Guidelines concordance of maintenance treatment in euthymic patients with bipolar disorder: Data from the national bipolar mania pathway survey (BIPAS) in mainland China

Background: Although the treatment guidelines of bipolar disorders (BPD) have spread more than a decade, the concordance with evidence-based guidelines was typically low in routine clinical practice. This study is to present the data on the maintenance treatment of BPD in mainland China. Methods: One thousand and twenty-three patients who had experienced a euthymia were eligible for entry into this survey on the maintenance treatment of BPD. Guidelines disconcordance was determined by comparing the medication(s) that patients were prescribed with the recommendations in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Results: Three hundred and sixty-four patients (35.6%) had not been prescribed with the maintenance treatment as guidelines recommendations, and 208 patients (20.3%) were prescribed with the antidepressants. A longer duration of BPD, a depressive episode at first onset, and a recent depressive or mixed episode significantly increased the risk for guidelines disconcordance and prescribing antidepressant. In contrast, a hospitalization history due to manic episode was associated with a significant decrease in the risk for guidelines disconcordance and prescribing antidepressant. Limitation: This study was a cross-sectional and retrospective investigation based on medical records. Conclusions: Considering the potentially hazardous effects of inappropriate treatment, individualized psychoeducational strategics for subjects with BPD are necessary to enhance treatment adherence and close the gap between guidelines and clinical practice in mainland China. (C) 2015 Elsevier B.V. All rights reserved.National Natural Science Foundation of China [81301159, 91232719]; Shanghai Key Medicine Specialties Program [ZK2012A12]; Hongkou District Key Medicine Specialties Program; Training Plan for Excellent Academic Leaders of Shanghai Health System [XBR2013087]; "12th Five-year Plan" of National Key Technologies RD Program [2012BAI01B04]; National Key Clinical Disciplines at Shanghai Mental Health Center [OMA-MH 2011-873]SCI(E)PubMedSSCIARTICLEwzwhk@163.com; yirufang@aliyun.com101-10518