Comparative Efficacy of Introducing Mood Stabilizers in Acute or Maintenance Treatment of Bipolar Disorder: An Observational Prospective Study

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. 

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.