title: [Current status and management of patients with bipolar disorder in France: the MONTRA survey].
abstract: OBJECTIVE
  The objectives were to assess the characteristics of patients with bipolar disorder (BD) and to evaluate the prescribing practices.
  
  
  METHODS
  MONTRA is a quantitative survey conducted between December 2010 and February 2011. Data were extracted by the psychiatrists from the medical files of BD patients seen on four consecutive days of consulting.
  
  
  RESULTS
  Four hundred and thirty-nine psychiatrists included 2529 patients (inpatients, n=319; outpatients from mental clinics, n=1090; outpatients consulting in private practice, n=1020). In the total patient population (mean age: 47 years; women, 58%), BD was distributed as follows: BD type I, 56%; BD type II, 40%; other types of BD, 4%; rapid cyclers, 10%. The prevalence of psychiatric comorbidities was high (anxiety disorders, 48%; abuse and dependence on toxic substances, 17 and 10% respectively), 36% of the patients had a history of suicide attempt and the risk of suicide, when assessed, was 6%. In about half the patients (48%), the polarity of the initial bipolar episode was of the depressive type (versus 39% for the manic/hypomanic type). Outpatients were globally independent and did not require assistance in the management of their disease or its treatment whereas the social and professional lives of inpatients were negatively affected by their condition. Based on the psychiatrist's declarations, 39 to 50% of the outpatients were symptom-free, 36 to 40% were in the intercurrent phase with residual symptoms, 11 to 17% presented either a manic or depressive acute BP episode, and 3 to 4% were in a mixed state; among inpatients, 52% presented an acute episode either manic or depressive, 38% were in the intercurrent phase and 9% were in a mixed state. In the symptomatic patients from the total population (61%), the most prevalent symptoms were depressive and corresponded to acute symptoms (patients with a depressive episode, 14%) or residual symptoms (patients in the intercurrent phase, 27%). The predominant depressive polarity was observed in both hospitalized and outpatients. The pharmacological treatment of BD included polytherapy in 73% of the patients. In the manic episodes (n=126), the patients were treated with a Mood Stabilizer (MS, 56%) or an atypical antipsychotic (AAP, 52%) in association. In the depressive episodes (n=342), the patients received an antidepressant drug associated with a MS or an AAP (70%). In symptom-free or symptomatic intercurrent periods (n=1943), the patients were treated with a MS (49-58%) or an AAP (37-49%), in association.
  
  
  CONCLUSIONS
  BD patients evaluated in our survey were in majority diagnosed with BD type I, associated with considerable comorbidity. In the symptomatic patients, the most prevalent symptoms, either acute or residual, were of the depressive type. In the majority of the patients, whatever the clinical status, polytherapy was prescribed for the BD.
authors.affiliation: Service de psychiatrie B, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France. pmllorca@chu-clermontferrand.fr
authors.forename: P-M
authors.initials: PM
authors.lastname: Llorca
authors.forename: V
authors.initials: V
authors.lastname: Camus
authors.forename: P
authors.initials: P
authors.lastname: Courtet
authors.forename: D
authors.initials: D
authors.lastname: Gourion
authors.forename: M
authors.initials: M
authors.lastname: Lukasiewicz
authors.forename: S
authors.initials: S
authors.lastname: Coulomb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000927:Anticonvulsants / Q000008:administration & dosage*; D000928:Antidepressive Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001714:Bipolar Disorder / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents