title: Current psychotropic medication prescribing patterns in late-life bipolar disorder.
abstract: Many patients with bipolar disorder are reaching old age, but whether they are receiving evidence-based psychotropic treatment remains unclear. Our objective was to describe current psychotropic prescribing patterns in a large Canadian late-life bipolar sample.
  
  
  
  Population-based cross-sectional study of 1443 bipolar disorder patients aged ≥ 66, discharged from a psychiatric hospitalization in Ontario, Canada from 1 April 2006 to 31 March 2012. We described psychotropic medication prescribing within 30 days post-discharge.
  
  
  
  Prescription of ≥2 psychotropic medications was highly prevalent (81.5%). The most common medications were atypical antipsychotics (75.3%), benzodiazepines/zopiclone (42.3%), and antidepressants (38.5%), with less frequent use of valproate (35.4%) and lithium (23.4%). Only 1.4% of patients were on lithium monotherapy, while 4.4% and 15.7% of patients were on antidepressant or atypical antipsychotic monotherapy; 8.9% of all patients were using ≥2 atypical antipsychotics.
  
  
  
  In clinical practice, older adults hospitalized with bipolar disorder are often prescribed multiple psychotropic medications upon discharge. In many instances, practices did not reflect bipolar treatment guidelines and may be putting patients at risk for poor physical health and psychiatric outcomes. One such example is the very infrequent use of lithium monotherapy. Future research should examine whether health system-wide protocolized late-life bipolar treatment may optimize prescribing to improve effectiveness and safety. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, Canada.
authors.forename: Kinwah
authors.initials: K
authors.lastname: Fung
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Department of Family Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs; D001569:Benzodiazepines; D014635:Valproic Acid; D008094:Lithium
keywords: bipolar disorder; geriatric; prescribing patterns; psychotropic medication