Clinical Psychopharmacology and Neuroscience Papers in Press available online.

Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from REAP-BD
Shih-Ku Lin , Shu-Yu Yang, Seon-Cheol Park, Ok-Jin Jang, Xiaomin Zhu, Yu-Tao Xiang, Wen-Chen Ouyang, Afzal Javed, M. Nasar Sayeed Khan, Sandeep Grover, Ajit Avasthi, Roy Abraham Kallivayalil, Kok Yoon Chee, Norliza Chemi, Takahiro A. Kato, Kohei Hayakawa, Pornjira Pariwatcharakul, Margarita Maramis, Lakmi Seneviratne, Sim Kang, Wai Kwong Tang, Tin Oo Oo, Norman Sartorius, Chay-Hoon Tan, Mian-Yoon Chong, Yong Chon Park, Naotaka Shinfuku
1Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, 2Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan
Objectives: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries.
Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method.
Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1619 (80.8%) patients received mood stabilizers, 1644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40.
Discussions: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment. A new definition of polypharmacy for bipolar disorder was proposed for easier comparison between different study sites and course phases.
Accepted Manuscript [Submitted on 2020-10-15, Accepted on 2020-12-26]