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Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial

  • Lars Vedel Kessing (a1), Hanne Vibe Hansen (a1), Anne Hvenegaard (a2), Ellen Margrethe Christensen (a3), Henrik Dam (a3), Christian Gluud (a4), Jørn Wetterslev (a4) and The Early Intervention Affective Disorders (EIA) Trial Group...
Abstract
Background

Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder.

Aims

To assess the effect of treatment in a specialised out-patient mood disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder.

Method

Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register.

Results

A total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37–0.97, P=0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care.

Conclusions

Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.

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Copyright
Corresponding author
Lars Vedel Kessing, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK 2100 Copenhagen Ø, Denmark. Email: lars.vedel.kessing@regionh.dk
Footnotes
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See editorial, pp. 170-171, this issue.

Declaration of interest

L.V.K. has been a consultant for Bristol-Myers Squibb, Eli Lilly, Lundbeck, AstraZeneca, Pfizer, Wyeth, Servier, and Janssen-Cilag.

Footnotes
References
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1 Kessing, LV, Hansen, MG, Andersen, PK. Course of illness in depressive and bipolar disorders. Naturalistic study, 1994-1999. Br J Psychiatry 2004; 185: 372–7.
2 Kessing, LV, Hansen, MG, Andersen, PK, Angst, J. The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders -a life-long perspective. Acta Psychiatr Scand 2004; 109: 339–44.
3 Tohen, M, Hennen, J, Zarate, CM Jr, Baldessarini, RJ, Strakowski, SM, Stoll, AL, et al Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry 2000; 157: 220–8.
4 Torres, IJ, Boudreau, VG, Yatham, LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 2007; 434: 1726.
5 Kessing, LV, Nilsson, FM. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses. J Affect Disord 2003; 73: 261–9.
6 Geddes, JR, Goodwin, GM, Rendell, J, Azorin, JM, Cipriani, A, Ostacher, MJ, et al Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 2010; 375: 385–95.
7 Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Goikolea, JM, Benabarre, A, et al A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60: 402–7.
8 Kessing, LV, Sondergard, L, Kvist, K, Andersen, PK. Adherence to lithium in naturalistic settings: results from a nationwide pharmacoepidemiological study. Bipolar Disord 2007; 9: 730–6.
9 Macneil, CA, Hallam, K, Conus, P, Henry, L, Kader, L, Berk, M. Are we missing opportunities for early intervention in bipolar disorder? Expert Rev Neurother 2012; 12: 57.
10 Macneil, CA, Hasty, MK, Berk, M, Henry, L, Evans, M, Redlich, C, et al Psychological needs of adolescents in the early phase of bipolar disorder; implications for early intervention. Early mterv Psychiatry 2011; 5: 100–7.
11 Nierenberg, AA, Ostacher, MJ, Borrelli, DJ, losifescu, DV, Perlis, RH, Desrosiers, A, et al The integration of measurement and management for the treatment of bipolar disorder: a STEP-BD model of collaborative care in psychiatry. J Clin Psychiatry 2006; 67 (suppl 11): 37.
12 Colom, F, Berk, L. Psychoeducation as a core element of psychological approaches for bipolar disorder, in Bipolar Disorder: Clinical and Neurobiological Foundations (eds Yatham, LN, Maj, M): 412–21. John Wiley & Sons, 2010.
13 Post, RM, Leverich, GS, Kupka, RW, Keck, PE Jr, McElroy, SL, Altshuler, LL, et al Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. J Clin Psychiatry 2010; 71: 864–72.
14 Rosa, AR, Gonzalez-Ortega, I, Gonzalez-Pinto, A, Echeburúa, E, Comes, M, Martínez-Àran, A, et al One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatr Scand 2012; 125: 335–41.
15 Rosa, AR, Reinares, M, Amann, B, Popovic, D, Franco, C, Comes, M, et al Six-month functional outcome of a bipolar disorder cohort in the context of a specialized-care program. Bipolar Disord 2011; 13: 679–86.
16 Post, RM, Fleming, J, Kapczinski, F. Neurobiological correlates of illness progression in the recurrent affective disorders. J Psychiatr Res 2012; 46: 561–73.
17 Kessing, LV, Hellmund, G, Andersen, PK. Predictors of excellent response to lithium: results from a nationwide register-based study. Int Clin Psychopharmacol 2011; 26: 323–8.
18 Manji, HK, Moore, GJ, Chen, G. Clinical and preclinical evidence for the neurotrophic effects of mood stabilizers: implications for the pathophysiology and treatment of manic-depressive illness. Biol Psychiatry 2000; 48: 740–54.
19 Fountoulakis, KN, Vieta, E, Bouras, C, Notaridis, G, Giannakopoulos, P, Kaprinis, G, et al A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic? Int J Neuropsychopharmacol 2008; 11: 269–87.
20 Berk, M, Hallam, K, Lucas, N, Hasty, M, McNeil, CA, Conus, P, et al Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust 2007; 187: S114.
21 Macneil, CA, Hasty, M, Cotton, S, Berk, M, Hallam, K, Kader, L, et al Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study. Early Intetv Psychiatry 2012; 6: 380–8.
22 Vieta, E. Bipolar units and programmes: are they really needed? World Psychiatry 2011; 10: 152.
23 Zwarenstein, M, Treweek, S, Gagnier, JJ, Altman, DG, Tunis, S, Haynes, B, et al Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008; 337: a2390.
24 Kessing, LV, Hansen, HV, Christensen, EM, Dam, H, Gluud, C, Wetterslev, J. The effects of centralised and specialised combined pharmacological and psychological intervention compared with decentralised and non-specialised treatment in the early course of severe unipolar and bipolar affective disorders-design of two randomised clinical trials. Trials 2011; 12: 32.
25 World Health Organization. Klassifikation af sygdomme. Systematisk Del [international Statistical Classification of Diseases and Health Related Problems (10th rev, Danish edn)]. Munksgaard, 1993.
26 Goodwin, GM. Evidence-based guidelines for treating bipolar disorder: revised second edition - recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2009; 23: 346–88.
27 Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978; 133: 429–35.
28 Hamilton, M. Development of a rating scale for primary depressive illness. Br J Clin Psychol 1967; 6: 278–96.
29 Munk-Jorgensen, P, Mortensen, PB. The Danish Psychiatric Central Register. Dan Med Bull 1997; 44: 82–4.
30 Olsen, LR, Jensen, DV, Noerholm, V, Martiny, K, Bech, P. The internal and external validity of the Major Depression inventory in measuring severity of depressive states. Psychol Med 2003; 33: 351–6.
31 Hirschfeld, RM, Williams, JB, Spitzer, RL, Calabrese, JR, Flynn, L, Keck, PE Jr, et al Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry 2000; 157: 1873–5.
32 Kessing, LV, Hansen, HV, Ruggeri, M, Bech, P. Satisfaction with treatment among patients with depressive and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 148–55.
33 Kessing, LV, Hansen, HV, Hougaard, E, Hvenegaard, A, Albæk, J. Preventive Outpatient Treatment in Affective Disorders. Results from a Health Tecnology Assessment (HTA). National Board of Health, Danish Centre for Evaluation and Health Tecnology Assessment, 2006.
34 Danish Ministry of Health. Rate Guidance 2012. Danish Ministry of Health, 2012 (http://www.sum.dk).
35 Kessing, LV. Recurrence in affective disorder. II. Effect of age and gender. Br J Psychiatry 1998; 172: 2934.
36 Munk-Jorgensen, P, Mortensen, PB. The Danish Psychiatric Central Register. Dan Med Bull 1997; 44: 82–4.
37 Danish National Board of Health (Sundhedsstyrelsen). Cause of Death in Denmark. Sundhedsstyrelsen, 1992.
38 Khalsa, HM, Salvatore, P, Hennen, J, Baethge, C, Tohen, M, Baldessarini, RJ. Suicidal events and accidents in 216 first-episode bipolar I disorder patients: predictive factors. J Affect Disord 2008; 106: 179–84.
39 Perugi, G, Micheli, C, Akiskal, HS, Madaro, D, Socci, C, Quilici, C, et al Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients. Compr Psychiatry 2000; 41: 13–8.
40 Kessing, LV. Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10. J Affect Disord 2005; 85: 293–9.
41 Goodwin, FK, Jamison, KR. Manic Depressive illness. Bipolar Disorder and Recurrent Depression (2nd edn). Oxford University Press, 2007.
42 Kessing, LV. Validity of diagnoses and other register data in patients with affective disorder. Eur Psychiatry 1998; 13: 392–8.
43 Burns, T. End of the road for treatment-as-usual studies? Br J Psychiatry 2009; 195: 56.
44 Gupta, RD, Guest, JF. Annual cost of bipolar disorder to UK society. Br J Psychiatry 2002; 180: 227–33.
45 Scott, J, Colom, F, Popova, E, Benabarre, A, Cruz, N, Valenti, M, et al Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. J Clin Psychiatry 2009; 70: 378–86.
46 Colom, F, Vieta, E, Sánchez-Moreno, J, Palomino-Otiniano, R, Reinares, M, Goikolea, JM, et al Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009; 194: 260–5.
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Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial

