Differential Prescription of Maintenance Antipsychotics to African American and White Patients With New-Onset Bipolar Disorder

Background: Antipsychotic medications are commonly prescribed as maintenance pharmacotherapy for patients with bipolar disorder. However, double-blind, placebo-controlled studies have yet to demonstrate a significant prophylactic effect of maintenance antipsychotic use in bipolar disorder, and long-term use of antipsychotics may place the patient at risk for neuroleptic-induced tardive dyskinesia. African American patients may be at increased risk because excess antipsychotic prescription appears to be common in this population, although this issue has not been longitudinally studied in bipolar disorder.

Method: Fifty-eight patients meeting DSM-IV criteria for bipolar I disorder, with manic or mixed episode, were recruited at the time they were admitted for a first psychiatric hospitalization and then received longitudinal follow-up for up to 2 years. Comparisons were made between African American (N=24) and white (N=34) patients in medications prescribed and medication compliance after controlling for differences in clinical course.

Results: The African American and white patient groups were similar demographically. After controlling for differences in clinical course, African Americans, compared with white patients, (1) received antipsychotics for a significantly greater percentage of follow-up time (F=7.9, df=1,52; p<.007), (2) were more likely to receive antipsychotics during periods without psychotic symptoms, and (3) were significantly more likely to receive conventional antipsychotics (chi²=4.0, df=1, p<.05). African Americans also demonstrated poorer treatment adherence, although that finding did not explain the differences in antipsychotic prescription.

Conclusion: Even when demographically similar to white patients, African Americans with bipolar disorder may be more likely to receive maintenance antipsychotic treatment. The specific reasons for this finding are not clear, suggesting that studies are warranted that examine clinicians’ rationale for differentially prescribing antipsychotics for African American and white patients during the early course of bipolar disorder.