Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USA
Bibliographic record
Abstract
OBJECTIVES: This study aims to describe the utilization patterns of atypical antipsychotics (AA) among insured patients with bipolar I disorder in the USA. METHODS: We studied patients with bipolar I disorder who newly initiated an oral AA between 2002 and 2008. Utilization measures included adherence [medication possession ratio (MPR) ≥80%], persistence (gaps ≤15 days between refills and an absence of ≥30 days of continuous concomitant non-index AA use), non-compliance (16-29 day gaps with no evidence of switch/augmentation), and discontinuation of the index AA (≥30 days without index AA, no evidence of switch/augmentation). RESULTS: The study included 16 807 patients: mean age 43.3 years, 67.7% female. Overall, adherence to the index AA was low (8.3%; mean MPR = 0.2). Only 10.5% of the patients were persistent to index AA, another 13.6% were non-compliant, and 63.4% discontinued index AA with an average time to discontinuation of 66 days. A majority (69.5%) of the discontinued patients did not resume any antipsychotic therapy. Results were similar across insurance types and index AA. CONCLUSION: Adherence to and persistence with AA treatment were low in new users with bipolar I disorder. Most patients discontinued the index AA and did not restart any antipsychotic treatment. Future study should distinguish physician-directed discontinuation versus patient non-adherence.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".