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(To be filled only by physician)

A retrospective cross-sectional, observational survey study to analyse role of Quetiapine in the treatment of acute manic episode associated with bipolar disorder.

Inclusion criteria:

Patients of acute manic episode associated with bipolar disorder on Quetiapine.

DEMOGRAPHIC DATA

Initials*

Serial No.*

Age (yr) *

Weight (kgs)*

Gender *

Male Female

Marital status *

Single Married

Name of clinic/hospital*

Date of data collection*

DETAILS OF DIAGNOSIS AND TREATMENT

Comorbidities, if Yes

Conditions	YES or NO	Year	Months
Obesity
Type ll Diabetes
Cardiovascular disease
Anxiety
Migraine
Thyroid illness
Attention-deficit hyperactivity disorder
Mention others if any

Reasons for choosing Quetiapine*

Kindly tick the potential reasons for choosing in this patient

Maintenance therapy

Higher response rate

Lower relapse rate

Presence of Co-morbidities

Lower risk of EPS

Lower risk of Hyperprolactinemia

Patient acceptance

Better compliance

Better quality of lifes

Concomitant medication, if any

Sr. No	Generic Name	Route & Dose	Duration (months)
1
2
3
4
5

Any other comments