Download PDF
Pharmacopsychiatry 2008; 41(1): 29-36
DOI: 10.1055/s-2007-993213
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Determinants of Voluntary vs. Involuntary Admission in Bipolar Disorder and the Impact of Adherence

Results from the EMBLEM Study on Acute Mania of Bipolar Disorder D. Schuepbach 1 , D. Novick 2 , J. M. Haro 3 , C. Reed 2 , H. Boeker 1 , S. Noda 1 , J. Angst 1 , D. Hell 1 ,  the EMBLEM Advisory Board 1
  • 1Psychiatric University Hospital Zurich, Zurich, Switzerland
  • 2Eli Lilly and Company, Lilly Research Center, Windlesham, United Kingdom
  • 3Sant Joan de Déu-SSM, Sant Boi de Llobregat, Barcelona, Spain
Further Information

Publication History

received 08.06.2007 revised 08.09.2007

accepted 05.10.2007

Publication Date:
18 January 2008 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction: Treatment adherence plays a pivotal role in hospitalisation in bipolar disorder (BD). We examined the impact of adherence and pharmacological variables on involuntary vs. voluntary admission on a sample of inpatients from the European Mania in Bipolar Longitudinal Evaluation of Medication study (EMBLEM).

Methods: 1374 inpatients with an acute manic or mixed episode of BD participated in this observational study on clinical, functional and economic outcomes of pharmacological treatment. We analysed data at the time of study inclusion, and the primary outcome measure was admission status (voluntary vs. involuntary admission).

Results: The strongest baseline factor of admission status was adherence whereby patients’ adherence was significantly associated with admission when treated with atypical antipsychotics or lithium as monotherapy. Adherence with typical antipsychotics was not significantly associated with admission status.

Discussion: These results emphasise the crucial role of treatment adherence for admission status and, within the context of a naturalistic study, some advantage of atypical over typical antipsychotics on admission in acute mania of BD.

