Open Access Open Badges Research article

Pharmacotherapy for acute mania and disconcordance with treatment guidelines: bipolar mania pathway survey (BIPAS) in mainland China

Zuowei Wang12*, Keming Gao3, Wu Hong1, Mengjuan Xing1, Zhiguo Wu1, Jun Chen1, Chen Zhang1, Chengmei Yuan1, Jia Huang1, Daihui Peng1, Yong Wang1, Weihong Lu1, Zhenghui Yi1, Xin Yu4, Jingping Zhao5 and Yiru Fang1*

Author Affiliations

1 Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P. R. China

2 Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai 200083, P. R. China

3 Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA

4 Institute of Mental Health, Peking University, Beijing 100191, P. R. China

5 Mental Health Institute,The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P. R. China

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BMC Psychiatry 2014, 14:167  doi:10.1186/1471-244X-14-167

Published: 5 June 2014



With the recent attention to evidence-based medicine in psychiatry, a number of treatment guidelines for bipolar disorders have been published. This survey investigated prescribing patterns and predictors for guideline disconcordance in the acute treatment of a manic and mixed episode across mainland China.


The pharmacological treatments of 2828 patients with a recent hypomanic/manic episode or mixed state were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments.


The most common pattern of pharmacological treatments for an acute manic or mixed episode was a mood stabilizer plus an atypical antipsychotic (nā€‰=ā€‰1345, 47.6%), and the rate of guideline-disconcordant treatments was 11.1%. The patients who were treated in general hospitals were more likely to receive guideline-disconcordant treatments than those who were treated in psychiatric hospitals, with an OR of 1.84 (95% CI 1.44-2.36). Similarly, the patients with a mixed episode at study entry were more likely to receive guideline-disconcordant treatments than those with a manic episode, with an OR of 1.69 (95% CI 1.22-2.35). In contrast, the patients with a longer duration of disease (>5 years) were less likely to receive guideline-disconcordant treatments than those with a short duration, with an OR of 0.47 (95% CI 0.36-0.60).


In mainland China, the disconcordance with treatment guidelines for a most recent acute manic or mixed episode was modest under naturalistic conditions. The higher risk for disconcordance in general hospitals than in psychiatric hospitals suggests that special education based on treatment guidelines to practitioners in general hospitals is necessary in order to reduce the risk for disconcordant treatments.

Bipolar disorder; Mania; Pharmacotherapy; Treatment; Guidelines