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Comparative Efficacy of Introducing Mood Stabilizers in Acute or Maintenance Treatment of Bipolar Disorder: An Observational Prospective Study
Article Number: SIS053192AI141123
14th November, 2023
Author(s):
Eugene Oppong kyere, Ruth Owusu-Antwi, Courage Mawufemor Danku, Kwame Ohene Buabeng, Mercy Naa Aduele Opare-Addo
Abstract:
Bipolar disorder is a severe chronic psychiatric
disorder characterized by recurrent fluctuations in mood, energy, and behavior.
The study determined the comparative efficacy of introducing mood stabilizers
in the acute or maintenance treatment of bipolar disorder (BD). The study was
conducted at the Psychiatry Unit of the Komfo Anokye Teaching Hospital,
Kumasi-Ghana. Fifty-five (55) bipolar patients aged 14-77 years were recruited
for the study through a convenience sampling technique. The Medication Adherence Rating Scale (MARS),
which was a clinician-led tool, asked patients to respond to statements in the
questionnaire by circling the answer (yes or no) that best described their
behavior toward their medications over a time period; the Young Mania Rating
Scale (YMRS), which was a clinician-administered tool, was used for measuring
symptoms severity and monitoring resolution; the Insight and Treatment Attitude
Questionnaire (ITAQ), which was a clinician-led tool for measuring patients’
insight into their condition; and a structured questionnaire, which was a
clinician-led tool for measuring patients’ demographics, were adapted for the
study. Statistical Package
for Social Sciences (SPSS) version 25 was used to analyze the data. Most of the respondents
were between 25-36 years (54.6%). Females constituted 58.6% of the sample. Most
of the respondents had had education up to the Senior High School level
(40.0%). The majority of the respondents were self-employed (36.5%). There was
no difference in the duration of symptom resolution between given mood
stabilizers within 0-3 days (Median=2, N=33) and 4- 16 days (Median=2 N=20).
The test statistics were (U=309.00, Z=0.440, r=0.06, P=.660) using the
Mann-Whitney test. However, there was an
association between insight and religion (X²(4)=14.69, p=.005) and black
ethnicity (X² (2)=4.79, p=.002). Also, insight was associated with adherence
(X²(2)=44.21, p=<.001). Sodium valproate had a faster onset of mood
stabilizing effect (less than 7 days) than carbamazepine (7-14 days) and the
psychiatrist considered medication effectiveness and client history as the most
important factors in the choice of a mood stabilizer for BD. Impaired insight
is a predictor of non-adherence. Mood stabilizers can be started at any time in
the acute treatment of bipolar disorder. Sodium valproate must be given priority in the acute treatment of bipolar disorder, except in women of
reproductive age.