Medication burden in bipolar disorder: A chart review of patients at psychiatric hospital admission

Alpert Medical School of Brown University and Butler Hospital
Psychiatry Research 04/2014; 216(1). DOI: 10.1016/j.psychres.2014.01.038


Individuals with bipolar disorder (BD) often receive complex polypharmacy regimens as part of treatment, yet few studies have sought to evaluate patient characteristics associated with this high medication burden. This retrospective chart review study examined rates of complex polypharmacy (i.e.,≥4 psychotropic medications), patterns of psychotropic medication use, and their demographic and clinical correlates in a naturalistic sample of adults with bipolar I disorder (BDI; N=230) presenting for psychiatric hospital admission. Using a computer algorithm, a hospital administrator extracted relevant demographic, clinical, and community treatment information for analysis. Patients reported taking an average of 3.31(SD=1.46) psychotropic medications, and 5.94(SD=3.78) total medications at intake. Overall, 82 (36%) met criteria for complex polypharmacy. Those receiving complex polypharmacy were significantly more likely to be female, to be depressed, to have a comorbid anxiety disorder, and to have a history of suicide attempt. Women were significantly more likely than men to be prescribed antidepressants, benzodiazepines, and stimulants, even after controlling for mood episode polarity. Study data highlight the high medication burden experienced by patients with BD, especially those who are acutely symptomatic. Data also highlight the particularly high medication burden experienced by women with BD; a burden not fully accounted for by depression.

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    • "The latter figure is exactly double than the rate reported from the outpatients STEP-BD sample 3 though more consistent with rates of polypharmacy reported in voluntary BD registries. 41 Concordant with previous reports 58,59 , additional analyses carried out byWeinstock et al, 2014just relied on a " permissive " operative definition of polypharmacy, namely " the use of two or more class of psychotropic substances " . The prevalence rates of polypharmacy in European patients were therefore strikingly high, with almost 85% of the cases receiving " polypharmacy " in contrast to only 337 cases (or 15% of the total) receiving " monotherapy " (herein defined as the use of either antidepressants or antipsychotics or anticonvulsants or lithium, including within-class prescriptions). "

    No preview · Article · Jan 2016 · Neuropsychiatric Disease and Treatment
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    • "The purpose of this study was to investigate the availability of five medications routinely prescribed for bipolar disorder to a consumer in the US using online pharmacies. Drugs for bipolar disorder were investigated since long-term polypharmacy is commonly prescribed (Bauer et al., 2013; Weinstock et al., 2014; Centorrino et al., 2010). Also, many patients with bipolar disorder are educated but unemployed (Kogan et al., 2004), and may be interested in buying medications online at lower cost. "
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    ABSTRACT: Background There is increasing use of online pharmacies to purchase prescription drugs. While some online pharmacies are legitimate and safe, there are many unsafe and illegal so-called "rogue" online pharmacies. This study investigated the availability of psychotropic drugs online to consumers in the US, using 5 commonly prescribed drugs for bipolar disorder. Methods Using the search term "buy [drug name]" in the Google, Yahoo and Bing search engines, the characteristics of the online pharmacies found on the first two pages of search results were investigated. The availability of the requested dosage and formulations of two brand (Seroquel XR, Abilify) and three generic drugs (lamotrigine, lithium carbonate and bupropion SR) were determined. Results Of 30 online pharmacies found, 17 (57%) were rated as rogue by LegitScript. Of the 30 pharmacies, 15 (50%) require a prescription, 21 (70%) claim to be from Canada, with 20 of these having a Canadian International Pharmacy association (CIPA) seal on the website. Only 13 of the 20 sites with a CIPA seal were active CIPA members. There were about the same number of trust verification seals on the rogue and legitimate pharmacy sites. Some rogue pharmacies are professional in appearance, and may be difficult for consumers to recognize as rogue. All five brand and generic drugs were offered for sale online, with or without a prescription. However, many substitutions were presented such as different strengths and formulations including products not approved by the FDA. Limitations No evaluation of product quality, packaging or purchasing. Conclusions Psychotropic medications are available online with or without a prescription. The majority of online pharmacy websites were rogue. Physicians should ask about the use of online pharmacies. For those who choose to use online pharmacies, two measures to detect rogue pharmacies are recommended: (1) only purchase drugs from pharmacies that require a prescription, and (2) check all pharmacy verification seals directly on the website of the certifying organization, every time, before purchase.
    Full-text · Article · Dec 2015 · Journal of Affective Disorders
    • "A retrospective chart review was conducted for patients with BDI admitted to the inpatient or partial hospitalization programs at Butler Hospital in Providence, RI, USA during the 2010 calendar year [23]. To be considered eligible for inclusion, patients must have been 18 years or older and given a primary diagnosis of BDI at both hospital admission and discharge. "
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    ABSTRACT: Background: Published data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups. Methods: To evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis. Results: Thirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings. Conclusion: Patients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted.
    No preview · Article · Oct 2015 · Comprehensive psychiatry
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