A survey of prescribing practice of antipsychotic maintenance treatment for manic-depressive outpatients

Survey questionnaires were mailed to public hospital psychiatrists practising in a French region to obtain information on the manic-depressive outpatients they personally followed up. Data were collected on 222 manic-depressive outpatients managed by 43 separate psychiatrists. More than two thirds were receiving at least one antipsychotic, and 17% were prescribed a depot-neuroleptic. Predictors of antipsychotic prescription were a history of psychotic features (OR = 3.4; 95%CI 1.7-6.9), early age at onset (OR = 2.1; 95%CI 1.0-4.8) and low educational level (OR = 3.1; 95%CI 1.5-6.3). Similar predictors were found for depot-neuroleptic prescription. Although these indicate that the prescription of antipsychotic for manic-depressive outpatients is not random, only 14% of patients were receiving mood stabilizers only. Owing to the potential side effects of antipsychotics, the benefit-to-risk ratio of antipsychotic use in the maintenance treatment of manic-depressive patients has to be carefully taken into account.