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Brief Reports   |    
Psychotropic Polypharmacy for the Treatment of Bipolar Disorder in Taiwan
Galen Chin-Lun Hung, M.D., Sc.M.; Shu-Yu Yang, Ph.D.; Yuefan Chen, Sc.M.; Shih-Ku Lin, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200529
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Dr. Hung, Dr. Yang, and Dr. Lin are with Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan. Dr. Yang is also with the Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung City, Taiwan. Dr. Lin is also with the Department of Psychiatry, Taipei Medical University, Taipei City. Ms. Chen is with the Department of General Pediatrics, Boston Children's Hospital, and was with the Department of Social and Behavioral Science, Harvard School of Public Health, both in Boston, when this report was written. Send correspondence to Dr. Lin (e-mail: daf68@tpech.gov.tw).

Copyright © 2014 by the American Psychiatric Association


Objective  Psychotropic polypharmacy in the treatment of bipolar disorder has proliferated. Yet evidence about the prevalence and predictors of different combinations of polypharmacy in inpatient settings is scarce.

Methods  The Nationwide Psychiatric Inpatient Medical Claims (2000–2007) in Taiwan were used to examine prescriptions for mood stabilizers, antipsychotics, and antidepressants among recently discharged patients with bipolar disorder (N=5,449; 51% women, mean±SD age=36.8±12.4).

Results  A total of 71% of prescriptions involved between-class polypharmacy, and 17% involved within-class polypharmacy. Patients older than 50 and patients at medical centers (>500 beds) were less likely to receive polypharmacy. Lower prescribed doses predicted polypharmacy. Receiving polypharmacy was not associated with a higher rate of readmission within one year.

Conclusions  There was substantial use of various forms of polypharmacy in the treatment of inpatients with bipolar disorder. Randomized studies should be used to compare the cost-effectiveness of common psychotropic combinations and monotherapy to treat bipolar disorder.

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Table 1Predictors of between-class and within-class polypharmacy among recently discharged inpatients with bipolar disorder in Taiwan (N=5,449), 2000–2007
Table Footer Note

a Data for some patients are missing for some predictors. Because there are no reference groups for hospitalization and average daily dose, the comparison indicates the effects on polypharmacy of each increase of one unit.

Table Footer Note

b The average daily dose for the prescription was calculated by adding the daily doses of each medication and dividing by the number of medications prescribed. The daily dose of each medication was calculated by dividing the prescribed daily dose by the defined daily dose, which represents the amount assumed to be the average maintenance daily dose of a medication for an adult. Each unit increase of average daily dose halved the odds of both between-class polypharmacy and within-class polypharmacy.



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