Abordaje clínico y terapéutico del trastorno bipolar en España: una encuesta nacional

Abstract

Introduction

Bipolar disorder is characterized by heterogeneous clinical manifestations, which complicate its diagnosis and treatment. Despite the availability of evidence-based guidelines, their application is limited. This study analyzes the clinical and therapeutic approaches adopted by professionals involved in its management in Spain.

Methods

A 50-item, anonymous and voluntary self-administered survey of 83 psychiatrists was carried out. Diagnostic, clinical and therapeutic aspects were addressed.

Results

90% of the psychiatrists stated that they followed clinical guidelines, but gave priority to their personal experience when choosing the treatment. Forty-six percent never used psychometric scales. Mixed episodes were considered the most difficult to treat and depressive episodes were considered to have the greatest functional impact. Lithium was the most commonly used stabilizer in type I bipolar disorder, and antipsychotics in type II. Forty-two percent avoided prescribing lithium in patients over 65 years of age. Valproate was prescribed to women of childbearing age by 30%. Quetiapine was the most commonly used antipsychotic in maintenance and bipolar depression. Confidence in therapeutic adherence was low. Electroconvulsive therapy was considered an effective alternative by 48% and transcranial magnetic stimulation by 11%. Almost half did not perceive a significant impact of suicide prevention and stigma reduction campaigns.

Conclusions

The study highlights consensus and discrepancies in the approach to bipolar disorder, evidencing variability in prescription patterns. It highlights the relevance of continuous training and the need to promote greater adherence to clinical guidelines.