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Polypharmacy in Outpatients with Bipolar Disorder: Associated Factors and Treatment Characteristics in Türkiye

Yıl 2023, Cilt: 13 Sayı: 3, 421 - 430, 30.09.2023

Neriman Aras Fatma Çoker Nihan Küçük

https://doi.org/10.31832/smj.1178583

Öz

Objective: Polypharmacy is frequently used in the treatment of the bipolar disorder. We aimed to investigate polypharmacy rates, associated factors, and the types of drugs preferred in treatment among outpatients with bipolar disorder.
Method: A total of 209 bipolar disorder patients attending an outpatient psychiatry clinic were included in this study. Drug types, active substances, and combination forms were examined.
Results: The rate of polypharmacy among bipolar outpatients was 79.40%. Antipsychotics were the most frequently preferred drug for the treatment. The most commonly used antipsychotic was quetiapine, whereas the mood stabilizer was sodium valproate and the antidepressant was paroxetine. The most common form of treatment for bipolar disorder was the combined use of a mood stabilizer and an antipsychotic.
Conclusion: In contrast to treatment guidelines, polypharmacy has virtually become a standard in the treatment of bipolar disorder. It appears that the adoption of polypharmacy in treatment will persist for various reasons. As such, there is a need to develop new guidelines to guide psychiatrists in determining the patient groups and combinations in which combination therapy will be preferred. Moreover, interventions are needed to minimize the possible side effects, and risk of drug-drug interactions related to the use of multiple drugs, determine the benefit/harm ratio and reduce unnecessary psychotropic drug use.

