Randomized trial of a population-based care program for people with bipolar disorder

被引:69
作者
Simon, GE
Ludman, EJ
Unützer, J
Bauer, MS
Operskalski, B
Rutter, C
机构
[1] Grp Hlth Cooperat Puget Sound, Ctr Hlth Studies, Seattle, WA 98101 USA
[2] Univ Calif Los Angeles, Inst Neuropsychiat, Los Angeles, CA 90024 USA
[3] Providence Vet Affairs Med Ctr, Providence, RI USA
[4] Brown Univ, Providence, RI 02912 USA
关键词
D O I
10.1017/S0033291704002624
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background. Despite the availability of efficacious medications and psychotherapies, care of bipolar disorder in everyday practice is often deficient. This trial evaluated the effectiveness of a multi-component care management program in a population-based sample of people with bipolar disorder. Method. Four hundred and forty-one patients treated for bipolar disorder during the prior year were randomly assigned to continued usual care or usual care plus a systematic care management program including: initial assessment and care planning, monthly telephone monitoring including brief symptom assessment and medication monitoring, feedback to and coordination with the mental health treatment team, and a structured group psychoeducational program - all provided by a nurse care manager. Blinded quarterly assessments generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation. Results. Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period (Z = 2(.)44, p = 0(.)015) and approximately one-third less time in hypomanic or manic episode (2(.)59 weeks nu. 1(.)69 weeks). Mean depression ratings across the entire follow-up period did not differ significantly between the two groups, but the intervention group showed a greater decline in depression ratings over time (Z statistic for group-by-time interaction = 1(.)98, p = 0(.)048). Conclusions. A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months. Preliminary results suggest a growing effect on depression over time, but longer follow-up will be needed.
引用
收藏
页码:13 / 24
页数:12
相关论文
共 54 条
  • [1] [Anonymous], 2001, CROSS QUAL CHASM
  • [2] [Anonymous], 2013, Motivational Interviewing: Helping People Change, 3rd Edn
  • [3] Bauer M., 2003, STRUCTURED GROUP PSY, V2nd ed
  • [4] Bauer M S, 2001, Psychopharmacol Bull, V35, P109
  • [5] Bauer MS, 1997, PSYCHIATR SERV, V48, P491
  • [6] BAUER MS, 1991, ARCH GEN PSYCHIAT, V48, P807
  • [7] Principles of effectiveness trials and their implementation in VA cooperative study #430: 'Reducing the efficacy-effectiveness gap in bipolar disorder'
    Bauer, MS
    Williford, WO
    Dawson, EE
    Akiskal, HS
    Altshuler, L
    Fye, C
    Gelenberg, A
    Glick, H
    Kinosian, B
    Sajatovic, M
    [J]. JOURNAL OF AFFECTIVE DISORDERS, 2001, 67 (1-3) : 61 - 78
  • [8] The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample
    Bauer, MS
    Vojta, C
    Kinosian, B
    Altshuler, L
    Glick, H
    [J]. BIPOLAR DISORDERS, 2000, 2 (04) : 340 - 346
  • [9] The collaborative practice model for bipolar disorder: design and implementation in a multi-site randomized controlled trial
    Bauer, MS
    [J]. BIPOLAR DISORDERS, 2001, 3 (05) : 233 - 244
  • [10] A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder
    Bowden, CL
    Calabrese, JR
    McElroy, SL
    Gyulai, L
    Wassef, A
    Petty, F
    Pope, HG
    Chou, JCY
    Keck, PE
    Rhodes, LJ
    Swann, AC
    Hirschfeld, RMA
    Wozniak, PJ
    [J]. ARCHIVES OF GENERAL PSYCHIATRY, 2000, 57 (05) : 481 - 489