Blood monitoring of mood stabilizers and antipsychotics in bipolar disorder

Background: Bipolar disorder (BD) is a lifelong episodic mental disorder that causes powerful mood swings. It is manageable through a variety of pharmacological interventions of mood stabilizers and antipsychotics, of which encompass several different adverse drug effects (ADEs) and have narrow therapeutic windows. Therefore, it is crucial to conduct routine blood monitoring based on standard international recommendations such as that of the National Institute of Clinical Excellence (NICE). Objectives and Rationale: To conduct an Audit that looks at long-term adherence of blood monitoring of mood Stabilizers and antipsychotics to NICE guidelines in the behavioural medicine department, Sultan Qaboos University Hospital (SQUH)to provide recommendations. Methods: Patients of all ages who were diagnosed with BD on antipsychotics and mood stabilizers were admitted to the Department of Behavioral Medicine for a period of 1 year were included. The data was collected retrospectively and compared to the NICE guidelines for blood monitoring. Results: A total of 249 BD patients met the inclusion criteria in the study. 219 of them were prescribed with Antipsychotics. Lipid, prolactin and glucose were measured only 9.1 %( 9), 29.7 %( 65) and 18.6 %( 40) respectively. 144 of thepatients were prescribed with Sodium Valproate. Complete Blood Count and Liver Function were measured only 31.7 % (97) and 32.6(45) respectively. 41 patients were prescribed with Lithium; urea, thyroid and plasma drug levels were measured 61.5 %( 24), 51.2 %( 21) and 57.5 %( 23) respectively. Finally, 12 patients were prescribed with Carbamazepine. Urea, CBC and Plasma drug levels were only measured 8.3 %( 1), 25 %( 3) and 8.3 %( 1) respectively. Conclusion: Blood monitoring of Mood Stabilizers and Antipsychotics in BD patients at SQUH falls below standards when compared to NICE guidelines. The findings could be due to several organizational and patient factors. Measures need to be taken and further audits need to be conducted to improve adherence to monitoring recommendations.