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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESeveral organizations have developed guidelines to assist with the treatment of patients with bipolar disorder (eg, The American Psychiatric Association, The Canadian Network for Mood and Anxiety Treatments, The Texas Medical Algorithm Project, and the National Institute for Health and Clinical Excellence); however, there is not much in the literature about how these guidelines are implemented in clinical practice.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESeveral organizations have developed guidelines to assist with the treatment of patients with bipolar disorder (eg, The American Psychiatric Association [APA], The Canadian Network for Mood and Anxiety Treatments [CANMAT], The Texas Medical Algorithm Project [TMAP], and the National Institute for Health and Clinical Excellence [NICE]); however, there is not much in the literature about how these guidelines are implemented in clinical practice.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMegan Jo Ehret, PharmD, BCPP, University of Connecticut, Storrs, CT, presented the results of a study that was conducted to identify the demographic and clinical features that are associated with receiving guideline-based pharmacotherapy for bipolar depression in routine clinical care. The study sample comprised 281 inpatients aged 18 to 59 years (73.3% white; 63.7% women) who were discharged from a single facility between January 1, 2005 and December 31, 2007. All patients had a primary clinical diagnosis of bipolar 1 disorder, with the most recent episode being depression. Patients with dementia were excluded. For patients who had more than 1 admission, data from the first admission were used.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDischarge treatment medications were classified by treatment level, based on a consensus of existing guidelines (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11335\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11335\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11335\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EDischarge Treatment Level Classifications.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EIn this study, most discharged patients were prescribed 2 to 4 medications. Approximately 83% of patients were discharged on mood stabilizers (MSs) (198 with 1 MS, 33 with 2 MSs, and 1 patient with 3 traditional MSs; 49 were discharged without a MS). The most common MSs that were prescribed at discharge were divalproex (\u223c90 patients) and lithium (\u223c80 patients). A total of 225 (80%) patients were discharged on antidepressants, the majority of which was a selective serotonin reuptake inhibitor (SSRI). The majority of patients who were discharged on an antipsychotic was prescribed quetiapine (n=\u223c100 patients); 33 patients were discharged on an atypical antipsychotic without a MS.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EPatients with psychotic features were significantly (p\u0026lt;0.001) more likely to be prescribed atypical antipsychotics than those without psychotic features (OR 4.0; 95% CI, 2.0 to 8.3). African-American patients were more likely to receive atypical antipsychotics compared with other races, but the difference was not significant (OR 3.1; 95% CI, 1.0 to 9.2; p=NS). Women were significantly (p=0.004) less likely to receive a MS than men (77.7% vs 91.2%; OR 0.3; 95% CI, 0.2 to 0.7) but were slightly more likely to receive an atypical antipsychotic in the absence of a mood stabilizer (15.6% vs 4.9%; OR 3.6; 95% CI, 1.3 to 9.6; p=NS).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EPatients with psychotic features (29.1% vs 12.3% for those without psychotic features; OR 3.5; 95% CI, 1.8 to 7.0) and patients with borderline personality disorder (35.9% vs 12.0%; OR 4.5; 95% CI, 2.2 to 9.0; p\u0026lt;0.001) were significantly (p\u0026lt;0.001) more likely to be discharged with \u22654 psychotropic medications. African-Americans were significantly (p=0.020) less likely to be discharged with \u22654 psychotropic medications (3.0% vs 19.4% for all other races; OR 0.1; 95% CI, 0.01 to 1.0).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003E\u201cThe patients most at risk for not receiving guideline-based treatment in this study,\u201d said Dr. Ehret, \u201cwere women and patients with psychotic features or borderline personality disorder.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe overall results of this study were mixed when compared with other studies that examined concordance with guideline-based therapy, in that the rate of compliance was higher than that seen by Lim and colleagues [Lim PZ et al. \u003Cem\u003EBipolar Disord\u003C\/em\u003E 2001] but less than what was reported from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BP) trial [Dennehy EB et al. \u003Cem\u003EPsychopharmacol Bull\u003C\/em\u003E 2007]. This may be attributed to differences in study design as well as the population that was studied.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/3\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmk01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmk01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}