  • Lars Vedel Kessing (a1), Hanne Vibe Hansen (a1), Anne Hvenegaard (a2), Ellen Margrethe Christensen (a3), Henrik Dam (a3), Christian Gluud (a4), Jørn Wetterslev (a4) and The Early Intervention Affective Disorders (EIA) Trial Group...
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eLetters

Re: Treatment in a specialised out patient mood disorder clinic v standard out-patient treatment in bipolar disorder

Architha P. Srinivasan, Medical Student
01 July 2013

The recent publication on "Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early courseof bipolar disorder: randomised controlled trial"1 was an interesting read. However, the likelihood of the findings being useful in a setting outside Denmark could reduce the paper's relevance to the international audience. Firstly, the vast difference between the type of treatment received by patients in the mood disorder clinic (MDC) and the standard outpatient treatment units (SOPT) makes it almost impossible to identify the featuresof the MDC that makes it successful, such that they may be replicated to improve service elsewhere. While the authors go into significant detail with regards to the type of treatment and support received by the patientsin the MDC, there is very little information on the patients who went through SOPT. If SOPT is an appointment with GP or a private psychiatrist without any support from the community mental health teams then generalising the results to UK might be problematic as these patients would normally be with the community mental health teams with some or other type of enhanced care programme approach. Secondly, when refusal rates are as high as the authors mentioned in this article - out of 474 eligible patients only 158 participated in the trial - a judgement must be made as to how far the volunteers that remain can beconsidered representative of the target population. They might, for example, in this study be younger on average than the refusers. Is this important in relation to the study question?Thirdly, the authors refer to psychopharmacological treatments in SOPT being 'more likely to be based on the preferences of the individual physician than on national and international guidelines'; however, they make no effort to control or correct for these factors in the analysis of results, although it has been recognised that patients from the MDC are more likely to use mood stabilisers. Finally, the cost difference between the SOPT and MDC is mainly due to thein-patient costs for patients within SOPT. This again highlights the need for adjusting the effect of medications and this would have at the least given us some better understanding about the pharmacological treatment being offered within the SOPT!

References1.Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, etal. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry 2013; 202: 212-9.

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Conflict of interest: None declared

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