The Maudsley bipolar disorder project. A survey of psychotropic prescribing patterns in bipolar I disorder

Objectives:  The outcome of Bipolar 1 Disorder (BD1) is greatly dependent on the adequacy and appropriateness of its treatment. As the treatment choices in BD1 disorder are increasing the aim of this study was to examine the current use of the pharmacological agents in BD1 patients and its association with clinical characteristics.
Methods:  Case note review of the pharmacotherapy of a sample of BD1 patients from a specified South London sector of a National Health Service Trust.
Results:  Half of the patients were on mood-stabilizers (usually lithium) and their use was associated with female gender and multiple admissions. Antipsychotics were more commonly used in patients with psychotic features and multiple manic episodes. Antidepressants were rarely prescribed alone and were not associated with increased number of manic episodes. Combination treatments were mostly used in patients in acute episodes and with multiple hospitalizations.
Conclusions:  In ordinary care, the treatment of BD1 is often driven by symptoms and falls short of the existing practice guidelines.