Pharmacopsychiatry 2010; 43(1): 17-23
DOI: 10.1055/s-0029-1237396
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Antipsychotic use Patterns in Persons Initially Treated with Mood Stabilizers: A Naturalistic Study

H. Verdoux1 , A. Cougnard1 , G.-R. Auleley2 , 3 , J. Deligne2 , C. Blum-Boisgard2 , B. Bégaud1 , M. Tournier1
  • 1INSERM U657, Université Victor Segalen, Bordeaux 2, France
  • 2Caisse Nationale du Régime Social des Indépendants, Direction du Service Médical National, La Plaine-Saint-Denis Cedex, France
  • 3Institut National du Cancer, Boulogne-Billancourt, France
Further Information

Publication History

received 31.03.2009 revised 18.07.2009

accepted 23.07.2009

Publication Date:
10 December 2009 (online)

Abstract

Introduction: Little information is available on the pattern of use of antipsychotics in naturalistic conditions in persons initially treated with “conventional” mood stabilizers (lithium and anticonvulsants).

Methods: Data on community prescriptions were extracted from the 2004–2006 claims database of a French health care insurance fund for self-employed workers. Patients included were those continuously exposed to mood stabilizers without concomitant dispensing of antipsychotics over at least a 3-month period.

Results: Of the 3 958 persons included, 17.8% had at least one addition/switch to antipsychotics over the follow-up period. The most frequent pattern was addition of second-generation antipsychotics (SGAPs) (41%) or first-generation antipsychotics (FGAPs) (23%) to the mood stabilizer for a relatively short period of time. A switch from mood stabilizer to SGAPs (20%) or FGAPs (15%) was less frequent. Mood stabilizers alone were prescribed again in most patients with the addition of FGAPs (72%) or SGAPs (61%) to mood stabilizers. Conversely, the majority of patients with a switch from mood stabilizers to FGAPs (55%) or SGAPs (58%) went on with these latter treatments over the follow-up.

Conclusions: SGAPs are preferentially prescribed in combination with mood stabilizers and their pattern of use is similar to that of FGAPs.

References

  • 1 Aparasu RR, Bhatara V, Gupta S. U. S. national trends in the use of antipsychotics during office visits, 1998–2002.  Ann Clin Psychiatry. 2005;  17 147-152
  • 2 Ashcroft DM, Frischer M, Lockett J. et al . Variations in prescribing atypical antipsychotic drugs in primary care: cross-sectional study.  Pharmacoepidemiol Drug Saf. 2002;  11 285-289
  • 3 Baldessarini RJ, Leahy L, Arcona S. et al . Patterns of psychotropic drug prescription for U. S. patients with diagnoses of bipolar disorders.  Psychiatr Serv. 2007;  58 85-91
  • 4 Bauer MS, Mitchner L. What is a “mood stabilizer”? An evidence-based response.  Am J Psychiatry. 2004;  161 3-18
  • 5 Bellantuono C, Barraco A, Rossi A. et al . The management of bipolar mania: a national survey of baseline data from the EMBLEM study in Italy.  BMC Psychiatry. 2007;  7 33
  • 6 Berghofer A, Alda M, Adli M. et al . Long-term effectiveness of lithium in bipolar disorder: A multicenter investigation of patients with typical and atypical features.  J Clin Psychiatry. 2008;  69 1860-1868
  • 7 Caceres MC, Penas-Lledo EM, de la Rubia A. et al . Increased use of second generation antipsychotic drugs in primary care: potential relevance for hospitalizations in schizophrenia patients.  Eur J Clin Pharmacol. 2008;  64 73-76
  • 8 Crismon ML, Argo T, SD B. et al .Texas Medication Algorithm Project. Bipolar Disorder Algorithms Procedural Manual. Texas Department of State Health Services 2007
  • 9 Essock SM, Covell NH, Davis SM. et al . Effectiveness of switching antipsychotic medications.  Am J Psychiatry. 2006;  163 2090-2095
  • 10 Garver D, Lazarus A, Rajagopalan K. et al . Racial differences in medication switching and concomitant prescriptions in the treatment of bipolar disorder.  Psychiatr Serv. 2006;  57 666-672
  • 11 Ghaemi SN, Hsu DJ, Thase ME. et al . Pharmacological Treatment Patterns at Study Entry for the First 500 STEP-BD Participants.  Psychiatr Serv. 2006;  57 660-655
  • 12 Kaye JA, Bradbury BD, Jick H. Changes in antipsychotic drug prescribing by general practitioners in the United Kingdom from 1991 to 2000: a population-based observational study.  Br J Clin Pharmacol. 2003;  56 569-575
  • 13 Li J, McCombs JS, Stimmel GL. Cost of treating bipolar disorder in the California Medicaid (Medi-Cal) program.  J Affect Disord. 2002;  71 131-139
  • 14 Maj M. The impact of lithium prophylaxis on the course of bipolar disorder: A review of the research evidence.  Bipolar Disord. 2000;  2 93-101
  • 15 NICE: Bipolar disorder .The management of bipolar disorder in adults, children and adolescents, in primary and secondary care in Clinical Guideline No 38. National Institute for Health and Clinical Excellence 2006
  • 16 Russo P, Smith MW, Dirani R. et al . Pharmacotherapy patterns in the treatment of bipolar disorder.  Bipolar Disord. 2002;  4 366-377
  • 17 Sankaranarayanan J, Puumala SE. Antipsychotic use at adult ambulatory care visits by patients with mental health disorders in the United States, 1996–2003: national estimates and associated factors.  Clin Ther. 2007;  29 723-741
  • 18 Sernyak MJ, Griffin RA, Johnson RM. et al . Neuroleptic exposure following inpatient treatment of acute mania with lithium and neuroleptic.  Am J Psychiatry. 1994;  151 133-135
  • 19 Stata Statistical Software .Release 9.0. College Station. Texas, Stata Corporation 2005
  • 20 Taylor M, Shajahan P, Lawrie SM. Comparing the use and discontinuation of antipsychotics in clinical practice: an observational study.  J Clin Psychiatry. 2008;  69 240-245
  • 21 Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders.  Br J Psychiatry Suppl. 2001;  41 S184-S190
  • 22 Tschoner A, Engl J, Rettenbacher M. et al . Effects of six second generation antipsychotics on body weight and metabolism − risk assessment and results from a prospective study.  Pharmacopsychiatry. 2009;  42 29-34
  • 23 Verdoux H, Gonzales B, Takei N. et al . A survey of prescribing practice of antipsychotic maintenance treatment for manic-depressive outpatients.  J Affect Disord. 1996;  38 81-87
  • 24 Verdoux H, Tournier M. Trends in costs of antipsychotics in France.  Eur Psychiatry. 2009;  24 214-215
  • 25 Weinbrenner S, Assion HJ, Stargardt T. et al . Drug prescription patterns in schizophrenia outpatients: analysis of data from a German health insurance fund.  Pharmacopsychiatry. 2009;  42 66-71
  • 26 Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration − New York metropolitan region.  Schizophr Bull. 2002;  28 31-42
  • 27 Yatham LN, Kennedy SH, O’Donovan C. et al . Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007.  Bipolar Disord. 2006;  8 721-739

Correspondence

Prof. H. Verdoux

Hôpital Charles Perrens

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33076 Bordeaux Cedex

France

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Fax: +33/556/56 35 46

Email: helene.verdoux@u-bordeaux2.fr