Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice

Abstract

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.

A nationwide study on concordance with multimodal treatment guidelines in bipolar disorder

“…The Treatment of Bipolar Disorder in the Netherlands study (TBDN) is a nationwide, multicenter, non-intervention study on concordance with guideline recommendations for the long-term treatment of BD and SZA in mental health outpatient treatment settings (Renes et al 2014 ). The study was performed between December 2009 and June 2014.…”

Attitudes towards pharmacotherapy in late-life bipolar disorder

“…weight gain) (Dols et al, 2013). This has contributed to less than 8% lithium prescription rates of bipolar disorder in North American patients (Carney and Goodwin, 2005) compared to 30%-55% rates seen in Europe and worldwide (Hayes et al, 2011;Kessing et al, 2011;Renes et al, 2014). This has contributed to less than 8% lithium prescription rates of bipolar disorder in North American patients (Carney and Goodwin, 2005) compared to 30%-55% rates seen in Europe and worldwide (Hayes et al, 2011;Kessing et al, 2011;Renes et al, 2014).…”

“…Still, the general opinion about lithium is negative amongst clinicians (Strejilevich et al , 2011). This has contributed to less than 8% lithium prescription rates of bipolar disorder in North American patients (Carney and Goodwin, 2005) compared to 30%–55% rates seen in Europe and worldwide (Hayes et al , 2011; Kessing et al , 2011; Renes et al , 2014). Because of the importance of the therapeutic alliance and clinicians’ support in maintaining patients’ positive attitudes towards bipolar treatment (Pompili et al , 2013; Chang et al , 2014), clinicians’ negative attitudes could translate into poor patient attitudes towards lithium.…”

Response to Lithium in Patients with Bipolar Disorder: What are Psychiatrists’ Experiences and Practices Compared to Literature Review?

“…These results were also compared to the current state of the literature. To our knowledge, this study is the first on this subject, although studies on clinical practices of psychiatrists and treatment guidelines in mood disorders have been published [16,17]. Our results revealed the lack of consensus among psychiatrists in general concerning both the definition of prophylactic response to lithium and the criteria that might help to identify patients with successful response.…”