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Treatment strategies according to clinical features in a naturalistic cohort study of bipolar patients: A principal component analysis of lifetime pharmacological and biophysic treatment options

Lookup NU author(s): Emeritus Professor Jan Scott


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Background: The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription. Objective: The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients. Methods: Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD. Results: Three main factors corresponding to three main prescription patterns were identified, which explained about 60% of cases, namely, Factor 1 (21.1% of common variance), defined the "antimanic stabilisation package" including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4%), "anti-depressive stabilisation package" that grouped predominantly depressed patients, and Factor 3 (16.4%) defined the "anti-bipolar II package", including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours. Conclusions: This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients. (c) 2012 Elsevier B.V. and ECNP. All rights reserved.

Publication metadata

Author(s): Nivoli AMA, Colom F, Pacchiarotti I, Murru A, Scott J, Valenti M, Mazzarini L, Bonnin CD, Sanchez-Moreno J, Serretti A, Vieta E

Publication type: Article

Publication status: Published

Journal: European Neuropsychopharmacology

Year: 2013

Volume: 23

Issue: 4

Pages: 263-275

Print publication date: 01/04/2013

Online publication date: 28/08/2012

Acceptance date: 24/07/2012

ISSN (print): 0924-977X

ISSN (electronic): 1873-7862

Publisher: Elsevier


DOI: 10.1016/j.euroneuro.2012.07.015


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Funder referenceFunder name
PI09/1044Spanish Ministry of Economy and Competitivity
Astra Zeneca
Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM)
Forest Research Institute
Instituto de Salud Carlos III
MRC UK BP II Cohort Study
Rio-Hortega grant
Stanley Medical Research Institute
Union Europea
United Biosource Corporation
Bristol-Myers Squibb
Eli Lilly
Fondo Europeo de Desarrollo Regional
Instituto de Salud Carlos III Subdireccion General de Evaluacion y Fomento de la Investigacion
Juan de la Cierva grant
NHS RfPB Early Intervention Study
NTW NHS Trust FSF Research Fun
Seventh European Framework Programme (ENBREC)
Spanish Ministry of Science and Innovation (CIBERSAM)
2009 SGR 1022Generalitat de Catalunya
2009 1148 SGR 1022Generalitat de Catalunya
AP2008-01923Spanish Ministry of Education through a FPU
CP08/00140Instituto Carlos III, through a "Miguel Servet" postdoctoral contract
CP08/00140Una manera de hacer Europa, through a "Miguel 1150 Servet" postdoctoral contract
CM11/00163Rio Hortega contract