2026 ECNP Congress

PS02-2114

Treatment trends in bipolar mania and discrepancies between clinical practice and guideline recommendations in Bavarian psychiatric clinics

Sophie Ressel — O. Pogarell, C. Schüle, L. Mußmann, F. Seemüller · Ludwig-Maximilians-University, Department of Psychiatry and Psychotherapy, Munich, Germany

2026 ECNP Congress

Objectives

Mania is a complex psychiatric condition that often requires pharmacological intervention to reduce symptoms and improve patient outcomes. While guidelines provide evidence-based recommendations for appropriate treatment options, real-world prescription patterns frequently differ from these recommendations. Identifying such discrepancies is crucial for ensuring consistent, safe, and effective patient care.Therefore, this study aims to examine pharmacological treatment patterns for mania in Bavarian psychiatric clinics between 2014 and 2023, as well as potential trends over time. Furthermore, observed prescribing practices are compared with recommendations outlined in the German S3 guidelines “Diagnosis and Treatment of Bipolar Disorders”.

Methods

A descriptive analysis of prescription patterns in 1,739 inpatients diagnosed with F30, F31.1, or F31.2 was conducted. Data were drawn from the Bavarian Pharmaco-Epidemiology and Vigilance project (Pharmako-EpiVig). Chi-square tests were performed using R to assess significant changes in prescription practices over time.

Results

Overall, 85.1% received at least one antipsychotic (AP). Second-generation APs were administered to 76.2% of patients, while the use of first-generation APs declined (29.8%). Mood stabilisers (MSs) were prescribed to 58.6%, although their use decreased over time. Valproate prescriptions declined significantly (28.5%), whereas lithium use remained stable (29.5%). Antidepressants (ADs) were given to 9.7% and benzodiazepines to 35.3% of patients. Monotherapy was applied in 22.9% of cases and increased significantly over time, primarily involving APs (16.7%) and MSs (5.3%). Of the patients, 70% received combination therapy with MSs, ADs, and/or APs, resulting in 478 different treatment regimens. The majority of patients were treated with two agents simultaneously (38.2%), followed by three (24%), four (6.5%), five (1%), or six agents (0.3%). The most frequently prescribed drugs were quetiapine (n = 566) and lithium (n = 513). The most common regimens were AP+MS (24.8%), AP monotherapy (16.7%), and AP+AP+MS (14.8%). Treatment approaches fully consistent with guideline recommendations for mania, involving specific APs and MSs, either as monotherapy or in specifically recommended combinations, were identified in 40.8% of patients. Overall, 10.9% did not receive any guideline-recommended medication for the treatment of mania.

Conclusions

The findings of this study reveal discrepancies between treatment regimens recommended in the S3 guidelines and the prescription patterns in real-world clinical practice. Nevertheless, the majority of patients received at least one guideline-recommended agent in their treatment regimens. Despite limited evidence for efficacy and increased risks of adverse effects and drug interactions, a high prevalence of combination therapies and polypharmacy was observed, which likely also reflects the complexity of severely affected inpatients. Overall, prescribing practices were largely consistent with previous studies, showing higher rates of APs than of MSs and the use of ADs in mania. Notably, lithium prescriptions remained stable, the use of valproate declined, and monotherapy was applied more frequently over time. These findings underscore the need for more extensive research on effective strategies for implementing guidelines in clinical practice, as well as on the efficacy and safety of combination therapies and polypharmacy in mania.

References

No references