title: Pharmacotherapy for acute mania and disconcordance with treatment guidelines: bipolar mania pathway survey (BIPAS) in mainland China.
abstract: BACKGROUND
  With the recent attention to evidence-based medicine in psychiatry, a number of treatment guidelines for bipolar disorders have been published. This survey investigated prescribing patterns and predictors for guideline disconcordance in the acute treatment of a manic and mixed episode across mainland China.
  
  
  METHODS
  The pharmacological treatments of 2828 patients with a recent hypomanic/manic episode or mixed state were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments.
  
  
  RESULTS
  The most common pattern of pharmacological treatments for an acute manic or mixed episode was a mood stabilizer plus an atypical antipsychotic (n = 1345, 47.6%), and the rate of guideline-disconcordant treatments was 11.1%. The patients who were treated in general hospitals were more likely to receive guideline-disconcordant treatments than those who were treated in psychiatric hospitals, with an OR of 1.84 (95% CI 1.44-2.36). Similarly, the patients with a mixed episode at study entry were more likely to receive guideline-disconcordant treatments than those with a manic episode, with an OR of 1.69 (95% CI 1.22-2.35). In contrast, the patients with a longer duration of disease (>5 years) were less likely to receive guideline-disconcordant treatments than those with a short duration, with an OR of 0.47 (95% CI 0.36-0.60).
  
  
  CONCLUSIONS
  In mainland China, the disconcordance with treatment guidelines for a most recent acute manic or mixed episode was modest under naturalistic conditions. The higher risk for disconcordance in general hospitals than in psychiatric hospitals suggests that special education based on treatment guidelines to practitioners in general hospitals is necessary in order to reduce the risk for disconcordant treatments.
authors.affiliation: Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P, R, China. wzwhk@163.com.
authors.forename: Zuowei
authors.initials: Z
authors.lastname: Wang
authors.forename: Keming
authors.initials: K
authors.lastname: Gao
authors.forename: Wu
authors.initials: W
authors.lastname: Hong
authors.forename: Mengjuan
authors.initials: M
authors.lastname: Xing
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Wu
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Chengmei
authors.initials: C
authors.lastname: Yuan
authors.forename: Jia
authors.initials: J
authors.lastname: Huang
authors.forename: Daihui
authors.initials: D
authors.lastname: Peng
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Weihong
authors.initials: W
authors.lastname: Lu
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Yi
authors.forename: Xin
authors.initials: X
authors.lastname: Yu
authors.forename: Jingping
authors.initials: J
authors.lastname: Zhao
authors.forename: Yiru
authors.initials: Y
authors.lastname: Fang
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000592:standards* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002681:China; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D055553:Prescription Drugs / Q000592:standards / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D055553:Prescription Drugs