Anahtar Kelimeler

Bipolar disorder Outpatients Polypharmacy Drug Treatment Combination

Kaynakça

  • REFERENCES
  • 1. Holzapfel EM, Szabo CP. Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population. Global Psychiatry. 2018;1(2):39-52.
  • 2. Lyall LM, Penades N, Smith DJ. Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. The British Journal of Psychiatry. 2019;215(1):415-421.
  • 3. Peselow ED, Naghdech L, Pizano D, IsHak WW. Polypharmacy in maintenance of bipolar disorder. Clinical Neuropharmacology. 2016;39(3):132-134.
  • 4. Kim K, Yang H, Na E, Lee H, Jang OJ, Yoon HJ, ... & Park YC. Examining patterns of polypharmacy in bipolar disorder: findings from the REAP-BD, Korea. Psychiatry Investigation. 2019;16(5):397.
  • 5. Levine J, Chengappa KR, Brar JS, Gershon S, Yablonsky E, Stapf D, Kupfer DJ. Psychotropic drug prescription patterns among patients with bipolar I disorder. Bipolar Disorders. 2000;2(2):120-130.
  • 6. Bohlken J, Bauer M, Kostev K. Drug treatment for patients with bipolar disorders in psychiatric practices in Germany in 2009 and 2018. Psychiatry Research. 2020;289:112965.
  • 7. Golden JC, Goethe JW, Woolley SB. Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: a prospective cohort study of 2712 inpatients. Journal of Affective Disorders. 2017;221:6-10.
  • 8. Adli M, Whybrow PC, Grof P, Rasgon N, Gyulai L, Baethge C, ... & Bauer M. Use of polypharmacy and self-reported mood in outpatients with bipolar disorder. International Journal of Psychiatry in Clinical Practice. 2005;9(4):251-256.
  • 9. APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition American Psychiatric Association, Washington, DC. 2013.
  • 10. Banerjee I, Sathian B, Chakraborty PK, Banerjee I, Roy B, Jauhari AC, Saha A. Pharmacotherapy of bipolar affective disorder: a hospital based study from sub Himalayan Valley of Nepal. Journal of clinical and diagnostic research: JCDR. 2014;8(6):HC22.
  • 11. Jaracz J, Tetera-Rudnicka E, Bierejszyk M, Witczyk K, Raczyńska A, Nowak W, ... & Jaracz K. The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland. Pharmacological Reports. 2018;70(4):694-698.
  • 12. Bauer M, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, ... & Whybrow PC. Drug treatment patterns in bipolar disorder: analysis of long-term self-reported data. International journal of bipolar disorders. 2013;1(1):1-8.
  • 13. Hung GCL, Yang SY, Chen Y, Lin SK. Psychotropic polypharmacy for the treatment of bipolar disorder in Taiwan. Psychiatric services. 2014;65(1):125-128.
  • 14. Goldberg JF. Complex combination pharmacotherapy for bipolar disorder: knowing when less is more or more is better. FOCUS, A Journal of the American Psychiatric Association. 2019;17(3):218-231.
  • 15. Adachi, N, Azekawa T, Edagawa K, Goto E, Hongo S, Kato M, ... & Yoshimura R. Estimated model of psychotropic polypharmacy for bipolar disorder: Analysis using patients' and practitioners' parameters in the MUSUBI study. Human Psychopharmacology: Clinical and Experimental. 2021;36(2):e2764.
  • 16. Fornaro M, De Berardis D, Koshy AS, Perna G, Valchera A, Vancampfort D, Stubbs B. Prevalence and clinical features associated with bipolar disorder polypharmacy: a systematic review. Neuropsychiatric Disease and Treatment. 2016;12:719.
  • 17. Fung VC, Overhage LN, Sylvia LG, Reilly-Harrington NA, Kamali M, Gao K, ... & Nierenberg AA. Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Journal of affective disorders. 2019;257:17-22.
  • 18. Karadağ H, Kokurcan A, Güriz SO, Atmar M, Örsel S. Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: A cross-sectional study. Psychiatry and Clinical Psychopharmacology. 2019;29(4):558-564.
  • 19. Akkaya C, Deniz G, Cangür Ş, Kırlı S. Bipolar bozukluk hastalarının ilaç kullanım sürelerinin sosyodemografik ve hastalık özellikleri ile ilişkisi. Bipolar bozukluk hastalarının ilaç kullanım sürelerinin sosyodemografik ve hastalık özellikleri ile ilişkisi. Türk Psikiyatri Dergisi. 2014;25(2):94-105.
  • 20. Gültekin BK, Kesebir S, Tamam L. Türkiye'de bipolar bozukluk. Psikiyatride Güncel Yaklaşımlar. 2014;6(2):199-209.
  • 21. Baek JH, Ha K, Yatham LN, Chang JS, Ha TH, Jeon, HJ., ... & Park Y. Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines. Journal of clinical psychopharmacology. 2014;34(5):577-587.
  • 22. Sachs GS, Peters AT, Sylvia L, Grunze H. Polypharmacy and bipolar disorder: what's personality got to do with it?. International Journal of Neuropsychopharmacology. 2014;17(7):1053-1061.
  • 23. Blanco C, Laje G, Olfson M, Marcus SC, Pincus HA. Trends in the treatment of bipolar disorder by outpatient psychiatrists. American Journal of Psychiatry. 2002;159(6):1005-1010.
  • 24. Kendall T, Morriss R, Mayo-Wilson E, Marcus E. Assessment and management of bipolar disorder: summary of updated NICE guidance. Bmj. 2014;349.
  • 25. Kessing LV, Vradi E, Andersen PK. Nationwide and population‐based prescription patterns in bipolar disorder. Bipolar disorders. 2016;18(2), 174-182.
  • 26. Yazıcı O, Oral T. (2010) Koruyucu Sağaltım. In: Aydemir O, Uluşahin A, Akdeniz F, editors. Türkiye Psikiyatri Derneği İki Uçlu Bozukluk Sağaltım Kılavuzu. Ankara (Türkiye): Türkiye Psikiyatri Derneği Yayınları; 2010. p. 63-82.
  • 27. Vahip S, Aydemir O. Depresif Dönemin Sağaltımı, In: Aydemir O, Uluşahin A, Akdeniz F, editors. Türkiye Psikiyatri Derneği İki Uçlu Bozukluk Sağaltım Kılavuzu. Ankara (Türkiye): Türkiye Psikiyatri Derneği Yayınları; 2010. p. 41-62.
  • 28. Ghaemi SN, Hsu DJ, Thase ME, Wisniewski SR, Nierenberg AA, Miyahara S, Sachs G. Pharmacological treatment patterns at study entry for the first 500 STEP-BD participants. Psychiatric Services. 2006;57(5):660-665.
  • 29. Karanti A, Kardell M, Lundberg U, Landén M. Changes in mood stabilizer prescription patterns in bipolar disorder. Journal of Affective Disorders. 2016;195:50-56.

Polypharmacy in Outpatients with Bipolar Disorder: Associated Factors and Treatment Characteristics in Türkiye

Yıl 2023, Cilt: 13 Sayı: 3, 421 - 430, 30.09.2023

Neriman Aras Fatma Çoker Nihan Küçük

https://doi.org/10.31832/smj.1178583

Öz

Objective: Polypharmacy is frequently used in the treatment of the bipolar disorder. We aimed to investigate polypharmacy rates, associated factors, and the types of drugs preferred in treatment among outpatients with bipolar disorder.
Method: A total of 209 bipolar disorder patients attending an outpatient psychiatry clinic were included in this study. Drug types, active substances, and combination forms were examined.
Results: The rate of polypharmacy among bipolar outpatients was 79.40%. Antipsychotics were the most frequently preferred drug for the treatment. The most commonly used antipsychotic was quetiapine, whereas the mood stabilizer was sodium valproate and the antidepressant was paroxetine. The most common form of treatment for bipolar disorder was the combined use of a mood stabilizer and an antipsychotic.
Conclusion: In contrast to treatment guidelines, polypharmacy has virtually become a standard in the treatment of bipolar disorder. It appears that the adoption of polypharmacy in treatment will persist for various reasons. As such, there is a need to develop new guidelines to guide psychiatrists in determining the patient groups and combinations in which combination therapy will be preferred. Moreover, interventions are needed to minimize the possible side effects, and risk of drug-drug interactions related to the use of multiple drugs, determine the benefit/harm ratio and reduce unnecessary psychotropic drug use.

Anahtar Kelimeler

Bipolar disorder Outpatients Polypharmacy Drug Treatment Combination

Kaynakça

  • REFERENCES
  • 1. Holzapfel EM, Szabo CP. Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population. Global Psychiatry. 2018;1(2):39-52.
  • 2. Lyall LM, Penades N, Smith DJ. Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. The British Journal of Psychiatry. 2019;215(1):415-421.
  • 3. Peselow ED, Naghdech L, Pizano D, IsHak WW. Polypharmacy in maintenance of bipolar disorder. Clinical Neuropharmacology. 2016;39(3):132-134.
  • 4. Kim K, Yang H, Na E, Lee H, Jang OJ, Yoon HJ, ... & Park YC. Examining patterns of polypharmacy in bipolar disorder: findings from the REAP-BD, Korea. Psychiatry Investigation. 2019;16(5):397.
  • 5. Levine J, Chengappa KR, Brar JS, Gershon S, Yablonsky E, Stapf D, Kupfer DJ. Psychotropic drug prescription patterns among patients with bipolar I disorder. Bipolar Disorders. 2000;2(2):120-130.
  • 6. Bohlken J, Bauer M, Kostev K. Drug treatment for patients with bipolar disorders in psychiatric practices in Germany in 2009 and 2018. Psychiatry Research. 2020;289:112965.
  • 7. Golden JC, Goethe JW, Woolley SB. Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: a prospective cohort study of 2712 inpatients. Journal of Affective Disorders. 2017;221:6-10.
  • 8. Adli M, Whybrow PC, Grof P, Rasgon N, Gyulai L, Baethge C, ... & Bauer M. Use of polypharmacy and self-reported mood in outpatients with bipolar disorder. International Journal of Psychiatry in Clinical Practice. 2005;9(4):251-256.
  • 9. APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition American Psychiatric Association, Washington, DC. 2013.
  • 10. Banerjee I, Sathian B, Chakraborty PK, Banerjee I, Roy B, Jauhari AC, Saha A. Pharmacotherapy of bipolar affective disorder: a hospital based study from sub Himalayan Valley of Nepal. Journal of clinical and diagnostic research: JCDR. 2014;8(6):HC22.
  • 11. Jaracz J, Tetera-Rudnicka E, Bierejszyk M, Witczyk K, Raczyńska A, Nowak W, ... & Jaracz K. The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland. Pharmacological Reports. 2018;70(4):694-698.
  • 12. Bauer M, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, ... & Whybrow PC. Drug treatment patterns in bipolar disorder: analysis of long-term self-reported data. International journal of bipolar disorders. 2013;1(1):1-8.
  • 13. Hung GCL, Yang SY, Chen Y, Lin SK. Psychotropic polypharmacy for the treatment of bipolar disorder in Taiwan. Psychiatric services. 2014;65(1):125-128.
  • 14. Goldberg JF. Complex combination pharmacotherapy for bipolar disorder: knowing when less is more or more is better. FOCUS, A Journal of the American Psychiatric Association. 2019;17(3):218-231.
  • 15. Adachi, N, Azekawa T, Edagawa K, Goto E, Hongo S, Kato M, ... & Yoshimura R. Estimated model of psychotropic polypharmacy for bipolar disorder: Analysis using patients' and practitioners' parameters in the MUSUBI study. Human Psychopharmacology: Clinical and Experimental. 2021;36(2):e2764.
  • 16. Fornaro M, De Berardis D, Koshy AS, Perna G, Valchera A, Vancampfort D, Stubbs B. Prevalence and clinical features associated with bipolar disorder polypharmacy: a systematic review. Neuropsychiatric Disease and Treatment. 2016;12:719.
  • 17. Fung VC, Overhage LN, Sylvia LG, Reilly-Harrington NA, Kamali M, Gao K, ... & Nierenberg AA. Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Journal of affective disorders. 2019;257:17-22.
  • 18. Karadağ H, Kokurcan A, Güriz SO, Atmar M, Örsel S. Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: A cross-sectional study. Psychiatry and Clinical Psychopharmacology. 2019;29(4):558-564.
  • 19. Akkaya C, Deniz G, Cangür Ş, Kırlı S. Bipolar bozukluk hastalarının ilaç kullanım sürelerinin sosyodemografik ve hastalık özellikleri ile ilişkisi. Bipolar bozukluk hastalarının ilaç kullanım sürelerinin sosyodemografik ve hastalık özellikleri ile ilişkisi. Türk Psikiyatri Dergisi. 2014;25(2):94-105.
  • 20. Gültekin BK, Kesebir S, Tamam L. Türkiye'de bipolar bozukluk. Psikiyatride Güncel Yaklaşımlar. 2014;6(2):199-209.
  • 21. Baek JH, Ha K, Yatham LN, Chang JS, Ha TH, Jeon, HJ., ... & Park Y. Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines. Journal of clinical psychopharmacology. 2014;34(5):577-587.
  • 22. Sachs GS, Peters AT, Sylvia L, Grunze H. Polypharmacy and bipolar disorder: what's personality got to do with it?. International Journal of Neuropsychopharmacology. 2014;17(7):1053-1061.
  • 23. Blanco C, Laje G, Olfson M, Marcus SC, Pincus HA. Trends in the treatment of bipolar disorder by outpatient psychiatrists. American Journal of Psychiatry. 2002;159(6):1005-1010.
  • 24. Kendall T, Morriss R, Mayo-Wilson E, Marcus E. Assessment and management of bipolar disorder: summary of updated NICE guidance. Bmj. 2014;349.
  • 25. Kessing LV, Vradi E, Andersen PK. Nationwide and population‐based prescription patterns in bipolar disorder. Bipolar disorders. 2016;18(2), 174-182.
  • 26. Yazıcı O, Oral T. (2010) Koruyucu Sağaltım. In: Aydemir O, Uluşahin A, Akdeniz F, editors. Türkiye Psikiyatri Derneği İki Uçlu Bozukluk Sağaltım Kılavuzu. Ankara (Türkiye): Türkiye Psikiyatri Derneği Yayınları; 2010. p. 63-82.
  • 27. Vahip S, Aydemir O. Depresif Dönemin Sağaltımı, In: Aydemir O, Uluşahin A, Akdeniz F, editors. Türkiye Psikiyatri Derneği İki Uçlu Bozukluk Sağaltım Kılavuzu. Ankara (Türkiye): Türkiye Psikiyatri Derneği Yayınları; 2010. p. 41-62.
  • 28. Ghaemi SN, Hsu DJ, Thase ME, Wisniewski SR, Nierenberg AA, Miyahara S, Sachs G. Pharmacological treatment patterns at study entry for the first 500 STEP-BD participants. Psychiatric Services. 2006;57(5):660-665.
  • 29. Karanti A, Kardell M, Lundberg U, Landén M. Changes in mood stabilizer prescription patterns in bipolar disorder. Journal of Affective Disorders. 2016;195:50-56.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Neriman Aras 0000-0001-7410-2497

Fatma Çoker 0000-0002-3818-8796

Nihan Küçük 0000-0002-9205-1467

Yayımlanma Tarihi 30 Eylül 2023
Gönderilme Tarihi 22 Eylül 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 13 Sayı: 3

Kaynak Göster

AMA Aras N, Çoker F, Küçük N. Polypharmacy in Outpatients with Bipolar Disorder: Associated Factors and Treatment Characteristics in Türkiye. Sakarya Tıp Dergisi. Eylül 2023;13(3):421-430. doi:10.31832/smj.1178583

30703

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