Objective: Documentation of antipsychotic use in hospitalized manic patients in Turkey.
Methods: Naturalistic data was collected retrospectively from patients’ hospital records. Records of 435 patients with acute manic episode who were hospitalized throughout the year of 2008 from 15 hospitals in Turkey were included in the study.
Results: About one third of hospitalized manic patients were administered antipsychotic (AP) monotherapy at the initiation phase of their treatment: 22.5% first generation antipsychotic (FGA) and 8.5% second generation antipsychotic (SGA). Small group of patients (3.9%) received FGA+SGA combination as a first regimen. Mood stabilizer/antipsychotic combination (with or without benzodiazepine) was the most common modality (53.2%) and SGAs were more common than FGAs in this combination group: 41.1% vs. 12.1%. Distribution among individual APs in the first regiment was as follows: haloperidol (38.4%), quetiapine (30.4%), olanzapine (25.5%), chlorpromazine (23.9%) and risperidone (9.4%). Significant amount of FGAs administered in second step (n: 182/346, 52.6%) and third step (n: 111/207, 53.6%) of patients’ treatment. None of the demographic and illness characteristics has significant association with AP and FGA use.
Conclusions: Use of classical antipsychotics either alone or in combinations are still common in the treatment of hospitalized manic patients in Turkey despite many national and international treatment guidelines and nationwide postgraduate educational activities. Possible explanations about this phenomenon and clinicians’ attitude such as beliefs, pressure to discharge earlier due to insufficient number of beds, cultural and local attitudes of less sensitivity in the safety of drugs and university/mental hospital differentiation need to be investigated further.