Trends in use of antipsychotics and mood stabilizers among Medicaid beneficiaries with bipolar disorder, 2001-2004.
ABSTRACT This study examined longitudinal trends in the use of mood stabilizers and antipsychotics for treatment of bipolar disorder in a large public mental health system and whether trends differed by age, gender, and race-ethnicity.
Data were from Medicaid beneficiaries with bipolar disorder receiving services in the San Diego County public mental health system from 2001 to 2004. For each year the proportion of clients receiving any pharmacotherapy and the proportion receiving antipsychotics alone, mood stabilizers alone, or antipsychotics plus mood stabilizers were determined. Pharmacotherapy use was examined by age, gender, and race-ethnicity.
A total of 1,473 clients were identified who were continuously enrolled in Medicaid during the four years. Seventy-five percent received mood stabilizers or antipsychotics. Of this group, 33% received antipsychotics alone, 23% mood stabilizers alone, and 44% both antipsychotics and mood stabilizers. The percentage receiving mood stabilizers or antipsychotics increased significantly, from 71% in 2001 to 77% in 2004, primarily because of increased use among women. Use of mood stabilizers alone declined from 25% to 20%, and use of antipsychotics alone increased from 32% to 36%. African Americans and Latinos were less likely than non-Latino whites to receive mood stabilizers or antipsychotics; this pattern was stable over time.
Antipsychotics were prescribed for a larger percentage of clients than mood stabilizers. Persons from ethnic minority groups were less likely to receive either medication type. Research is needed to examine factors affecting pharmacotherapy in bipolar disorder and mechanisms underlying racial-ethnic disparities in pharmacotherapy, including their persistence over time.
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ABSTRACT: Recibido el 20 de mayo de 2011; aceptado el 30 de agosto de 2011 PALABRAS CLAVE Bipolar; Preferencias; Tratamiento; Latinoamérica Resumen Objetivo: Este estudio evaluó la preferencia farmacológica de los psiquiatras latinoamericanos para tratar a sus pacientes con trastorno bipolar y si estas preferencias se adecuan a las guías actuales de tratamiento publicadas. Métodos: Se diseñó una encuesta que comprendía catorce preguntas. Todas las preguntas esta-ban dirigidas al tratamiento de pacientes con trastorno bipolar tipo I solamente. Distribuimos la encuesta a psiquiatras de ocho diferentes países: Argentina, Brasil, Colombia, Costa Rica, Ecuador, México, Perú y Venezuela. Entre mayo del 2008 y junio del 2009 recolectamos 1.143 encuestas. Resultados: Como la elección inicial de tratamiento para un paciente que debuta con manía, un 61,3% escogieron una combinación de un antipsicótico atípico y un eutimizante. Carbonato de litio (50%) fue la primera elección para un eutimizante en un episodio de manía aguda. Olanzapina (55,4%) fue la primera elección para un antipsicótico en el tratamiento de manía aguda. Para el tratamiento de depresión bipolar aguda, un 27% escogieron lamotrigina como primera opción. La mayoría de los psiquiatras (74,8%) utiliza antidepresivos para el tratamiento de depresión bipolar. Para la prevención de futuros episodios de depresión bipolar, la primera elección fue lamotrigina (50,3%). La mayoría de los psiquiatras (89,1%) prescriben dos o más psicofármacos para el tratamiento de mantenimiento de sus pacientes bipolares. * Autor para correspondencia.Revista Española de Psiquiatria y Salud Mental. 01/2011; 4:205-211.
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ABSTRACT: This study assessed the treatment preferences among Latin-American psychiatrists for their bipolar disorder patients and if these preferences reflect the current guidelines. We designed a survey comprised of fourteen questions. All the questions were aimed at the treatment of bipolar I patients only. We distributed the survey by hand or e-mail to psychiatrists in eight different countries: Argentina, Brasil, Colombia, Costa Rica, Ecuador, México, Perú and Venezuela. Between May 2008 and June 2009, we were able to gather 1143 surveys. As the initial choice of treatment for a bipolar patient who debuts with mania, 61.3% choose a combination of an atypical antipsychotic and a mood stabilizer. Lithium Carbonate (50%) was the first choice for a mood stabilizer in a manic episode. Olanzapine (55.4%) was the initial antipsychotic of choice for the treatment of acute mania. For the treatment of acute bipolar depression, 27% choose Lamotrigineas their first choice. Most of the psychiatrists (74.8%) prescribe antidepressants for the treatment of bipolar depression. For maintenance treatment of bipolar depression most psychiatrists first choice would be Lamotrigine (50.3%). Most of the psychiatrists (89.1%) prescribed two or more psychotropic drugs for the maintenance treatment of their bipolar patients. There were some similarities with the studies previously done in the US. It seems that for the most part the Latin-American psychiatrists don't strictly follow the literature guidelines that are published, but rather adapt the treatment to the specific case. More longitudinal studies of prescribing patterns in bipolar disorder are needed to corroborate these findings.Revista de psiquiatrí́a y salud mental. 10/2011; 4(4):205-11.
Article: Aripiprazole in the maintenance treatment of bipolar disorder: a critical review of the evidence and its dissemination into the scientific literature.[show abstract] [hide abstract]
ABSTRACT: Aripiprazole, a second-generation antipsychotic medication, has been increasingly used in the maintenance treatment of bipolar disorder and received approval from the U.S. Food and Drug Administration for this indication in 2005. Given its widespread use, we sought to critically review the evidence supporting the use of aripiprazole in the maintenance treatment of bipolar disorder and examine how that evidence has been disseminated in the scientific literature. We systematically searched multiple databases to identify double-blind, randomized controlled trials of aripiprazole for the maintenance treatment of bipolar disorder while excluding other types of studies, such as open-label, acute, and adjunctive studies. We then used a citation search to identify articles that cited these trials and rated the quality of their citations. Our evidence search protocol identified only two publications, both describing the results of a single trial conducted by Keck et al., which met criteria for inclusion in this review. We describe four issues that limit the interpretation of that trial as supporting the use of aripiprazole for bipolar maintenance: (1) insufficient duration to demonstrate maintenance efficacy; (2) limited generalizability due to its enriched sample; (3) possible conflation of iatrogenic adverse effects of abrupt medication discontinuation with beneficial effects of treatment; and (4) a low overall completion rate. Our citation search protocol yielded 80 publications that cited the Keck et al. trial in discussing the use of aripiprazole for bipolar maintenance. Of these, only 24 (30%) mentioned adverse events reported and four (5%) mentioned study limitations. A single trial by Keck et al. represents the entirety of the literature on the use of aripiprazole for the maintenance treatment of bipolar disorder. Although careful review identifies four critical limitations to the trial's interpretation and overall utility, the trial has been uncritically cited in the subsequent scientific literature. Please see later in the article for the Editors' Summary.PLoS Medicine 05/2011; 8(5):e1000434. · 16.27 Impact Factor