Pharmacological management of acute mania – does current prescribing practice reflect treatment guidelines?

Abstract

The records of 70 inpatients with an acute manic episode were audited, to examine the relationship between current prescribing practice, the recommendations of recent clinical guidance and short-term clinical outcomes. Overall, 38 combinations of medication were prescribed. Within the first 24 hours of treatment, monotherapy with a second generation antipsychotic was favoured. At discharge, combination treatment (a mood stabilizer and a second generation antipsychotic) predominated. Early initiation of medication was significantly associated with an earlier clinical decision to discharge. Prescribing was generally in accord with published guidelines. The findings reinforce the value of prescribing surveys in mental health and the need to share understanding of the constraints that may lead to deviation from prescribing guidelines.

Keywords

acute mania prescribing guidelines

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References

Ahmed Z , Anderson I M (2001) Treatment of bipolar affective disorder in clinical practice. Journal of Psychopharmacology 15(1): 55–57

American Psychiatric Association (2002) Practice guidelines for the treatment of patients with bipolar disorder, revision. American Journal of Psychiatry 159: 1–50

Anderson I M , Haddad P M , Chaudhry I (2004) Changes in pharmacological treatment for bipolar disorder over time in Manchester: a comparison with Lloyd et al., (2003). Journal of Psychopharmacology 18(3): 441–444

Baker R W , Brown E , Akiskal H S , Calabrese J R , Ketter T A , Schuh L M , Trzepacz P T , Watkin J G , Tohen M . (2004) Efficacy of olanzapine combined with valproate or lithium in the treatment of dysphoric mania. Br J Psychiatry 185: 472–478

Battaglia J (2005) Pharmacological management of acute agitation. Drugs 65(9): 1207–1222

Bowden C L (2005) Atypical antipsychotic augmentation of mood stabilizer therapy in bipolar disorder. J Clin Psychiatry 66 (suppl. 3): 12–19

Drugs and Therapeutics Bulletin (2005) Drug treatments in Bipolar Disorder 1 – acute manic or depressive episode. DTB 43: 28–32

Goodwin G M , Consensus Group of the British Association for Psychopharmacology (2003) Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 17(2): 149–173

Lloyd A J , Harrison C L , Ferrier I N , Young A H (2003) The pharmacological treatment of bipolar affective disorder: practice is improving but could still be better. Journal of Psychopharmacology 17(2): 230–233

10.

Macritchie K , Geddes J R , Scott J , Haslam D , de Lima M , Goodwin G (2003) Valproate for acute mood episodes in bipolar disorder: The Cochrane Database of systematic reviews, issue 1. Art. No. CD004052. DOI: 10.1002/ 14651858. CD004052

11.

National Institute for Clinical Excellence (2003) Olanzapine and valproate in the treatment of acute mania associated with bipolar I disorder, September

12.

National Institute for Clinical Excellence (2005) Violence – the short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. February

13.

NHS Research and Development Forum (2005) Guidance on developing procedures within NHS organisations for appropriate authorization and management of research and related projects. http://www.rdforum.nhs.uk/docs/categorising_projects_guidance.doc

14.

Rendell J M , Gijsman H J , Keck P , Goodwin G M , Geddes J R (2003) Olanzapine alone or in combination for acute mania: The Cochrane Database of systematic reviews, issue 1. Art. No. CD004040, DOI: 10.1002/ 14651858. CD004040

15.

Rendell J M , Gijsman H J , Bauer M S , Goodwin G M , Geddes G R (2006) Risperidone alone or in combination for acute mania. Cochrane Database Syst Rev 25(1): CD004043

16.

Tohen M , Chengappa K N R , Suppes T , Zarate C A Jr , Calabrese J R , Bowden C L , Sachs G S , Kupfer D J , Baker R W , Risser R C , Keeter E L , Feldman P D , Tollefson G D , Breier A (2002) Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Archives of General Psychiatry 59(1): 62–69

17.

Zarate C A Jr , Tohen M , Land M , Cavanagh S (2000) Functional impairment and cognition in bipolar disorder. Psychiatric Quarterly 71(4): 309–329