Use of mood stabilizers for hospitalized psychotic and bipolar disorder patients.

Treatments given to patients with primary psychotic disorders include mood stabilizers (MSs) combined with other psychotropics, despite the limited evidence of efficacy, safety, and lack of regulatory approval. We analyzed records of 636 inpatients at the McLean Hospital (2002-2009), who were diagnosed with bipolar disorder (n=318), a schizoaffective disorder (n=210), or schizophrenia (n=108), to evaluate MS-usage, drug-selections, combinations and doses, improvement, adverse-effect risks, associated factors, and secular trends. Between 2002 and 2009, the use of MSs increased from 53 to 94% of patients, MSs per patient increased by 74%, and the total final doses (lithium-equivalents in milligrams/day) increased by 35%. The most commonly prescribed MSs ranked: valproate, lithium, lamtogrine. With the use of MSs, the duration of hospitalization was longer by an average of 18%, Clinical Global Impression ratings improved by 55%, and adverse-effects risk was lower by 22%. In multivariate logistic modeling, treatment with a MS was associated with: (i) most recent year of sampling, (ii) more psychotropics per patient at discharge, (iii) diagnosis (schizophrenia < schizoaffective or bipolar disorders), (iv) longer period of hospitalization, and (v) somewhat younger age. MSs, usually in combination with antipsychotics, were used increasingly for inpatients over the past decade, including for patients with primary psychotic disorders. The effectiveness and safety of this practice remain to be evaluated adequately.

Changes in medication practices for hospitalized psychiatric patients: 2009 versus 2004.

BACKGROUND: We tested the hypothesis that combinations and total daily doses of psychotropics for hospitalized patients diagnosed with major psychiatric disorders are rising. METHODS: We evaluated McLean Hospital records of 481 consecutive inpatients with DSM-IV schizophrenia, schizoaffective, or bipolar disorders in 2004 (n = 278) or 2009 (n = 203) to compare characteristics and treatments. RESULTS: In 2009, Clinical Global Impression (CGI)-severity scores were 6% lower at intake and improved 1.7 times more than in 2004, as hospitalization-length decreased by 12%. Polytherapy (> or = 2 psychotropics) increased in 2009 (affective or schizoaffective disorders > schizophrenia). Total psychotropics/patient (3.1-3.2) remained stable but mood-stabilizers/patient increased markedly and antipsychotics/patient decreased somewhat in 2009. Antipsychotic-choice (2009) ranked: quetiapine, aripiprazole, risperidone, and others; mood-stabilizers ranked: lamotrigine, valproate, lithium, and others (1/4 off-label). In 2009, final total antipsychotic doses (mg/day) increased by 97%, and mood-stabilizers by 75%. Adverse-effect rates fell by half. Factors differing independently for 2009 versus 2004 ranked: (a) more CGI improvement, (b) more mood-stabilizers/patient, (c) lower admission CGI scores, and (c) higher total antipsychotic dose. COMMENT: Combinations and doses of antipsychotic and mood-stabilizing drugs for inpatients increased markedly (2004 vs. 2009) without consistent correspondence of agents/person and doses, without apparent increase in major adverse effects, and with possibly superior clinical improvement.