papers

Complexity and continuity of treatments among privately insured youth diagnosed with bipolar disorder

Front Psychiatry 1:144.

Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, UK

OBJECTIVES: To examine longitudinal patterns of complexity, continuity, and initiation of treatment for youth diagnosed with bipolar disorder. Additionally, we explore bipolar diagnosis stability and its relationship to observed treatment patterns.

METHODS: A cohort of 426 privately insured youth (ages 6-18) diagnosed with bipolar disorder was identified from the 2000-2001 Thomson/Medstat-MarketScan(®) database. Medication complexity was defined as number of different psychotropic medication classes dispensed during a 6-month period following a new treatment episode of bipolar disorder. Treatment continuity was examined over a 6-month follow-up period, specifically focusing on mood stabilizing medications and antidepressant monotherapy. Predictors of complexity and continuity were investigated.

RESULTS: Fifty-five percent of youth received more than one and 25% received three or more different types of psychotropic medication classes during follow-up. This was contrasted with several youth having no prescription fills (21%) and 31% discontinuing mood stabilizing medication. Youth with a stable bipolar diagnosis were more likely to have continuity of mood stabilizing prescriptions (OR: 4.05), but also greater psychotropic medication complexity. Age, health status/comorbidity, and being in a managed care plan were also related to complexity and continuity of psychotropic medication class regimens.

CONCLUSIONS: More evidence is needed on the causal patterns leading to increased psychotropic medication complexity and continuity and how diagnosis of bipolar disorder may drive treatment patterns.

PMID: 21423452

PMCID: PMC3059620