Antipsychotics Plus Lithium Reduced Hospital Stay for Bipolar Manic Episodes

In this study, patients were assessed for hospital stay on the basis of treatment regimen.

The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.


Patients treated with a combinatorial therapy of lithium and antipsychotics for bipolar disorder had shorter hospital stays during manic episodes. These findings were presented during the American Psychiatric Association annual meeting held virtually May 1 to 3, 2021.

Data were sourced from the National Inpatient Sample for patients (N=1435) with bipolar manic episodes who were treated with lithium in the United States. Patients were assessed for hospital stay on the basis of treatment regimen.

A third of patients (34.5%) were receiving a combinatorial therapy of antipsychotics (eg, haloperidol, olanzapine, risperidone, quetiapine) with the mood stabilizer lithium.

Stratified by treatment, no significant difference in age or gender was observed, but more patients on the combinatorial therapy were above the 75th percentile of familial income (56.4%) and covered with private insurance (47.5%). Compared with White patients, non-White Hispanic (odds ratio [OR], 2.3; 95% CI, 1.49-3.57) and Black (OR, 2.0; 95% CI, 1.43-2.82) patients were more likely to be treated with the combinatorial therapy.

Patients who were on a combinatorial therapy had a shorter hospital stay for the treatment of a manic episode by 2.8 (95% CI, 1.13-4.53) days from 14.3±18.25 to 11.5±8.57 days (P =.001).

The decreased length of stay during hospitalization corresponded with a reduction of hospital charges from $38,555±$81,877 to $41,560±$29,213, although the charges were not significantly different (mean difference, -$3004; 95% CI, -$11,629 to $5261; P =.495).

Despite the fact data were sourced from a nationwide database, this study was underpowered due to its low sample size.

These data indicated that a combinatorial therapy of antipsychotics with a mood stabilizer was effective at reducing length of hospital stay during a manic episode among patients with bipolar disorder. The study authors highlighted the fact that the combinatorial therapy, although shown to be 20% more effective, was less well tolerated than lithium alone and may not be a suitable treatment for some patients.

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Lee HK, Patel RS. Adding antipsychotics with lithium reduces hospitalization stay in bipolar manic episodes. Presented at: APA annual meeting May 1-3, 2021. Abstract/Poster: 4017