title: Antipsychotic adjunctive therapy to mood stabilizers and 1-year rehospitalization rates in bipolar disorder: A cohort study.
abstract: Antipsychotic adjunctive therapy to mood stabilizers (MSs) may improve relapse prevention; however, only a few naturalistic studies, reflecting more generalizable bipolar disorder (BD) samples, support this notion. We compared the 1-year rehospitalization rates of manic patients with bipolar I disorder (BD-I) who were discharged with MS (lithium or valproate) monotherapy or with adjunctive atypical or typical antipsychotic therapy.
  
  
  
  A total of 201 patients with BD-I who were hospitalized with manic episodes between 2005 and 2013 were retrospectively followed for 1-year rehospitalization rates according to treatment at discharge: MS monotherapy, MS with atypical antipsychotics, and MS with typical antipsychotics. Additionally, time to rehospitalization during the 1-year period after discharge was compared between treatment groups. Multivariable survival analyses adjusted for covariates known to influence rehospitalization were conducted.
  
  
  
  Rehospitalization rates within 1 year were significantly lower in the MS with atypical antipsychotics group (6.3%) compared to the MS monotherapy group (24.3%, P=.008) and to the MS with typical antipsychotics group (20.6%, P=.02). Time to rehospitalization was significantly longer for the MS with atypical antipsychotics group (345.5 days) compared to the MS monotherapy group (315.1 days, P=.006) and to the MS with typical antipsychotics group (334.1 days, P=.02). The MS with atypical antipsychotics group had a significantly reduced adjusted risk of rehospitalization (hazard ratio=0.17, 95% confidence interval: 0.05-0.61, P=.007) compared to the MS monotherapy group.
  
  
  
  Atypical antipsychotic adjunctive therapy to MSs may be more effective than MS monotherapy in preventing rehospitalization during the 1-year period after a BD manic episode.
authors.affiliation: Geha Mental Health Center, Petach-Tikva, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel.
authors.forename: Eldar
authors.initials: E
authors.lastname: Hochman
authors.affiliation: Geha Mental Health Center, Petach-Tikva, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Krivoy
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Ayal
authors.initials: A
authors.lastname: Schaffer
authors.affiliation: Geha Mental Health Center, Petach-Tikva, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.|Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach-Tikva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Geha Mental Health Center, Petach-Tikva, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Valevski
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000145:classification / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007557:Israel; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D014635:Valproic Acid; D008094:Lithium
keywords: atypical antipsychotics; bipolar disorder; lithium; manic episode; rehospitalization; typical antipsychotics; valproate