently in both time periods, showing a significant increase (P<0.001). Prescriptions of quetiapine (P<0.001) and lamotrigine (P=0.033) increased significantly, carbamazepine showed a significant decrease (P<0.001). Prescriptions of lithium and olanzapine decreased without reaching significance. The significant increase in the prescription of MS reflects the increasing awareness and implementation of recent evidence-based medicine guidelines into clinical practice. Clinical decision making, usually made on the basis of individual clinical experience, should always be reevaluated using periodically updated evidence-based medicine guidelines.
authors: Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria. michaela.walpoth@i-med.ac.at
authors: Michaela
authors: M
authors: Walpoth-Niederwanger
authors: Georg
authors: G
authors: Kemmler
authors: Heinz
authors: H
authors: Grunze
authors: Ulrike
authors: U
authors: Weiss
authors: Christine
authors: C
authors: Hörtnagl
authors: Robert
authors: R
authors: Strauss
authors: Imrich
authors: I
authors: Blasko
authors: Armand
authors: A
authors: Hausmann
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001317:Austria; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006785:Hospitals, University; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs