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Drug treatment of mania: 6 month prospective follow-up in a naturalistic multi-site survey

Background

Obtaining quantitative measures on the clinician's habits for using anti-manic drugs, and analyzing the stability of primary treatment choice.

Materials and methods

In March 2003, 110 psychiatrists were selected to be representative at a national level in France. Each investigator should include 3 consecutive patients presenting acutely at least 2 manic symptoms. A structured file was designed to collect precise information on drug prescriptions during a 6-month prospective follow-up (at inclusion, D15, D30, D60, D90, and D180).

Population: 286 patients with acute manic symptoms (61.2% primary bipolars and 30.4% psychotics) were included and 90.6% completed the study. At inclusion, Mood-stabilizers (MS) were choused as primary treatment in 63.3% of cases (32.9% divalproate, 14.3% lithium, 9.4% valpromide, 4.6% carbamazepine), and anti- psychotics (AP) in 26.6% (10.8% olanzapine, 3.1% haloperidol, 2.8 risperidone).

Results

At the end of follow-up, we observed a global stability for diagnosis in 93% of patients and for the choice of primary anti-manic drug therapy in 74%. In case of changing primary treatment, almost half of changes were done within the same drug family and half toward a switch to another family. At D180, the switch rate from MS to AP was 5% and from AP to MS 14.5%. The global rate of treatment modifications (including changing of dose) was 44% at D15, 42% at D30, 34% at D60, 35% at D90, 32% at D180, and the major reason for modifications was partial efficacy (respectively 17.5%, 15%, 9.4%, 12.2% and 9.4%). Intolerance was the second reason (respectively 8%, 6.3%, 7%, 4.2% and 3.8%).

Discussion

The data suggested the global stability of diagnosis in patients presenting with acute manic symptoms and also the stability of primary drug therapy choice.

Acknowledgement

Funding source: unrestricted grant from Sanofi-Aventis France

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Hantouche, EG., Lachaux, B. & Vallier, L. Drug treatment of mania: 6 month prospective follow-up in a naturalistic multi-site survey. Ann Gen Psychiatry 5 (Suppl 1), S100 (2006). https://doi.org/10.1186/1744-859X-5-S1-S100

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  • DOI: https://doi.org/10.1186/1744-859X-5-S1-S100

Keywords

  • Carbamazepine
  • Haloperidol
  • Risperidone
  • Olanzapine
  • Primary Treatment