Bipolar-specific disease management gives good returns

By Lucy Piper, Senior medwireNews Reporter

Diagnostic-specific management of bipolar II disorder is associated with significant clinical improvements, show findings that support the need for greater recognition of the condition.

“Our findings are… extremely encouraging in suggesting that diagnosing a bipolar disorder condition in patients previously diagnosed as having a unipolar mood or other disorder is associated with distinct improvement in their overall illness trajectory,” say the researchers, led by Gordon Parker (Prince of Wales Hospital, Sydney, Australia).

Most of the 157 patients who were told that they had bipolar disorder received the news well, with 93% accepting the diagnosis. A high proportion felt relieved and reassured, and viewed the diagnosis as important.

As a result of the diagnosis, disease management was changed, with clinicians recommending medication changes, maintenance or initiation of fish oil, mood charting, education about bipolar disorder, referral to or continuation with a psychologist, implementation of a well-being plan, and lifestyle changes.

In a 12-week evaluation involving 106 (68%) of the patients, clinicians judged 6% of patients to have recovered and 56% as experiencing distinctly fewer highs or lows. Only 9% had worse symptoms.

Among the patients, 68% considered their improvement to be moderate to significant, while 7% judged that their symptoms had worsened.

The patients showed significant improvement across five of six self-report quantitative measures, including the Overall Functioning Assessment and the Quick Inventory of Depressive Symptomatology. The only exception was on the Altman Self-Rating Mania Scale.

Of all the treatment strategies implemented, the introduction of a mood stabilizer – recommended for 87.9% of patients – had the greatest impact.

Multivariate analysis showed that receipt of the principal mood stabilizer increased the odds of improvement 4.7-fold. And the odds increased 10.5-fold among bipolar II disorder patients, specifically. The researchers acknowledge, however, that this marked improvement with mood-stabilizer initiation may be partly explained by the cessation of antidepressant treatment, but they were unable to measure this in their study.

Implementation of a well-being plan also increased the odds of improvement, by 2.6-fold for the whole group of patients and 5.4-fold in those with bipolar II disorder, whereas engaging in psychologic therapy and using fish oil had less of an impact.

“As treatment outcomes were measured only three months after initial consultation and the identification of a bipolar disorder – and when medication was likely to be the prioritized strategy – assessing the contributory impact of non-drug strategies to overall mood stabilization would likely demand a lengthier follow-up,” the researchers comment in Bipolar Disorders.

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