Clinical Practice Guidelines for Bipolar Disorder From the Department of Veterans Affairs

Bauer, Mark S.; Callahan, Ann M.; Jampala, Chowdary; Petty, Frederick; Sajatovic, Martha; Schaefer, Vicky; Wittlin, Byron J.; Powell, Barbara J.

doi:10.4088/jcp.v60n0104

Cited by 234 publications

(65 citation statements)

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“…While most studies agree that MxD has worse outcomes than non-MxD and is less responsive to, or even worsened by, common antidepressant treatments [24,25,26,27,28,29,30,31], one recent large study found that the likelihood of remission was greater in depressive patients with DSM-5 mixed features treated with antidepressants [32]. However, data on this topic are limited [7,33,34,35,36].…”

Section: Introductionmentioning

confidence: 99%

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Sani¹,

Napoletano

Vöhringer

et al. 2014

Psychother Psychosom

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Background: Mixed depression (MxD) is narrowly defined in the DSM-IV and somewhat broader in the DSM-5, although both exclude psychomotor agitation as a diagnostic criterion. This article proposes a clinical description for defining MxD, which emphasizes psychomotor excitation. Methods: Two hundred and nineteen consecutive outpatients were diagnosed with an MxD episode using criteria proposed by Koukopoulos et al. [Acta Psychiatr Scand 2007;115(suppl 433):50-57]; we here report their clinical features and antidepressant-related effects. Results: The most frequent MxD symptoms were: psychic agitation or inner tension (97%), absence of retardation (82%), dramatic description of suffering or weeping spells (53%), talkativeness (49%), and racing or crowded thoughts (48%). MxD was associated with antidepressants in 50.7% of patients, with similar frequency for tricyclic antidepressants (45%) versus selective serotonin reuptake inhibitors (38.5%). Positive predictors of antidepressant-associated MxD were bipolar disorder type II diagnosis, higher index depression severity, and higher age at index episode. Antipsychotic or no treatment was protective against antidepressant-associated MxD. Conclusions: MxD, defined as depression with excitatory symptoms, can be clinically identified, is common, occurs in both unipolar depression and bipolar disorder, and is frequently associated with antidepressant use. If replicated, this view of MxD could be considered a valid alternative to the DSM-5 criteria for depression with mixed features.

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Section: Introductionmentioning

confidence: 99%

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Sani¹,

Napoletano

Vöhringer

et al. 2014

Psychother Psychosom

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“…The guidelines placed ziprasidone also in the group of agents which are promising but would require further study. A similar set of guidelines, Clinical Practice Guidelines for Bipolar Disorder from the Department of Veterans Affairs, is also now outdated and was compiled before the SGAs were FDA approved and mention very little about SGA use overall (Bauer et al, 1999).…”

Section: Ziprasidone In Treatment Guidelinesmentioning

confidence: 99%

Ziprasidone in the Treatment of Bipolar Disorder

Schwartz

Stahl

Pappadopulos

et al. 2011

Bipolar Psychopharmacotherapy

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“…The medication measures were consistent with other pharmacotherapy guidelines for bipolar disorder published until year 2002 (6,19,20). Although the guidelines recommend maintenance treatment with lithium, valproate, or carbamazepine, we used a minimum threshold for these measures as a liberal estimate of quality-that is, whether or not individuals received at least one prescription.…”

Section: Quality Measuresmentioning

confidence: 99%

Changes in the Quality of Care for Bipolar I Disorder During the 1990s

Busch¹,

Ling²,

Frank³

et al. 2007

Psychiatric Services

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Objective-This study estimated changes during the 1990s in the quality of usual-care treatment among persons diagnosed as having bipolar I disorder in a privately insured population.Methods-Retrospective private insurance administrative data were analyzed for enrollees aged 18 to 64 who were diagnosed as having bipolar I disorder during 1991 (431 person-years), 1994 (598 person-years), and 1999 (600 person-years). Medication and psychotherapy quality indicators were derived from bipolar disorder expert guidelines published in 1994, which were consistent with guidelines published until year 2002.Results-The unadjusted prevalence of receiving any lithium, valproate, or carbamazepine improved over the study period (68 percent in 1991, 64 percent in 1994, and 77 percent in 1999), whereas, compared with 1991, receiving any antidepressant in the absence of lithium, valproate, or carbamazepine increased in 1994 and then declined in 1999 (13 percent in 1991, 23 percent in 1994, and 14 percent in 1999). The unadjusted prevalence of receiving any psychotherapy declined steadily and sharply (94 percent in 1991, 89 percent in 1994, and 69 percent in 1999). The unadjusted prevalence of receiving any lithium, valproate, or carbamazepine and therapy together declined over time (65 percent in 1991, 58 percent in 1994, and 54 percent in 1999). After the analyses adjusted for patient characteristics, these changes were significant from p<.01 to p<.001.Conclusions-The prevalence of receiving the pharmacotherapy recommended in the guidelines improved after guideline publication in 1994, whereas other quality measures that included receiving psychotherapy declined throughout the study period. These results suggest different psychotherapeutic modalities are under differing constraints under managed care, constraints that overpower consensus in the literature of quality practice. Policy makers should measure a variety of key therapeutic modalities when measuring quality in order to capture these differences.Bipolar disorder is chronic, recurring, disabling (1-4), and often deadly (5,6). It is estimated to have higher direct health care costs per person than diabetes, other general medical conditions, and major depression (7), as well as all other psychiatric illness in a privately insured population (8). Also, departures from evidenced-based treatment-such as delaying or not providing medications like lithium, valproate, or carbamazepine-have been associated with higher health care costs (9). Despite the significant personal, economic, and social consequences of bipolar disorder, the existing literature raises quality concerns ranging from accurate diagnosis (10) to appropriate pharmacotherapy (9,11,12) and adequate monitoring of lithium, valproate, or carbamazepine (13,14).Beginning in the 1990s the development of new pharmacotherapy and psychotherapy has improved the potential to effectively treat bipolar disorder. Treatment guidelines have reflected this growing evidence base. Concurrently, the 1990s saw an increase in the...

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Clinical Practice Guidelines for Bipolar Disorder From the Department of Veterans Affairs

Cited by 234 publications

References 0 publications

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Ziprasidone in the Treatment of Bipolar Disorder

Changes in the Quality of Care for Bipolar I Disorder During the 1990s

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