{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:03:25Z","timestamp":1789988605464,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V113C\u2010213"],"award-info":[{"award-number":["V113C\u2010213"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["VGH\u2010V114C\u2010146"],"award-info":[{"award-number":["VGH\u2010V114C\u2010146"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113\u20102314\u2010B\u2010075\u2010039\u2010MY3"],"award-info":[{"award-number":["113\u20102314\u2010B\u2010075\u2010039\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["112\u20102314\u2010B\u2010075\u2010012"],"award-info":[{"award-number":["112\u20102314\u2010B\u2010075\u2010012"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Relapse after a first manic episode is common in bipolar I disorder and frequently leads to rehospitalization. Lithium and valproate, often prescribed with atypical antipsychotics, remain central to maintenance therapy; however, no randomized trials have directly compared these regimens in early\u2010course illness. This study compared lithium plus atypical antipsychotics (Li\u2009+\u2009AAPs) versus valproate plus atypical antipsychotics (Val\u2009+\u2009AAPs) for preventing bipolar\u2010related rehospitalizations after the first hospitalization for mania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a new\u2010user, propensity score\u2013matched cohort study of patients discharged after their first hospitalization for acute mania, using Taiwan's National Health Insurance claims data (2011\u20132022). Patients initiating Li\u2009+\u2009AAPs or Val\u2009+\u2009AAPs within 30\u2009days of discharge were followed for rehospitalization for any mood episode (manic, depressive, or mixed). Secondary outcomes included episode\u2010specific rehospitalization and annualized hospitalization rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3,909 matched patients (1397 Li\u2009+\u2009AAP and 2,512 Val\u2009+\u2009AAP; mean [SD] age, 42.4 [14.2] years; 42.9% male), Li\u2009+\u2009AAPs were associated with a higher risk of rehospitalization for any mood episode compared to Val\u2009+\u2009AAPs (hazard ratio [HR], 1.18; 95% CI, 1.03\u20131.35), primarily driven by manic relapse (HR, 1.16; 95% CI, 1.01\u20131.35). No significant differences were observed for depressive or mixed episodes. The annual rehospitalization rate for any mood episodes was also higher with Li\u2009+\u2009AAPs (incidence rate ratio, 1.34; 95% CI, 1.17\u20131.54).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this nationwide cohort of patients with first\u2010episode mania, Val\u2009+\u2009AAPs were associated with a lower risk of bipolar rehospitalization compared to Li\u2009+\u2009AAPs, suggesting potential early\u2010phase maintenance advantages of valproate combinations over lithium combinations following first mania discharge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bdi.70184","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:35:46Z","timestamp":1789986946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of Lithium\u2010 Vs. Valproate\u2010Based Combinations With Atypical Antipsychotics in Preventing Rehospitalization After a First Manic Episode of Bipolar I Disorder"],"prefix":"10.1111","volume":"28","author":[{"given":"Pei\u2010Ying","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2153-6632","authenticated-orcid":false,"given":"Meng\u2010Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7011-0323","authenticated-orcid":false,"given":"Jia\u2010Shyun","family":"Jeng","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3693-2669","authenticated-orcid":false,"given":"Tzu\u2010Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3105-7728","authenticated-orcid":false,"given":"Tung\u2010Ying","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4664-7536","authenticated-orcid":false,"given":"Yi\u2010Hsuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0841-8834","authenticated-orcid":false,"given":"Ying\u2010Jay","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"Department of Psychiatry, Faculty of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215\u20100366(15)00505\u20102"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.12"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40345\u2010022\u201000264\u20106"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)31544\u20100"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2020-0874"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.163.2.217"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.4088\/jcp.v64n0503"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12991\u2010020\u201000304\u20104"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.9758\/cpn.2017.15.3.248"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12609"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2023.103480"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105618.2011.00898.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.22136"},{"issue":"5","key":"e_1_2_11_15_1","first-page":"9","article-title":"Monotherapy Versus Combined Treatment With Second Generation Antipsychotics in Bipolar Disorder","volume":"69","author":"Ketter T. A.","year":"2008","journal-title":"Journal of Clinical Psychiatry"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000037270"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v66n0116"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510360044034"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S196293"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u20104733.2006.00159.x"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2019.04.003"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.03.054"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.3.257"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57060587"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7501"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H018"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/pcn.12145"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003196.pub2"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/YIC.0b013e328333ac1b"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/YIC.0b013e3282fd827c"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004714\u2010200004000\u201000012"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/00048674221077619"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2010.10.025"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1517\/17425255.2012.660918"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1159\/000449417"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213\u2010008\u20101221\u20109"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000001813"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/ph15010105"},{"issue":"6","key":"e_1_2_11_40_1","first-page":"515","article-title":"Long\u2010Term Treatment of Bipolar Disorder: How Should We Use Lithium Salts?","volume":"47","author":"Del Grande C.","year":"2012","journal-title":"Rivista di Psichiatria"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010018\u20101622\u20101"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.encep.2016.02.006"}],"container-title":["Bipolar Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bdi.70184","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bdi.70184","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bdi.70184","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:35:48Z","timestamp":1789986948000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bdi.70184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":41,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/bdi.70184"],"URL":"https:\/\/doi.org\/10.1111\/bdi.70184","archive":["Portico"],"relation":{},"ISSN":["1398-5647","1399-5618"],"issn-type":[{"value":"1398-5647","type":"print"},{"value":"1399-5618","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"assertion":[{"value":"2025-10-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70184"}}