Eleven cards out of 127: what Russian psychiatrists entered as the reason for changing bipolar treatment

• A non-interventional cross-sectional survey of prescribing decisions, published in Russian in a journal not indexed in PubMed. Full reference, so that it can be reached: Medvedev VE. Primenenie antipsikhotikov v real'noi klinicheskoi praktike v Rossii (po rezul'tatam programmy EPIDEMICUS); official English title, The use of antipsychotics in the real-world clinical practice in Russia (based on the results of the EPIDEMICUS program). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2025;17(1):24–33. DOI 10.14412/2074-2711-2025-1-24-33, published 16 February 2025; free full text at https://nnp.ima-press.net/nnp/article/download/2445/1771. Single author, Department of Psychiatry, Psychotherapy and Psychosomatic Pathology, RUDN University, Moscow. Psychiatrists in 21 Russian cities completed one registration card per outpatient at a single visit; no outcome was measured and no primary outcome was registered. 1,264 records, of which 411 carry a bipolar diagnosis: mean age 34.5 years, mean age at onset 28.7 years, mean illness duration 5.1 years, mean severity on the Clinical Global Impression scale 4.4.
• The mirror, and its denominators. Table 6 gives three reasons for changing treatment. Improvement of tolerability was entered in 70.5% of the schizophrenia records and in 8.7% of the bipolar ones; the need for stronger sedation in 67.3% and 33.1%; a stronger antipsychotic effect in 61.9% and 30.7%. The bipolar column is headed n=127, and 127 turns each printed percentage into a whole number of cards: 39, 42 and 11. So 8.7% is eleven cards out of 127. The schizophrenia column is headed n=287, which reproduces none of its three percentages; the denominator that does is 349, that is 228 replacements plus 121 additions from Table 5.
• Doses. The mean prescribed dose of quetiapine, published in the subgroup table of the 2023 report of the same programme, is 263.7±27.7 mg a day in bipolar disorder against 359.2±75.8 mg in schizophrenia; Table 2 of the 2025 article records a maximum of 800 mg a day on switching. Table 4 gives the frequency of a therapy change involving each drug as a share of the diagnostic group; for the 411 bipolar records every entry at 1.0% and above reads olanzapine 6.1%, haloperidol 3.9%, risperidone 3.4%, generic quetiapine 3.2%, chlorpromazine 2.4%, amitriptyline 2.2%, aripiprazole 1.7%, valproate 1.5%, lamotrigine 1.5%, bromdihydrochlorphenylbenzodiazepine 1.2%, lithium 1.0%, with carbamazepine 0.7% and gabapentin 0.5% below that. How many patients were taking each drug on entry is not reported, so these are rates of change and not rates of use.
• What the author calls his own main conclusion, Conclusion section, pages 31 to 32: a switch or augmentation of therapy is required by no less than a third of patients taking antipsychotics for various conditions; the causes may be errors of diagnosis or of drug choice as well as insufficient efficacy or poor tolerability; and quetiapine (Seroquel) is perceived by psychiatrists as a highly effective and well tolerated antipsychotic with a broad spectrum of action going beyond the official indications. His closing sentence adds that doctors' ideas about the antiresistant properties of the drug require confirmation in real clinical practice and in randomised trials. The article states that it is sponsored by NovaMedica; the second author of the 2023 report, I.G. Kuznetsova, is listed with the affiliation NovaMedica LLC, Moscow.

A switch or augmentation of therapy is required by no less than a third of patients taking antipsychotics, the author concludes on pages 31 to 32, and quetiapine is perceived by psychiatrists as a highly effective and well tolerated antipsychotic with a broad spectrum of action going beyond the official indications; his own closing sentence adds that doctors' ideas about the antiresistant properties of the drug require confirmation in real clinical practice and in randomised trials. The article is sponsored by NovaMedica, and a patient entered the programme only if the treating doctor had already decided on quetiapine.

The article states that it is sponsored by NovaMedica, and the second author of the 2023 report of the same programme, I.G. Kuznetsova, is listed with the affiliation NovaMedica LLC, Moscow. The drug is also the axis of the design: a patient entered only if the treating doctor had already decided to prescribe quetiapine or to switch the patient onto it, and prior intolerance of quetiapine was an exclusion criterion, so the structure of prescribing for bipolar disorder in Russia does not follow from this sample. Funding, conflict of interest and author contribution are merged into a single paragraph rather than declared separately, with the formula that the conflict of interests did not affect the results of the study; ethics committee approval appears in the 2023 report and not in this one; the period of data collection is stated in neither. There was one visit, no follow-up and no measured outcome, so nothing here describes whether any patient improved. Reasons were entered by the doctor, more than one could be marked for one patient, and Table 6 is not the full list, since Table 2 carries five reason columns and the 2023 report adds the choice of the original preparation over a generic in 459 observations (36%). Denominators shift between tables: 411 in the diagnostic and tactics tables, 127 in the bipolar column of the reasons table, 86 in the bipolar column of the syndrome table, and the schizophrenia column of the reasons table is headed 287 while its own percentages and the totals row require 349. Table 4 gives the frequency of a change involving each drug and not the frequency of its use, so the lithium value of 1.0% says nothing about how many patients were receiving lithium. The discrepancy between the 2023 and 2025 reports over how many generic-to-original switches occurred is left unused in either direction. Somatic comorbidity was recorded at low rates, hypertension 2%, cerebral ischaemia 0.6%, and diabetes, hypothyroidism and obesity 0.2% each; the 2023 report does not leave these unremarked but offers them, together with substance misuse in 1.8%, as a possible explanation for symptomatology it calls uncharacteristic of bipolar disorder, with schizoaffective disorder named as an alternative.