Mood disorder clinics improve bipolar disorder outcomes

By Lucy Piper, Senior medwireNews Reporter

Early treatment of patients with bipolar disorder in a specialized mood disorder clinic substantially reduces the risk for readmission to a psychiatric hospital, clinical trial findings show.

Such treatment significantly reduced the risk for readmission over an average 2.5-year period by 40% compared with standard treatment, say Lars Vedel Kessing (Copenhagen University Hospital, Denmark) and colleagues.

"The main advantage of specialised mood disorder clinics is that focused treatment programs combining updated evidence-based pharmacological treatment with group psychological interventions such as group psychoeducation can be provided by a cross-disciplinary team of professionals that are specialised and scientifically up to date about bipolar disorder," they comment.

A total of 158 patients with an ICD-10 diagnosis of a manic episode or bipolar disorder being discharged from psychiatric hospital for the first, second or third time were randomly assigned to receive treatment in a mood disorder clinic or standard care.

Treatment of 72 patients in the mood disorder clinic combined evidence-based pharmacologic treatment with group psychoeducation once a week for 12 weeks, followed by three additional booster sessions. By comparison, the remaining 86 patients received treatment by a primary care physician, a private psychiatrist, or at the local community mental health center.

Patients attending the mood disorder clinic were less likely to be readmitted to hospital in the 0-6 years following discharge from the clinic, at a rate of 36.1% versus 54.7%. The duration of first readmission and all readmissions cumulatively were also shorter if patients had attended the mood disorder clinic, at a median of 12 versus 22 days and 33 versus 49 days, respectively.

Mood stabilizer and antipsychotic treatment was more often used by patients in the mood disorder clinic group and their satisfaction with treatment was greater when compared with those in the standard care group.

The researchers note in The British Journal of Psychiatry that the effect of the program offered at the mood disorder clinic extended beyond discharge from the clinic, with the difference in the rate of readmission to hospital continuing to increase after the 2-year treatment period.

They conclude: "It is possible with early and sustained pharmacological and psychological treatment, like that offered in a mood disorder clinic, to improve the long-term course of illness in bipolar disorder.

"These findings suggest that more focus should be put on early out-patient intervention among patients with severe mania/bipolar disorder."

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