MONTRA est une enquête réalisée sur le territoire métropolitain entre 2010 et 2011 auprès de 439 psychiatres dont l’objectif a été de décrire les conditions de prise en charge de patients souffrant d’un trouble bipolaire (TB) en situation habituelle de pratique clinique. Ont été analysés 2529 dossiers de patients vus au cours de quatre journées de consultation (âge moyen, 47ans ; femmes, 58 % ; TB type I, 56 % ; TB type II, 40 %). Les patients ambulatoires (87 %, n=2210) étaient pour la plupart en phase euthymique (39 et 50 % des patients suivis respectivement en consultation publique ou libérale) ou en phase intercurrente avec des symptômes résiduels le plus souvent dépressifs (respectivement, 24 et 30 % des patients). Les patients hospitalisés (13 %, n=319) étaient tous symptomatiques et présentaient un épisode thymique aigu maniaque (25 %) ou dépressif (27 %), ou bien étaient en phase intercurrente avec des symptômes résiduels le plus souvent dépressifs (25 %). Tous les patients (100 %) recevaient un traitement médicamenteux du TB, prescrit le plus souvent en association (73 %) et comportant selon le statut clinique, un thymorégulateur, un antipsychotique atypique et/ou un antidépresseur. Une prise en charge non médicamenteuse était proposée chez 90 % des patients (principalement psychothérapie de soutien, 73 %). En conclusion dans cette enquête, la présentation clinique des patients symptomatiques était dominée par une polarité dépressive des symptômes et les psychiatres ont déclaré recourir plus fréquemment à une association médicamenteuse pour traiter les différentes phases du TB.

The objectives were to assess the characteristics of patients with bipolar disorder (BD) and to evaluate the prescribing practices.

MONTRA is a quantitative survey conducted between December 2010 and February 2011. Data were extracted by the psychiatrists from the medical files of BD patients seen on four consecutive days of consulting.

Four hundred and thirty-nine psychiatrists included 2529 patients (inpatients, n=319; outpatients from mental clinics, n=1090; outpatients consulting in private practice, n=1020). In the total patient population (mean age: 47 years; women, 58%), BD was distributed as follows: BD type I, 56%; BD type II, 40%; other types of BD, 4%; rapid cyclers, 10%. The prevalence of psychiatric comorbidities was high (anxiety disorders, 48%; abuse and dependence on toxic substances, 17 and 10% respectively), 36% of the patients had a history of suicide attempt and the risk of suicide, when assessed, was 6%. In about half the patients (48%), the polarity of the initial bipolar episode was of the depressive type (versus 39% for the manic/hypomanic type). Outpatients were globally independent and did not require assistance in the management of their disease or its treatment whereas the social and professional lives of inpatients were negatively affected by their condition. Based on the psychiatrist's declarations, 39 to 50% of the outpatients were symptom-free, 36 to 40% were in the intercurrent phase with residual symptoms, 11 to 17% presented either a manic or depressive acute BP episode, and 3 to 4% were in a mixed state; among inpatients, 52% presented an acute episode either manic or depressive, 38% were in the intercurrent phase and 9% were in a mixed state. In the symptomatic patients from the total population (61%), the most prevalent symptoms were depressive and corresponded to acute symptoms (patients with a depressive episode, 14%) or residual symptoms (patients in the intercurrent phase, 27%). The predominant depressive polarity was observed in both hospitalized and outpatients. The pharmacological treatment of BD included polytherapy in 73% of the patients. In the manic episodes (n=126), the patients were treated with a Mood Stabilizer (MS, 56%) or an atypical antipsychotic (AAP, 52%) in association. In the depressive episodes (n=342), the patients received an antidepressant drug associated with a MS or an AAP (70%). In symptom-free or symptomatic intercurrent periods (n=1943), the patients were treated with a MS (49–58%) or an AAP (37–49%), in association.

BD patients evaluated in our survey were in majority diagnosed with BD type I, associated with considerable comorbidity. In the symptomatic patients, the most prevalent symptoms, either acute or residual, were of the depressive type. In the majority of the patients, whatever the clinical status, polytherapy was prescribed for the BD.