References

  • 1 American Psychiatric Association (APA) .Diagnostic and statistical manual of mental disorders (4th edn.) 1994 Washington, DC
  • 2 Bowden CL. Clinical correlates of therapeutic response in bipolar disorder.  J Affect Disord. 2001;  67 257-265
    CrossrefPubMedGoogle Scholar
  • 3 Calabrese JR, Keck Jr PE, MacFadden W, Minkwitz M, Ketter TA, Weisler RH, Cutler AJ, MacCoy R, Wilson E, Mullen J. A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression.  Am J Psychiatry. 2005;  162 1351-1360
    CrossrefPubMedGoogle Scholar
  • 4 Castberg I, Spigset O. Effects of comedication on the serum levels of aripiprazole: evidence from a routine therapeutic drug monitoring service.  Pharmacopsychiatry. 2007;  40 107-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Cohen J. Statistical Power Analysis for the Behavioral Sciences, p 258, 2nd edn. Lawrence Erlbaum Associates, Inc., Hillsdale, New Jersey 1988
  • 6 Craig TJ, Grossman S, Mojtabai R, Gibson PJ, Lavelle J, Carlson GA, Bromet EJ. Medication use patterns and 2-year outcome in first-admission bipolar disorder with psychotic features.  Bipol Disord. 2004;  6 406-415
    PubMedGoogle Scholar
  • 7 Figuerido JL, Gutierrez M, Mosquera F, Lalaguna B, Gonzales Pinto A. Involuntary hospitalization in the first psychotic episodes: associated factors.  Actas Esp Psiquiatr. 2000;  28 275-278
    PubMedGoogle Scholar
  • 8 Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder.  Am J Psychiatry. 1995;  152 1635-1640
    PubMedGoogle Scholar
  • 9 Goetz I, Tohen M, Reed C, Lorenzo M, Vieta E. the EMBLEM Advisory Board . Functional impairment in patients with mania: baseline results of the EMBLEM study.  Bipol Disord. 2007;  9 45-52
    CrossrefPubMedGoogle Scholar
  • 10 Goldberg JF, Harrow M, Grossman LS. Recurrent affective syndromes in bipolar and unipolar mood disorders at follow-up.  Br J Psychiatry. 1995;  166 382-385
    PubMedGoogle Scholar
  • 11 Gonzalez-Pinto A, Ballestreros J, Al Dama A, Perez de Heredia JL, Gu M, Mosquera F, Gonzalesz-Pinto A. Principal components of mania.  J Affect Disord. 2003;  76 95-102
    CrossrefPubMedGoogle Scholar
  • 12 Goodwin FK, Jamison KR. Manic-Depressive Illness. New York, NY: Oxford University Press 1990
  • 13 Grove W, Fain J. A comparison of voluntary and committed psychiatric patients.  Arch Gen Psychiatry. 1977;  34 669-676
    PubMedGoogle Scholar
  • 14 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
    CrossrefPubMedGoogle Scholar
  • 15 Haro JM, Os J van, Vieta E, Reed C, Lorenzo M, Goetz I. EMBLEM Advisory Board . Evidence for three distinct classes of “typical”, “psychotic” and “dual” mania: results from the EMBLEM study.  Acta Psychiatr Scand. 2006;  113 112-120
    CrossrefPubMedGoogle Scholar
  • 16 Humble F, Berk M. Pharmacological management of aggression and violence.  Hum Psychopharmacol Clin Exp. 2003;  18 423-436
    CrossrefPubMedGoogle Scholar
  • 17 Ichikawa J, Chung YC, Dai J, Meltzer HY. Valproic acid potentiates both typical and atypical antipsychotic-induced prefrontal cortical dopamine release.  Brain Res. 2005;  1052 56-62
    CrossrefPubMedGoogle Scholar
  • 18 Keck Jr PE, McElroy SL, Strakowski SM, West SA, Sax KW, Hawkins JM, Bourne ML, Haggard P. 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.  Am J Psychiatry. 1998;  155 646-652
    PubMedGoogle Scholar
  • 19 Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, Andreasen NC. The Longitudinal Interval Follow-Up Evaluation.  Arch Gen Psychiatry. 1987;  44 540-548
    PubMedGoogle Scholar
  • 20 Khanna S, Vieta E, Lyons B, Grossman F, Eerdekens M, Kramer M. Risperidone in the treatment of acute mania: double-blind, placebo-controlled study.  Br J Psychiatry. 2005;  187 229-234
    CrossrefPubMedGoogle Scholar
  • 21 Loyd D, Simpson JC, Tsuan MT. Are there sex differences in the long-term outcome of schizophrenia?. Comparisons with mania, depression, and surgical controls.  J Nerv Ment Dis. 1985;  173 643-649
    PubMedGoogle Scholar
  • 22 Malla A, Norman RMG, Helmes E. Factors associated with involuntary admission to psychiatric facilities in Newfoundland.  Can Med Assoc J. 1987;  136 1166-1171
