Prescription patterns in clinically stable patients with bipolar disorder: Findings from the Bipolar Disorder Course and Outcome from India (BiD-CoIN) study

Grover, Sandeep; Chakravarty, Rahul; Dan, Amitava; Chakraborty, Kaustav; Neogi, Rajarshi; Desouza, Avinash; Nayak, Omkar; Praharaj, Samir Kumar; Menon, Vikas; Pattanayak, Raman Deep; Bathla, Shalu; Subramanyam, Alka A; Nebhinani, Naresh; Ghosh, P.; Lakdawala, Bhavesh; Bhattacharya, Ranjan; Gania, Abmajid

doi:10.1016/j.ajp.2021.102549

Cited by 14 publications

(14 citation statements)

References 18 publications

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“…A medication truly treating bipolar disorder diminishes the need of employing a multiplicity of drugs, each targeting some symptom or phases of the disease. This is a well desired goal, as polypharmacy stands for the rule in the treatment of bipolar disorder (Kim, Salstein, and Goldberg 2021; Grover et al 2021), an approach not devoid of risks: it difficults adherence and tolerability, burden up side effects, increases costs and is often misleading, to name a few (V. C. Fung et al 2019; V. Fung et al 2013).…”

Section: Discussionmentioning

confidence: 99%

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“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

Marchionatti

Rocha

Magalhaes

2021

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BackgroundThe term “mood stabilizer” is controversial in literature. As there is no consensual meaning, its retirement has been suggested to avoid confusion and misuse. On the other hand, it remains largely employed, and some advocate it carries an important meaning. This issue has not been previously approached using a validated qualitative inquiry.MethodsWe employed document analysis for reviewing proposed definitions for mood stabilizer. Then, we used concept analysis as a qualitative methodology to clarify meanings associated with the term. Based on its results, we built a theoretical model for mood stabilizer, matching it with evidence for drugs used in the treatment of bipolar disorder.ResultsConcept analysis of documents defining the term unearthed four attributes of a mood stabilizer that could be usefully nested into the following ascending hierarchy: “not worsening”, “acute effects”, “prophylactic effects”, and “advanced effects”. To be considered a mood stabilizer, a drug had to reach the “prophylactic effects” tier, as this was discussed by authors as the core aspect of the class. After arranging drugs according to this scheme, “lithium” and “quetiapine” received the label, but only the former fulfilled all four attributes, as evidence indicates it has neuroprotective action.ConclusionThe proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. This could modify long-term outcomes and illness trajectory.

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Section: Discussionmentioning

confidence: 99%

“…Helping patients achieve remission on monotherapy is another argument for keeping the concept. A medication truly treating bipolar disorder diminishes the need of employing extensive polypharmacy, each targeting some symptom or phases of the disease (Kim et al 2021; Grover et al 2021; Fung et al 2019).…”

Section: Discussionmentioning

confidence: 99%

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

Marchionatti

Rocha

Magalhaes

2021

Preprint

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“…The study methodology and sample description, prescription pattern, and course and outcome have been published. [ 28 29 30 31 ]…”

Section: Methodsmentioning

confidence: 99%

Prevalence and association of comorbid substance dependence on the course and outcome of bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

Grover¹,

Chakravarty²,

Dan³

et al. 2022

Indian Journal of Psychiatry

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Aim: To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD). Materials and Methods: A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability. Results: About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate. Conclusion: About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.

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“…In Taiwan, 80.0% of BD patients received MS treatment at hospital discharge, 7 83.2% of BD patients in Japan, 8 and 94.3% in India. 9 These observations indicate that MSs are widely considered an important component of clinical management of patients with BD. However, regional variations in their use and dosing, as well as clinical factors associated with selection and dosing of particular MSs, are not well documented.…”

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confidence: 97%

“…High rates of MS-use to treat BD also were found in Asia. In Taiwan, 80.0% of BD patients received MS treatment at hospital discharge, 7 83.2% of BD patients in Japan, 8 and 94.3% in India 9 …”

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Dosing of Mood Stabilizers for Bipolar Disorder Patients in the Research on Asian Psychotropic Prescription Patterns Consortium Study

Wang¹,

Chew

Lin

et al. 2022

J Clin Psychopharmacol

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BackgroundBecause use and dosing of mood stabilizers (MSs) to treat bipolar disorder (BD) patients in Asia are not well documented, we examined prevalence and clinical correlates of treatment of Asian BD patients with relatively high doses of MSs.MethodsWe conducted a pharmacoepidemiological survey across 13 Asian countries and territory in the Research on Asian Psychotropic Prescription Patterns Consortium. Mood stabilizer doses were converted to lithium carbonate equivalents (Li-eq milligrams per day). We compared relatively high (>900 Li-eq mg/day) versus lower MS doses by bivariate comparisons, followed by multivariable linear regression to identify factors associated with higher MS doses.ResultsAmong 1647 participants, MS dose averaged 584 (confidence interval, 565–603 Li-eq mg/d). Preliminarily, the 13.1% of the subjects given greater than 900 mg/d versus those given lower doses were younger, male, currently hospitalized, not currently depressed, and reported lifetime suicidal ideation; they also received relatively high doses of antipsychotics, received electroconvulsive treatment within the previous 12 months, and had greater ratings of tremors and sedation. By linear regression modeling, the mean proportion given high doses of MS was associated significantly and independently with higher doses of antipsychotics, younger age, male sex, hospitalized, more years of illness, country, higher body mass index, recent electroconvulsive treatment, and being in illness remission.ConclusionsRelatively high doses of MSs for BD are prevalent, but vary markedly among Asian countries, and are particularly likely among young males, ill for many years, and given high doses of antipsychotics or ECT. These characteristics allow better identification of patient profiles that can guide treatment of BD patients.

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Prescription patterns in clinically stable patients with bipolar disorder: Findings from the Bipolar Disorder Course and Outcome from India (BiD-CoIN) study

Cited by 14 publications

References 18 publications

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

Prevalence and association of comorbid substance dependence on the course and outcome of bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

Dosing of Mood Stabilizers for Bipolar Disorder Patients in the Research on Asian Psychotropic Prescription Patterns Consortium Study

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