Antipsychotic Drug Use Patterns for In-hospital Treatment of Bipolar Disorder Patients Across A 10-Year Span

Abstract

Antipsychotic drugs are known to be effective in reducing psychotic symptoms and behavioral disruptions, and are mainly used during the first few days of acute manic phases of bipolar disorders. The purpose of this study was to investigate the use patterns of antipsychotics in the treatment of acute bipolar manic patients in a university hospital in Korea during the last decade. To track the use of antipsychotics from 1990 through 2000, a retrospective chart review was conducted by reviewing the medical records of bipolar disorder inpatients at the department of psychiatry, Soonchunhyang Medical Center in Seoul and Chunan. The following data were collected; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, and 4) drug titration records of all prescribed psychotropic medications. Of the 139 total subjects, 98.5% had been treated with more than one antipsychotics combined with a mood stabilizer for at least one week. Chlorpromazine was found to be the preferred antipsychotic between 1990 and 1995. However, preference of high-potency antipsychotics, such as haloperidol, to low-potency antipsychotics for bipolar disorder patients was observed between 1995 and 2000. The prescription percentage of atypical antipsychotics increased to 16.3% in 2000. The overall mean prescribed daily chlorpromazine equivalents was 669.9 mg/day(SD=514.3). In spite of unfavorable side effects and an established guideline for the usage of antipsychotics for bipolar disorder, most bipolar manic inpatients have been prescribed adjunctive antipsychotics at relatively high dosages. The results imply a need to reduce the discrepancy between daily clinical practice and recommended guidelines in the treatment of bipolar patients.