Abstract
With the recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have been published. This survey investigated prescribing pattern and predictors for guideline disconcordance in the acute treatment of bipolar depression across mainland China. Pharmacological treatments of 1078 patients with bipolar depression were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Predictors for guidelines discordance were analyzed with logistic regression. Of the 1078 patients, 50.2% patients were treated against treatment guidelines recommendations. The patients who were treated in general hospitals (OR = 1.53, 95% CI 1.18–1.97), with a depressive episode (OR = 1.67, 95% CI 1.27–2.19) and an older age at first onset (OR = 1.62, 95% CI 1.15–2.28) were more likely to receive guideline-disconcordant treatment than their counterparts. In contrast, the patients with current mental comorbidity, an older age at study entry, a longer duration of disease, and more frequent episodes in past year were less likely to receive guideline-disconcordant treatments than their counterparts with an OR of 0.43 (95% CI 0.24–0.77), 0.52 (95CI% 0.36–0.75), 0.48 (95% CI 0.36–0.65), and 0.50 (95% CI 0.38–0.64), respectively. Our finding suggested the disconcordance with treatment guidelines in patients with an acute bipolar depression is common under naturalistic conditions in mainland China, and the predicting factors correlated with guidelines disconcordance include both psychiatrist-specific (clinicians from general hospitals) and patient-specific features (a depressive episode at first onset, no current co-morbidity with mental disorders, a younger age at study entry, an older age at first onset, shorter duration of disease, and non-frequent episodes in past year).
Highlights
There is growing recognition that bipolar disorder (BPD) is common, with bipolar disorder type I (BP-I) and type II (BP-II) affecting about 2% of the world’s population and subthreshold forms of the disorder affecting another 2% [1,2]
Several practice guidelines have been published for the treatment of patients with BPD, which include guideline of the American Psychiatric Association [7], the British Psychological Society [8], the Chinese Medical Association [9], the World Federation of Societies of Biological Psychiatry [10,11,12], the Health Ministry of Singapore [13], and the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International Society for Bipolar Disorders (ISBD) [14]
The reported concordant rate of treatment guidelines for bipolar disorders worldwide were from 17.0% to 87.5% among different populations, which depends on types of disease and episode, severity of episode, comorbid psychotic features, duration of treatment and intervention for adherence to guidelines [23]
Summary
There is growing recognition that bipolar disorder (BPD) is common, with bipolar disorder type I (BP-I) and type II (BP-II) affecting about 2% of the world’s population and subthreshold forms of the disorder affecting another 2% [1,2]. Bipolar disorder is a leading cause of premature mortality due to suicide and comorbid medical conditions such as diabetes and cardiovascular diseases [3,4]. Several practice guidelines have been published for the treatment of patients with BPD, which include guideline of the American Psychiatric Association [7], the British Psychological Society [8], the Chinese Medical Association [9], the World Federation of Societies of Biological Psychiatry [10,11,12], the Health Ministry of Singapore [13], and the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International Society for Bipolar Disorders (ISBD) [14]. There is evidence that greater provider adherence to treatment guideline recommendations was associated with a greater reduction in symptoms and greater improvement in the outcome of diseases [15,16]
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