European psychiatrists' approaches to the treatment of bipolar disorder

The European Psychiatric Association (EPA) undertook a study to investigate treatment preferences of European psychiatrists towards Bipolar Disorder (BD), as part of the Ambassador programme series of surveys.

We conducted a cross-sectional online survey among psychiatrists and psychiatry trainees from 40 European countries. The questionnaire contained clinical vignettes of different phases of BD including manic, rapid cycling, mixed, hypomanic, and depressive episodes, for both initial and subsequent treatment strategies.

The final sample consisted of 654 participants, from Central and Eastern Europe (CEE), Southern Europe (SE), Northern Europe (NE), and Western Europe (WE). The majority preferred pharmacotherapy, most commonly as a combination of two or three drugs to treat all phases of the BD, with lithium being the most preferred option in all phases.Among antipsychotics, olanzapine and quetiapine were the most commonly chosen. Antidepressants were applied in almost 20% of responses for the depressive phase. Psychosocial interventions were not systematically implemented, particularly during manic and mixed episodes, but when recommended, the most common approaches included psychoeducation, cognitive behavioural therapy (CBT) in up to 40% in depressive phase, and lifestyle recommendations. However, latent class analysis identified four different classes of prescribers.

Psychiatrists showed broadly similar pharmacological treatment preferences for BD, with frequent use of lithium-based combination therapies and limited implementation of psychosocial interventions, although latent class analysis revealed distinct prescribing profiles. These findings support the need for enhanced dissemination of evidence-based guidelines and greater integration of psychosocial approaches in BD care.