Clin Psychopharmacol Neurosci.  2022 Feb;20(1):61-69. 10.9758/cpn.2022.20.1.61.

Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian Prescription Pattern-Bipolar Disorder

Affiliations
  • 1Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan.
  • 2Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
  • 3Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan.
  • 4Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Korea.
  • 5Department of Psychiatry, Bugok National Hospital, Changyeong, Korea.
  • 6Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China.
  • 7Department of Psychiatry, Beijing Anding Hospital of Capital Medical University, Beijing, China.
  • 8Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
  • 9Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan, Taiwan.
  • 10Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • 11Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
  • 12Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan.
  • 13Department of Psychiatry, Services Hospital, Lahore, Pakistan.
  • 14Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
  • 15Pushpagiri Institute of Medical Sciences, Tiruvalla, India.
  • 16Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
  • 17Department of Psychiatry and Mental Health, Hospital Kajang, Selangor, Malaysia.
  • 18Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
  • 19Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • 20Department of Psychiatry, Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
  • 21Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
  • 22Institute of Mental Health, Buangkok Green Medical Park, Singapore.
  • 23Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
  • 24Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar.
  • 25Association for the Improvement of Mental Health Programs, Geneva, Switzerland.
  • 26Department of Pharmacology, National University of Singapore, Singapore.
  • 27Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Linkou, Taiwan.
  • 28School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan.

Abstract


Objective
Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed.
Methods
The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method.
Results
Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries.
Conclusion
Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

Keyword

Bipolar disorder; Polypharmacy; Psychotropic drug load; Antipsychotics; Mood stabilizers
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