    PubMedGoogle Scholar
  • 23 Marken PA, Pies RW. Emerging treatments for bipolar disorder: safety and adverse effect profiles.  Ann Pharmacother. 2006;  40 276-285
    PubMedGoogle Scholar
  • 24 Potkin SG, Keck Jr PE, Segal S, Ice K, English P. Ziprasidone in acute bipolar mania: a 21-day randomized, double-blind, placebo-controlled replication trial.  J Clin Psychopharmacol. 2005;  25 301-310
    PubMedGoogle Scholar
  • 25 Quirk A, Lelliott P. What do we know about life on acute psychiatric wards in the UK? A review of research evidence.  Soc Sci Med. 2001;  53 1565-1574
    CrossrefPubMedGoogle Scholar
  • 26 Schuepbach D, Goetz I, Boeker H, Hell D. Voluntary vs. involuntary hospital admission in acute mania of bipolar disorder: Results from the Swiss sample of the EMBLEM study.  J Affect Disord. 2006;  90 57-61
    CrossrefPubMedGoogle Scholar
  • 27 Schuepbach D, Goetz I, Noda S, Hell D. The impact of admission status in acute mania of bipolar disorder: Results from the EMBLEM study.  Biol. Psychiatry. 2006;  59 22S
    PubMedGoogle Scholar
  • 28 Strakowski SM, Williams JR, Fleck DE, Delbello MP. Eight-month functional outcome from mania following a first psychiatric hospitalization.  J Psychiatr Res. 2000;  34 193-200
    CrossrefPubMedGoogle Scholar
  • 29 Suppes T, Ozcan ME, Carmody T. Response to clozapine of rapid cycling versus non-cycling patients with a history of mania.  Bipol Disord. 2004;  6 329-332
    PubMedGoogle Scholar
  • 30 Tohen M, Greil W, Calabrese JR, Sachs GS, Yatham LN, Oerlinghausen BM, Koukopoulos A, Cassano GB, Grunze H, Licht RW, Dell’Osso L, Evans AR, Risser R, Baker RW, Crane H, Dossenbach MR, Bowden CL. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month, randomized, double-blind, controlled clinical trial.  Am J Psychiatry. 2005;  162 1281-1290
    Google Scholar
  • 31 Tohen M, Grundy S. Management of acute mania.  J Clin Psychiatry. 1999;  60 ((suppl 5)) 31-34
    PubMedGoogle Scholar
  • 32 Tohen M, Ketter TA, Zarate CA, Suppes T, Frye M, Altshuler L, Zajecka J, Schuh LM, Risser RC, Brown E, Baker RW. Olanzapine versus divalproex sodium for the treatment of acute mania and maintenance of remission: a 47 -week study.  Am J Psychiatry. 2003;  160 1263-1271
    CrossrefPubMedGoogle Scholar
  • 33 Tohen M, Waternaux CM, Tsuang MT. Outcome in mania: a 4-year prospective follow-up of 75 patients utilizing survival analysis.  Arch Gen Psychiatry. 1990;  47 1106-1111
    PubMedGoogle Scholar
  • 34 Vieta E, Bourin M, Sanchez R, Marcu R, Stock E, McQuade R, Carson W, Abou-Gharbia N, Swanink R, Iwamoto T, on behalf of the Aripriprazole Study Group. Effectiveness of aripiprazole v. haloperidol in acute bipolar mania: double-blind, randomised, comparative. 12-week trial Br.  J Psychiatry. 2005;  187 235-242
    PubMedGoogle Scholar
  • 35 Welge JA, Keck PE, Meinhold JM. Predictors of response to treatment of acute bipolar manic episodes with divalproex sodium or placebo in 2 randomized, controlled, parallel-group trials.  J Clin Psychopharmacol. 2004;  24 607-612
    CrossrefPubMedGoogle Scholar
  • 36 Winokur G, Coryell W, Akiskal HS, Endicott J, Keller M, Mueller T. Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients.  Acta Psychiatr Scand. 1994;  89 102-110
    CrossrefPubMedGoogle Scholar
  • 37 World Health Organization (WHO) . International Classification of Diseases (10th edition) (ICD-10).  1991; 
    Google Scholar
  • 38 Yesavage JA. Bipolar illness: Correlates of dangerous inpatient behaviour.  Br J Psychiatry. 1983;  143 554-557
    PubMedGoogle Scholar
  • 39 Yoshimura R, Ueda N, Shinkai K, Nakamura J. Two cases of bipolar disorder successfully stabilized for five years with a low dose of risperidone and lithium.  Pharmacopsychiatry. 2006;  39 233-234
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Young RC, Biggs JT, Zeigler VE. A rating scale for mania: reliability, validity and sensitivity.  Br J Psychiatry. 1978;  133 429-435
    CrossrefPubMedGoogle Scholar

Correspondence

D. SchuepbachMD 

Psychiatric University Hospital Zurich

P.O. Box 1931

8032 Zurich

Switzerland

Phone: +41/44/384 21 11

Fax: +41/44/383 44 56

Email: daniel.schuepbach@puk.zh.ch