Naturalistic evaluation of inpatient treatment of mania in a private Brazilian psychiatric hospital

OBJECTIVE: To describe the clinical practices on the treatment of mania in a Brazilian hospital, and to compare them to other international similar reports and practice guidelines. METHODS: Chart revision of 425 consecutive admissions (269 patients) for the treatment of manic or mixed episodes (ICD-10 criteria) in a private psychiatric hospital of Belo Horizonte, Brazil, from 1996 to 2000. The rates of utilization of each antimanic medication and ECT were compared to those reported in similar international observational studies (X², bicaudate, alpha =0.05). RESULTS: The observed frequencies of use of each treatment modality were: lithium (71.5%); carbamazepine (34.8%); valproate (9.4%); antipsychotics (83.3%); benzodiazepines (62.4%); antidepressants (7.5%) and ECT (33.2%). The differences detected between local practice and international guidelines were: lower rate of valproate and higher rate of carbamazepine prescription; the use of sine wave devices for ECT; frequent concomitant use of ECT with lithium (72.3%), benzodiazepines (46.8%) and/or carbamazepine (31.2%). CONCLUSION: These results suggest the need to develop national practice guidelines for the treatment of mania and for the use of ECT, and to promote their propagation through specific medical educational programs, aiming at the standardization of practices based on the available scientific evidence.