Management of bipolar disorder in the intercontinental region: an international, multicenter, non-interventional, cross-sectional study in real-life conditions

Abstract

Most of the existing data on real-life management of bipolar disorder are from studies conducted in western countries (mostly United States and Europe). This multinational, observational cohort study aimed to describe the management and clinical outcomes of bipolar patients in real-life conditions across various intercontinental countries (Bangladesh, Egypt, Iran, Israel, Tunisia, and Ukraine). Data on socio-demographic and disease characteristics, current symptomatology, and pharmacological treatment were collected. Comparisons between groups were performed using standard statistical tests. Overall, 1180 patients were included. The median time from initial diagnosis was 80 months. Major depressive disorder was the most common initial diagnosis. Mood stabilizers and antipsychotics were the most common drugs being prescribed at the time of the study. Antidepressants (mainly selective serotonin uptake inhibitors [SSRIs]) were administered to 36.1% of patients. Patients with bipolar I disorder received higher number of antipsychotics and anxiolytics than those with bipolar II disorder (p < 0.001). Presence of depressive symptoms was associated with an increase in antidepressant use (p < 0.001). Bipolar disorder real-life management practice, irrespective of region, shows a delay in diagnosis and an overuse of antidepressants. Clinical decision-making appears to be based on a multidimensional approach related to current symptomatology and type of bipolar disorder.Bipolar disorder (BD) is a recurrent and chronic disease characterized by the occurrence of manic (or hypomanic), depressive, or mixed episodes. According to the World Health Organization, BD is one of the world's ten most disabling conditions 1 . Several studies have shown that a considerable proportion of BD patients (30-60%) in clinical remission live with significant functional impairment [2][3][4][5][6] . In the general population, the estimated lifetime prevalence of BD is approximately 0.2-5% and increases to 6% for a broad range of bipolar spectrum disorders [7][8][9][10]

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…This is a concern with a positive relationship seen between increasing urbanization and increasing number of suicides [88]. Prevalence rates for BD vary across countries with an estimated prevalence of more than 1% of the world's population [69,89,90] up to 5% [69,83,[91][92][93][94][95][96]. In their recent review, Clemente et al (2015) estimated that the pooled 1-year prevalence of BP-I was 0.71% (95%CI 0.56-0.86) principally among higher-income countries and 0.50% (95%CI 0.35-0.64) for BP-II [83].…”

“…BD is seen as one of the most disabling conditions worldwide [96], with a global burden of 9.9 million disability-adjusted life years (DALYs) in 2013 [82]. BD is a greater burden to health-care systems than, for instance, cancer, epilepsy, and Alzheimer's disease combined [66], with a 40.9% increase in DALYs attributable to BD between 1990 and 2010 [70] and 49.1% between 1990 and 2013 [82].…”

“…A considerable proportion of BD patients, even in clinical remission, also live with significant functional impairment as seen by high DALY rates [82,96,[116][117][118], with often poor quality of life among patients with BD [92,119].…”

“…In view of this, there is an urgent need across countries to identify and effectively treat patients with BD in order to reduce morbidity and mortality rates [90]. During the initial stages of BD, patient's symptoms can be confusing and challenging to diagnose due to heterogeneous clinical presentations [96]. It can be difficult to distinguish mania from other psychiatric disorders, including schizophrenia.…”

“…The psychosis episodes may be acute and transient, which makes misdiagnosis of BD patients common [90,97,111]. There are also concerns about confusion of patients with BP-II with unipolar depression among health-care professionals, with an estimated 35-45% of BD patients initially misdiagnosed with unipolar depression [81,90,96,115]. As a result, delays of several years can occur between an initial diagnosis of a mental disorder and a diagnosis of BD [96].…”