The aim of the current cross-sectional study was to estimate the prevalence of religious and spiritual (R/S) experiences and their perceived lasting influence in outpatients with bipolar disorder (BD; n = 196). A questionnaire with a range of R/S was constructed, building on the results of an earlier qualitative study. Experiences of horizontal transcendence (not necessarily referring to the divine) such as the experience of "intense happiness, love, peace, beauty, freedom" (77%) or "meaningful synchronicity" (66%) were the most prevalent. The experience of "divine presence" (vertical transcendence, referring to the divine) had a prevalence of 44%. Perceived lasting influence of the experiences was 20% to 67% of the total frequency, depending on the type. Most positive R/S experiences were significantly more related to BD I and mania, and on average, persons with BD I had more R/S experiences (mean = 4.5, SD = 2.6) than those with BD II (mean = 2.8, SD = 2.4, p = 0.000). Patient-reported R/S experiences in BD can have both R/S and pathological features.

BackgroundMost previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy. Few studies have included other treatment modalities.AimsTo study concordance with the Dutch guideline of various treatment modalities in outpatient treatment settings for patients with bipolar disorder and to identity factors associated with concordance.MethodsA nationwide non-interventional study using psychiatrists’ and patients’ surveys.Results839 patients with bipolar or schizoaffective disorder bipolar type were included. Concordance with the guideline was highest for participation of a psychiatrist in the treatment (98%) and for maintenance pharmacotherapy (96%), but lower for supportive treatment (73.5%), use of an emergency plan (70.6%), psychotherapy (52.2%), group psychoeducation (47.2%), and mood monitoring (47%). Presence of a written treatment plan, a more specialized treatment setting, more years of education, and diagnosis of bipolar I disorder versus bipolar II, bipolar NOS, or schizoaffective disorder were significantly associated with better concordance.ConclusionIn contrast to pharmacotherapy, psychosocial treatments are only implemented to a limited extend in everyday clinical practice in bipolar disorder. More effort is needed to implement non-pharmacological guideline recommendations for bipolar disorder.

BackgroundBipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands.Methods/designThe study concerns a two-armed cluster randomised clinical trial to evaluate the effectiveness of Collaborative Care (CC) in comparison with Care as usual (CAU) in outpatient clinics for bipolar disorder or mood disorders in general. Collaborative Care includes individually tailored interventions, aimed at personal goals set by the patient. The patient, his caregiver, the nurse and the psychiatrist all are part of the Collaborative Care team. Elements of the program are: contracting and shared decision making; psycho education; problem solving treatment; systematic relapse prevention; monitoring of outcomes and pharmacotherapy. Nurses coordinate the program. Nurses and psychiatrists in the intervention group will be trained in the intervention. The effects will be measured at baseline, 6 months and 12 months. Primary outcomes are psychosocial functioning, psychiatric symptoms, and quality of life. Caregiver outcomes are burden and satisfaction with care.DiscussionSeveral ways to enhance the quality of this study are described, as well as some limitations caused by the complexities of naturalistic treatment settings where not all influencing factors on an intervention and the outcomes can be controlled.Trial RegistrationThe Netherlands Trial Registry, NTR2600.

One point that emerges from qualitative research on religion and bipolar disorder (BD) is the problem patients with BD experience in distinguishing between genuine religious experiences and hyper-religiosity. However, clinical practice does not obviously address communication about differences in explanatory models for illness experiences. The aim of the current study is first to estimate the frequencies of different types of explanations (medical versus religious) for experiences perceived as religious and related to BD, second to explore how these types relate to diagnosis and religiousness, and third to explore the frequency of expectation of treatment for religiosity. In total, 196 adult patients at a specialist outpatient center for BD in the Netherlands completed a questionnaire consisting of seven types of explanations for religious experiences and several items on religiousness. Of the participants who had had religious experiences (66%), 46% viewed the experiences as 'part of spiritual development' and 42% as 'both spiritual and pathological,' 31% reported 'keeping distance from such experiences,' and 15% viewed them as 'only pathological.' Measures of religiousness were positively associated with 'part of spiritual development' and negatively associated with 'keeping distance from the experiences' and 'only pathological.' Half of the sample viewed religiosity as an important topic in treatment. It can be hypothesized that strength of religiousness may help people to integrate destabilizing experiences related to BD into their spiritual development. However, the ambiguity of strong religious involvement in BD necessitates careful exploration of the subject in clinical practice.

BackgroundWhile various guidelines on the treatment of bipolar disorder have been published over the last decades, adherence to guidelines has been reported to be low. In this article we describe the protocol of a nationwide, multicenter, longitudinal, non-intervention study on the treatment of bipolar disorder in the Netherlands. Study aims are to provide information on the nature and content of outpatient treatment of bipolar disorder, to determine to what extent treatment is in concordance with the Dutch guideline for the treatment of bipolar disorder (2008), and to investigate the relationship of guideline concordance with symptomatic and functional outcome.Methods/DesignBetween December 2009 and February 2010, all psychiatrists registered as member of the Dutch Psychiatric Association received a questionnaire with questions about their treatment setting, and whether they would be willing to participate in further research. Psychiatrists treating adult outpatients with bipolar disorder were invited to participate. Consenting psychiatrist subsequently approached all their patients with bipolar disorder. The study is performed with written patient and caregiver surveys at baseline and after 12 months, including data on demographics, illness characteristics, organization of care, treatments received, symptomatic and functional outcome, quality of life, and burden of care for informal caregivers.DiscussionThis study will provide information on the naturalistic treatment of bipolar disorder in the Netherlands, as well as degree of concordance of this treatment with the Dutch guideline, and its relationship with symptomatic and functional outcome. Limitations of a survey-based study are discussed.