Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population

Abstract

ObjectivesTo describe the range and frequency of psychotropics used in the management of bipolar disorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Specifically to determine congruence with recommended standard of care that might inform a review and refinement of prescribing within this context.MethodsThe study was a retrospective file review for patients with bipolar disorder (ICD 10 and or DSM IV TR diagnostic criteria) attending the outpatient clinic of a specialised psychiatric hospital (Tara Hospital) affiliated to the Department of Psychiatry (University of the Witwatersrand) in Johannesburg, South Africa. Data were presented both descriptively (continuous, discrete and categorical data) and with a range of appropriate statistical tests used for associations between categorical data (Chi Square; Fisher’s exact test; Cramer’s V and the phi coefficient).ResultsThe majority of patients (93.8%) were prescribed polypharmacy, with 3.2 as the mean number of psychotropic medications prescribed per patient (as determined from the last prescription written during the period of review, i.e. one year). There was a notable variety in the combinations used with no particular combination being prescribed in the majority of patients, noting, however, that 47% of the combinations used included a standard mood stabiliser prescribed together with an antipsychotic.ConclusionsThe current study provides data on the prescribing patterns for bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings reflect international studies and highlight polypharmacy and combination treatment as common in such settings. Where polypharmacy is prescribed, the variation in combinations prescribed indicate that whilst treatment guidelines may provide a best practice approach, studies determining the most useful combinations are few and ultimately clinical requirements for individual patients will dictate treatment.

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“…The results also show a reduction in polypharmacy, which was also observed in a previous study . Although the clinical outcomes of reduced polypharmacy were not recorded, the data is still useful as shown in bipolar disorders (Holzapfel E & Szabo C, 2018). In addition, these results show the important role of CPs in the selection of antipsychotics and in disseminating pharmacological knowledge, which is a novel approach in psychiatric practice in Central Europe.…”

<p>Medication Profile and Treatment Cost Estimation Among Outpatients with Schizophrenia, Bipolar Disorder, Depression, and Anxiety Disorders in Indonesia</p>

“…43 In addition, a 2009 study involving bipolar disorder outpatients in South Africa mentioned that most patients (83.8%) were prescribed at least one standard mood stabilizer and that sodium valproate was the most prescribed mood stabilizer (37.1%). 44 The National Institute for Health and Care Excellence (NICE) has recommended the use of valproate as first-line therapy in acute manic episodes. It can be combined with antidepressants for the treatment of acute depressive episodes and for prophylaxis.…”

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“…In this point of view, RCTs are not always representative for this population, which is even more important in elderly patients. More real clinical patients are often covered with observational clinical trials (Castaldelli-Maia et al, 2018b;Holzapfel & Szabo, 2018), which are very important especially in elderly patients with mental disorders (Stuhec & Gorenc, 2019).…”