Antipsychotic drugs in mania: factors predicting use of antipsychotic medication following inpatient treatment of mania.

Inpatients treated for mania are frequently discharged on antipsychotics. There has been disagreement in clinical guidelines concerning their use, and there is little knowledge of the factors predicting this. The aim of the present study was to identify those factors predicting discharge on typical antipsychotic medication after hospital admission for mania. Data were collected retrospectively from the hospital notes of 74 patients who had 100 consecutive psychiatric hospital admissions for mania during the 1990s. Univariate and multivariate analyses were used to estimate odds ratios. The rate of discharge on typical antipsychotics was 71.6% (53 out of the 74 episodes included in the analyses) (95% confidence interval 61.3-81.9). Three factors were found to predict this with odds ratios significant at the P<0.05 level: (i) use of typical antipsychotics during the first week of admission [odds ratio (OR)=13.3]; (ii) voluntary admission (OR=4.2); and (iii) male gender (OR=8.4). There was no evidence that psychotic symptoms or aggressive behaviour were associated. In conclusion, the use of antipsychotics early in the episode strongly predicted discharge on antipsychotics. It appears that clinicians use antipsychotics for their anti-manic effects and patients are often thought to still need the drugs at the time of discharge.