The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland

Abstract

Background: The concomitant use of two or more mood stabilisers (MS), second-generation antipsychotics (SGA), lamotrigine as well as antidepressants, is frequently reported in the treatment of bipolar patients The aim of this study was to investigate the pattern of pharmacological treatment with special regard to polypharmacy defined as two or more psychiatric drugs taken at the same time in the same patients with bipolar disorder discharged from psychiatric units in Poland.

Method: Pharmacotherapy of 127 consecutive patients (57 females and 70 males) with an ICD-10 diagnosis of bipolar disorder (BP) at the point of discharge from five psychiatric regional hospitals/units in Poland, was evaluated in 2015/2016 on the basis of medical files. The effect of treatment on mental status at discharge was examined using the Clinical Global Impression-Improvement scale (CGI-I).

Results: When only MS, SGA and lamotrigine, were taken into account, 78 (61%) of patients were prescribed two, 27 (21.3%) three and one patient four medications. The combination of MS and SGA was most commonly used (n=61, 48%). Medications preferred by Polish psychiatrists at patients' discharge were valproates (n=69, 54%), olanzapine (n=48, 37%), quetiapine (n=47, 37%) and lamotrigine (n=33, 25.9%). Thirty patients (23.6%) were prescribed lithium. No relationships were found between polypharmacy and patients' age, duration of illness and the rate of CGI-I. However, polypharmacy was significantly associated with types of bipolar disorder, particularly with the bipolar I disorder.

Conclusion: The prevalence of polypharmacy especially with MS and SGA in the treatment of bipolar patients discharged from psychiatric units in Poland is high. The most significant factor predisposing to polypharmacy is a diagnosis of bipolar - I disorder. In general, our study confirms trends observed in other countries.

Keywords: Bipolar disorder; Mood stabilisers; Polypharmacy; Second-generation antipsychotics.