title: Treatment strategies according to clinical features in a naturalistic cohort study of bipolar patients: a principal component analysis of lifetime pharmacological and biophysic treatment options.
abstract: BACKGROUND
  The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription.
  
  
  OBJECTIVE
  The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients.
  
  
  METHODS
  Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD.
  
  
  RESULTS
  Three main factors corresponding to three main prescription patterns were identified, which explained about 60% of cases, namely, Factor 1 (21.1% of common variance), defined the "antimanic stabilisation package" including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4%), "antidepressive stabilisation package" that grouped predominantly depressed patients, and Factor 3 (16.4%) defined the "anti-bipolar II package", including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours.
  
  
  CONCLUSIONS
  This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients.
authors.affiliation: Bipolar Disorder Program, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
authors.forename: Alessandra M A
authors.initials: AM
authors.lastname: Nivoli
authors.forename: Francesc
authors.initials: F
authors.lastname: Colom
authors.forename: Isabella
authors.initials: I
authors.lastname: Pacchiarotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Murru
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.forename: Marc
authors.initials: M
authors.lastname: Valentí
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mazzarini
authors.forename: Caterina
authors.initials: C
authors.lastname: Del Mar Bonnin
authors.forename: José
authors.initials: J
authors.lastname: Sánchez-Moreno
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serretti
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000328:Adult; 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* / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents