Abstract
Objective: Bipolar disorder (BD) is one of the leading causes of disability among medical and psychiatric disorders associated with prevalent, chronic, severe and highly disabling characteristics. This study was designed to identify clinical characteristics and practice patterns in the management of outpatients with BD across Turkey. Methods: This multi-center cross-sectional study involving 1001 patients diagnosed with using DSM-IV criteria was conducted prospectively at 31 outpatient psychiatry clinics for 12 months. Patient demographics, clinical features, family history, comorbid psychiatric disorders, and the treatment modalities were assessed by means of semi-structured questionnaire.
Results: Age at the onset of symptoms was 26.7±9.8 years, age at diagnosis was 28.9±10.4 years, and the time interval between them was 2.2 (4.7) years. Misdiagnosis prior to current diagnosis was evident in 40.3% of bipolar patients. The most common type of first episode was mania (57.1%) and depression (34.5%). Comorbid psychiatric illness was identified in 12.0% of patients. Only 10% of patients were receiving monotherapy. The most commonly prescribed drugs for depressive, manic and mixed episodes were lithium, sodium valproate and quetiapine, respectively. Conclusion: The time interval between onset of symptoms and the initial diagnosis in Turkish sample was quite shorter than reported in the literature. The misdiagnosis rate in the present study and recent studies were similar. A low comorbidity rate appears to indicate a lower prevalence of comorbid disorders in BD in Turkish sample. Lithium, sodium valproate and atypical antipsychotics were more commonly used drugs in the treatment of BD in Turkey.

Key words: Clinical practice pattern, bipolar disorder, disease management, medical practice, Turkey

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Türkiye’de bipolar bozukluðun ele alýnmasýnda pratik uygulamalar ve hasta özelliklerinin kesitsel incelenmesi

Ozet
Amaç: Bipolar bozukluk (BB), týbbi ve ruhsal bozukluklar arasýnda önemli yeti yitimine yol açan yaygýn, kronik bir hastalýktýr. Bu çalýþma Türkiye’de ayaktan izlenen hastalarýn klinik özellikleri ve pratik örüntülerini belirlemek amacýyla planlanmýþtýr. Yöntem: Çok merkezli kesitsel olan bu çalýþmaya 12 ay içinde ayaktan psikiyatri hizmetleri veren 31 kliniðe baþvuran DSM-IV ölçütlerine göre taný konan 1001 hasta alýnmýþtýr. Hastalarýn demografik, klinik özellik, aile öyküsü, eþlik eden ruhsal bozukluklar ve tedavi modaliteleri yarý yapýlandýrýlmýþ bir anketle deðerlendirilmiþtir. Bulgular: Bozukluðun baþlangýç yaþý 26.7±9.8, taný aldýðý yaþ 28.9±10.4 ve ikisinin arasýndaki süre 2.2±4.7 yýldýr. Þu anki tanýdan önce yanlýþ taný konma oraný %40.3’tür. En sýk ilk nöbet tipi mani (%57.1) ve depresyondur (%34.5). Eþlik eden ruhsal bozukluk hastalarýn %12’sinde saptanmýþtýr. Hastalarýn yalnýz %10’u monoterapi almaktadýr. En sýk reçete edilen ilaçlar depresif, manik ve karma nöbetler için sýrasýyla lityum, sodyum valproat ve ketiyapindir. Sonuç: Türkiye’deki örneklemde belirtilerin baþlangýcý ve ilk taný konma arasýndaki süre daha önce yapýlan çalýþmalarda bildirilen sürelerden kýsadýr. Yanlýþ taný konma oranlarý daha önce yapýlan çalýþmalarla benzerdir. Eþlik eden ruhsal bozukluk oranýnýn düþük çýkmasý Türk toplumu örnekleminde eþlik eden ruhsal bozukluk yaygýnlýðýnýn düþük olmasý ile iliþkilidir. Lityum, sodyum valproat ve atipik antipsikotikler Türkiye’de en sýk kullanýlan ilaç tedavilerdir.

Anahtar Kelimeler: Klinik pratik, bipolar bozukluk, hastalýðýn ele alýnmasý, týbbi pratik, Türkiye