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Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

  • Claudia Murton (a1), Michael Cooper (a1), Stephen Dinniss (a1), Shon Roberts (a1), Nicola Booth (a1) and Paul Newell (a2)...
Abstract
Aims and method

To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this.

Results

We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P < 0.0001.

Clinical implications

A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Claudia Anna Claire Murton (claudia.murton@cft.cornwall.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
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Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

  • Claudia Murton (a1), Michael Cooper (a1), Stephen Dinniss (a1), Shon Roberts (a1), Nicola Booth (a1) and Paul Newell (a2)...
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eLetters

Re: Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

Akintunde O Alabi, Psychiatry Trainee
11 February 2015

We read the very interesting article by Murton et al (1) and found the evidence for Acute RelapsePrevention (ARP) contributing towards reduced informal and formaladmissions was quite persuasive. We felt it might have been useful if the data had included differences between the pre-ARP cohort and the post-ARP cohort in terms of some other factors which are associatedwith relapse, such as stressful life events (2), compliance with medications when stable and so on.

The study examined the pre-ARP period between 2002 and 2007 and the post-ARP period up to 2011, a period when some important changes in the Mental Health Act were implemented, in particular Community Treatment Orders (CTOs), which came into place in 2008 (3). Even though there has been insufficient evidence demonstrating the benefits of CTOs in preventing readmissions (4), as clinicians we feel that the CTO provides a framework to ensure speedy management of certain situations. This may have influenced the results of this study as persons on structured care plans as part of a CTO may be more likely to comply and hence have a lower chance of relapse needing admission. We wonder how many persons in the sample were on a CTO and whether this could have influenced the overall results.

References: 1. Murton C, Cooper M, Dinniss S, Roberts S, Booth N, and Newell P. Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?BJPsych Bulletin 2014; 38: 276-280

2. Altman S, Haeri S, Cohen LJ, Ten A, Barron E, Galynker II, Duhamel KN(2006): Predictors of relapse in bipolar disorder: A review. J Psychiatr12(5):269-82.

3. Mental Health Act 2007 [Online]. [Accessed 21 December 2014]. Available from : http://www.legislation.gov.uk/ukpga/2007/12/pdfs/ukpga_20070012_en.pdf

4. Burns T, Rugkasa J, Molodynski A, Dawson J, Yeeles K, Vazquez-Montes M, Voysey M, Sinclair J, Priebe S(2013): Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. The Lancet381(9878):1627-1633.

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Conflict of interest: None declared

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