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Cited by 43Bipolar Disorder and TreatmentPersonality Disorders and PsychopathologySchizophrenia research and treatment

Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders

Arvilommi, Petri, Suominen, Kirsi S., Mantere, Outi K., Leppämäki, Sami, Valtonen, Hanna, Isometsä, Erkki T.·2007·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.v68n0114
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Abstract

OBJECTIVE: To investigate the adequacy of pharmacotherapy received by psychiatric inpatients and outpatients with a research diagnosis of bipolar I or II disorder, including patients both with and without a clinical diagnosis of bipolar disorder. METHOD: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric inpatients and outpatients in 3 Finnish cities were systematically screened between January 1, 2002, and February 28, 2003, for bipolar I and II disorders using the Mood Disorder Questionnaire. By using SCID-I and -II interviews, 191 patients were diagnosed with bipolar disorder (90 bipolar I and 101 bipolar II). Information was collected on clinical history, diagnosis, and treatment. The adequacy of treatment received was evaluated. RESULTS: Of the 162 patients with previous bipolar disorder episodes, only 34 (20.9%) of all and 30 (55.5%) of those with a clinical diagnosis of bipolar disorder were using a mood stabilizer at onset of the index episode. Only 81 (42.4%) of all 191 patients and 76 (65.0%) of those diagnosed with bipolar disorder received adequate treatment for the acute index phase. The factor most strongly independently associated with adequate treatment was clinical diagnosis of bipolar disorder (OR = 25.34). In addition, rapid cycling (OR = 2.45), polyphasic index episode (OR = 2.41), or depressive index phase (OR = 3.36) independently predicted inadequate treatment. Outpatients received adequate treatment markedly less often than inpatients. CONCLUSIONS: Clinical diagnosis of bipolar disorder is by far the most important prerequisite for adequate treatment. Problems in treatment are associated mostly with outpatient settings, where adequacy of treatment of bipolar depression is a major concern. Lack of attention to the longitudinal course of illness is another major problem area.

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  • Antidepressant monotherapy for bipolar disorder may trigger rapid cycling, induce mania, or increase treatment resistance.

    “Antidepressant drug monotherapy for bipolar disorder may precipitate rapid cycling, induce mania, or increase treatment resistance [40].”

    From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [40]

  • Recognising and clinically diagnosing bipolar disorder is the most important prerequisite for adequate treatment.

    “The recognition and clinical diagnosis of bipolar disorder is by far the most important prerequisite for adequate treatment [40].”

    From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [40]

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Authors
Arvilommi, P., Suominen, K. S., Mantere, O. K., Leppämäki, S., Valtonen, H., & Isometsä, E. T.
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2007-01-15
Volume
68
Issue
01
Pages
102-110
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.v68n0114
OpenAlex
W2077534644
Cited by
43
References
42
Citations by year
2023: 1 · 2020: 1 · 2018: 2 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 5 · 2012: 4
FWCI
4.02
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar I disorder, bipolar II disorder, treatment adequacy, mood stabilizers, diagnosis, underdiagnosis, bipolar depression, rapid cycling, psychiatric inpatients, psychiatric outpatients, Mood Disorder Questionnaire
MeSH terms
Adult, Antidepressive Agents, Bipolar Disorder, Female, Finland, Health Surveys, Humans, Male, Practice Patterns, Physicians', Retrospective Studies, Antipsychotic Agents

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