title: Psychopharmacological treatment of 1650 in-patients with acute mania-data from the AMSP study.
abstract: BACKGROUND
  Several studies have analyzed prescription patterns for bipolar disorder, but few have for acute mania. Treatment strategies in this complex domain change over time and do not always follow evidence-based guidelines.
  
  
  METHODS
  Prescription data of in-patients suffering from acute mania in the time period from 2005 to 2012 were obtained from the database of the Drug Safety Program in Psychiatry (Institut für Arzneimittelsicherheit in der Psychiatrie; AMSP). Data were collected on two index dates per year. Changes over time were analyzed comparing the time periods 2005/06 and 2011/12.
  
  
  RESULTS
  Among 1650 patients (mean ±SD; age: 48.9±14.91 years; 53.1% females) 54.1% received anticonvulsants, 74.5% second-generation antipsychotics (SGAs), 17.8% first-generation antipsychotics (FGAs), 29.1% lithium, 44.1% benzodiazepines and 14.5% antidepressants. Prescription of SGAs increased from 70% to 79% (p=0.005), while prescription of FGAs and anticonvulsants decreased from 19% to 13% (p<0.05) and 59% to 46% (p<0.001), respectively. Only 30% of patients received monotherapy with one mood stabilizer. We observed an impact of gender, age and psychotic symptoms on treatment strategy. 36.8% of the women≤40 years received valproate.
  
  
  CONCLUSIONS
  Follow-up data are missing and no differentiation between acute and maintenance treatments could be made due to the cross-sectional design. Additionally, our findings do not necessarily translate to outpatients or to other countries.
  
  
  CONCLUSIONS
  Combination therapies represent standard clinical practice. Though many results reflect clinical necessity, the high number of antidepressant prescriptions or valproate use in women of child-bearing age should be judged critically. Further prospective studies should focus on real-world prescription practice in acute mania to evaluate efficacy and safety of common practice. This paper is dedicated to Prof. Dr. Hanns Hippius on the occasion of his 90th birthday.
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany. Electronic address: kleimann.alexandra@mh-hannover.de.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kleimann
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Schrader
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Augsburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Stübner
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany; Psychiatric Hospital Kilchberg, Kilchberg-Zurich, Switzerland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Greil
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Kai G
authors.initials: KG
authors.lastname: Kahl
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bleich
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Grohmann
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Frieling
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Sermin
authors.initials: S
authors.lastname: Toto
mesh_terms: D000208:Acute Disease; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D001569:Benzodiazepines; D014635:Valproic Acid
keywords: AMSP; Acute Mania; Antipsychotics; Bipolar Disorder; Gender; Prescription practice