The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland.

BACKGROUND: The concomitant use of two or more mood stabilisers (MS), second-generation antipsychotics (SGA), lamotrigine as well as antidepressants, is frequently reported in the treatment of bipolar patients The aim of this study was to investigate the pattern of pharmacological treatment with special regard to polypharmacy defined as two or more psychiatric drugs taken at the same time in the same patients with bipolar disorder discharged from psychiatric units in Poland. METHOD: Pharmacotherapy of 127 consecutive patients (57 females and 70 males) with an ICD-10 diagnosis of bipolar disorder (BP) at the point of discharge from five psychiatric regional hospitals/units in Poland, was evaluated in 2015/2016 on the basis of medical files. The effect of treatment on mental status at discharge was examined using the Clinical Global Impression-Improvement scale (CGI-I). RESULTS: When only MS, SGA and lamotrigine, were taken into account, 78 (61%) of patients were prescribed two, 27 (21.3%) three and one patient four medications. The combination of MS and SGA was most commonly used (n=61, 48%). Medications preferred by Polish psychiatrists at patients' discharge were valproates (n=69, 54%), olanzapine (n=48, 37%), quetiapine (n=47, 37%) and lamotrigine (n=33, 25.9%). Thirty patients (23.6%) were prescribed lithium. No relationships were found between polypharmacy and patients' age, duration of illness and the rate of CGI-I. However, polypharmacy was significantly associated with types of bipolar disorder, particularly with the bipolar I disorder. CONCLUSION: The prevalence of polypharmacy especially with MS and SGA in the treatment of bipolar patients discharged from psychiatric units in Poland is high. The most significant factor predisposing to polypharmacy is a diagnosis of bipolar - I disorder. In general, our study confirms trends observed in other countries.

The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland.

BACKGROUND: The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. METHODS: Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. RESULTS: At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. CONCLUSIONS: The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.