title: Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines.
abstract: This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.
authors.affiliation: From the *Mood Disorder Clinic and Affective Neuroscience Laboratory, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam; †Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and ‡Seoul National Hospital, Seoul, Korea; §Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; ∥Department of Psychiatry, Kyungpook National University School of Medicine, Daegu; ¶Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul; #Department of Psychiatry, Yonsei University College of Medicine, Seoul; **Department of Psychiatry, Pusan National University Hospital Medical Research Institute, Busan; ††Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju; ‡‡Department of Psychiatry, Seoul Municipal Eunpyeong Hospital; §§Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine; and ∥∥Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, South Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Baek
authors.forename: Kyooseob
authors.initials: K
authors.lastname: Ha
authors.forename: Lakshimi N
authors.initials: LN
authors.lastname: Yatham
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Chang
authors.forename: Tae Hyon
authors.initials: TH
authors.lastname: Ha
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Jeon
authors.forename: Kyung Sue
authors.initials: KS
authors.lastname: Hong
authors.forename: Sung Man
authors.initials: SM
authors.lastname: Chang
authors.forename: Yong Min
authors.initials: YM
authors.lastname: Ahn
authors.forename: Hyun Sang
authors.initials: HS
authors.lastname: Cho
authors.forename: Eunsoo
authors.initials: E
authors.lastname: Moon
authors.forename: Boseok
authors.initials: B
authors.lastname: Cha
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Choi
authors.forename: Yeon Ho
authors.initials: YH
authors.lastname: Joo
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Joo
authors.forename: Se Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Yunseong
authors.initials: Y
authors.lastname: Park
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents