Factors Associated with the Prescribing of Olanzapine, Quetiapine, and Risperidone in Patients with Bipolar and Related Affective Disorders

Abstract

Objective To identify determinants of new use of the first-line SGAs associated with weight gain. Design Retrospective chart review. Setting Outpatient and inpatient psychiatry services at a tertiary, academic medical center. Patients Sample of 340 consecutive patients over two time periods with major depression with psychotic features, bipolar I, bipolar II, bipolar not otherwise specified, and schizoaffective disorder. Interventions None. Measurements and Main Results Clinical and sociodemographic variables associated with new use of olanzapine, risperidone, and quetiapine were identified using univariate and multivariate logistic regression. Several clinical factors were individually associated with initiation of these SGAs: mania (OR 3.6, 95% CI 1.2–10.8), psychosis (OR 3.3, 95% CI 1.5–6.9), and inpatient treatment (OR 3.8, 95% CI 1.8–7.9). Prevalent use of lithium (OR 0.3, 95% CI 0.1–0.9) and being married (OR 0.3, 95% CI 0.1–0.8) were inversely associated. Mania, psychosis, married status, and lithium use remained independently associated on multivariate analysis. Factors related to metabolic or vascular risk were not associated with SGA initiation. Conclusions Psychiatric clinicians weigh clinical features related to mental status and acuity heavily in determining whether to initiate SGAs. However, factors related to vascular risk were not associated. Future observational studies should consider current clinical status as an important factor in determining propensity to receive antipsychotics or other acute treatments for bipolar disorder.

Evidence for accelerated vascular aging in bipolar disorder

“…Sociodemographic and clinical characteristics are outlined in Table 1. The mean body mass index (BMI) was in the obese range (30.3 kg/m 2 ), consistent with chart review data from our institution [20, 21]. Participants retrospectively estimated spending a median of 22% (mean 28%) of time depressed and 7% (mean 12%) of the time manic in the past decade or since onset of illness if within the past decade.…”

Choice of randomization to clozapine versus other second generation antipsychotics in the CATIE schizophrenia trial

“…Weight was also not a factor in the selection of phase 2 or phase 3 pathways (Stroup et al, 2009). A similar result was found in the prescription of olanzapine, risperidone, and quetiapine for affective disorders (Prabhakar et al, 2011). This is unexpected, as one would imagine that individuals with weight or metabolic problems would avoid medications with a higher weight gain liability such as clozapine.…”

Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USA

“…Lurasidone is another AA currently being evaluated by FDA for this indication ( Latuda (lurasidone HCl) tablet , ). The initiation of a new prescription of AA is usually associated with symptoms of bipolar I disorder, including a diagnosis of manic or mixed episode and symptoms of mania (Blanco et al , ; Prabhakar et al , ). AA in general have displayed efficacy comparable with mood stabilizers and TA in treating bipolar mania, whereas the combined use of AA with mood stabilizers is considered as the most efficacious treatment (Tohen et al , , ; Scherk et al , ; Schneeweiss et al , ; Liauw and McIntyre, ).…”

“…The findings of these previous studies indicate insufficient compliance and potentially unmet medical needs in the treatment of bipolar disorder. Because bipolar I patients more frequently initiate new AAs (Blanco et al , ; Prabhakar et al , ) and are more likely associated with psychotic symptoms (“DSM‐IV‐TR Index,” ), they may be at a greater risk of low AA compliance as compared with other bipolar types. However, very few studies examined the comprehensive utilization patterns of AA specifically in the continuous treatment of bipolar I disorder, although the subject is of particular interest to proper disease management.…”