(PS5-2) Bipolar Disorder and Polypharmacy: Associations with Demographic Factors and Treatment Utilization

Intro: Bipolar disorder (BD) is a chronic and complex psychiatric illness characterized by cycling (hypo)manic and depressive episodes, and a high risk for suicide compared to the general population. Individuals with BD often receive a combination of psychopharmacological treatments, as BD affects several domains (e.g., affect, cognition, circadian rhythm); therefore, multiple pharmacological combinations and trials may be necessary to find the correct regimen. Further, the rate of polypharmacy has substantially increased, especially for BD, over the last decade. We aim to identify demographic and treatment utilization characteristics among patients with BD treated with multiple classes of psychiatric medications.

Methods: Data was obtained from Massachusetts General Hospital electronic health records of individuals (N=2238) who had at least one visit at the outpatient bipolar clinic between 2015 and 2023. Chi-square tests of independence were performed to evaluate the relationships between polypharmacy and self-reported gender, race, and primary language, and EHR-recorded hospital admissions (i.e., psychiatric, ED, medical) and mental health treatment utilization (i.e., individual, group, and family therapy). We defined polypharmacy as having been prescribed medications more than two psychiatric medication classes (e.g., mood stabilizers, anti-depressants, anti-psychotics).

Results: Patients were majority white (n=1926, 86.1%), women (n=1313, 58.7%), and primarily English speakers (n=2194, 98%). Over half of patients (n=1309, 58.5%) were prescribed polypharmacy care. Those receiving polypharmacy were more likely to have a psychiatric inpatient admission (χ² = 178.80), medical admission (χ² = 158.53), and ED admission (χ² = 174.40) (all p’s = < .001). Patients receiving polypharmacy were also more likely to engage in individual (χ² = 35.50), family (χ² = 7.41), and group therapy (χ² = 31.58) than those not receiving polypharmacy (all p’s = < .001). There were no significant gender, race, or language differences in polypharmacy care.

Discussion: Our results suggest that patients receiving outpatient care for BD are commonly prescribed psychiatric medications from multiple ( >2) classes. Moreover, those receiving polypharmacy not only have a higher likelihood of receiving adjunctive psychosocial treatment (e.g., individual therapy), but also to have a higher likelihood of admissions to inpatient, ED, and medical care. Future studies should focus on examining the relationship between polypharmacy and acute psychiatric care among individuals with BD.