The management of bipolar mania: a national survey of baseline data from the EMBLEM study in ItalyReportar como inadecuado

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BMC Psychiatry

, 7:33

First Online: 19 July 2007Received: 31 August 2006Accepted: 19 July 2007


BackgroundAlthough a number of studies have assessed the management of mania in routine clinical practice, no studies have so far evaluated the short- and long-term management and outcome of patients affected by bipolar mania in different European countries.

The objective of the study is to present, in the context of a large multicenter survey EMBLEM study, an overview of the baseline data on the acute management of a representative sample of manic bipolar patients treated in the Italian psychiatric hospital and community settings. EMBLEM is a 2-year observational longitudinal study that evaluates across 14 European countries the patterns of the drug prescribed in patients with bipolar mania, their socio-demographic and clinical features and the outcomes of the treatment.

MethodsThe study consists of a 12-week acute phase and a ≤ 24-month maintenance phase. Bipolar patients were included into the study as in- or out-patients, if they initiated or changed, according to the decision of their psychiatrist, oral antipsychotics, anticonvulsants and-or lithium for the treatment of an episode of mania.

Data concerning socio-demographic characteristics, psychiatric and medical history, severity of mania, prescribed medications, functional status and quality of life were collected at baseline and during the follow-up period.

ResultsIn Italy, 563 patients were recruited in 56 sites: 376 were outpatients and 187 inpatients. The mean age was 45.8 years. The mean CGI-BP was 4.4 ± 0.9 for overall score and mania, 1.9 ± 1.2 for depression and 2.6 ± 1.6 for hallucinations-delusions. The YMRS showed that 14.4% had a total score < 12, 25.1% ≥ 12 and < 20, and 60.5% ≥ 20. At entry, 75 patients 13.7% were treatment-naïve, 186 34.1% were receiving a monotherapy of which haloperidol 24.2%, valproate 16.7% and lithium 14.5% were the most frequently prescribed while 285 52.2% a combined therapy of which 8.0% were represented by haloperidol-lithium combinations. After a switch to an oral medication, 137 patients 24.8% were prescribed a monotherapy while the rest 415, 75.2% received a combination of drugs.

ConclusionData collected at baseline in the Italian cohort of the EMBLEM study represent a relevant source of information to start addressing the short and long-term therapeutic strategies for improving the clinical as well as the socio-economic outcomes of patients affected by bipolar mania. Although it-s not an epidemiological investigation and has some limitations, the results show several interesting findings as a relatively late age of onset of bipolar disorder, a low rate of past suicide attempts, a low lifetime rate of alcohol abuse and drug addiction.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-244X-7-33 contains supplementary material, which is available to authorized users.

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Autor: Cesario Bellantuono - Alessandra Barraco - Andrea Rossi - Iris Goetz


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