Collaborative care for patients with bipolar disorder: a randomised controlled trial

Abstract

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.

Collaborative care for patients with bipolar disorder: randomised controlled trial

“…These supervisory contacts were offered both individually by telephone and in group sessions in the treatment facility of the teams. A mean number of coaching contacts of 15.4 (range [11][12][13][14][15][16][17][18][19][20] was provided. Nurses in the TAU condition received no training, coaching or supervision.…”

Recognizing Depression, Anxiety, and Externalizing Behaviors in Children of a Parent with Mood Disorders: Weekly Symptom Monitoring in the Child Network

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Pioneering the Psychiatric Nurse Role in Foster Care

“…Literature has supported the use of psychiatric nurses to: (1)serve as knowledge brokers for health information, (2) provide case manager support, (3) provide medication management and/or oversight, (4) conduct health screening, and (5) provide education and advocacy training for youth, foster parents and caseworkers in order to increase the quality of care, satisfaction with services, and confidence in self-advocacy among service users (Bruskas, 2003; Galehouse, Herrick and Raphel, 2010; Gramkowski, et al, 2009; Hart, 2010; Kools, 1997; Kools & Kennedy, 2003; Pearson, 2013; Schneiderman, 2003; Schneiderman, 2004; Schneiderman, 2008; van der Voort et al, 2011). Psychiatric nurses are involved in relationship-building, education, and case consultation (American Psychiatric Nurses Association and International Society of Psychiatric and Mental Health Nurses, 2007).…”