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
  • [21] Effectiveness of psychosocial treatments in bipolar disorder: State of the evidence
    Huxley, NA
    Parikh, SV
    Baldessarini, RJ
    [J]. HARVARD REVIEW OF PSYCHIATRY, 2000, 8 (03) : 126 - 140
  • [22] JOHNSON R, 1992, HOSP COMMUNITY PSYCH, V45, P919
  • [23] Johnson RE, 1996, AM J PSYCHIAT, V153, P993
  • [24] Extending indications for long-term pharmacotherapy: Opportunities and challenges
    Kane, JM
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 2002, 159 (01) : 1 - 2
  • [25] COLLABORATIVE MANAGEMENT TO ACHIEVE TREATMENT GUIDELINES - IMPACT ON DEPRESSION IN PRIMARY-CARE
    KATON, W
    VONKORFF, M
    LIN, E
    WALKER, E
    SIMON, GE
    BUSH, T
    ROBINSON, P
    RUSSO, J
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 273 (13): : 1026 - 1031
  • [26] Randomized trial of a depression management program in high utilizers of medical care
    Katzelnick, DJ
    Simon, GE
    Pearson, SD
    Manning, WG
    Helstad, CP
    Henk, HJ
    Cole, SM
    Lin, EHB
    Taylor, LH
    Kobak, KA
    [J]. ARCHIVES OF FAMILY MEDICINE, 2000, 9 (04) : 345 - 351
  • [27] 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode
    Keck, PE
    McElroy, SL
    Strakowski, SM
    West, SA
    Sax, KW
    Hawkins, JM
    Bourne, ML
    Haggard, P
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 1998, 155 (05) : 646 - 652
  • [28] KELLER MB, 1987, ARCH GEN PSYCHIAT, V44, P540
  • [29] A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder - Outcome of the first year
    Lam, DH
    Watkins, ER
    Hayward, P
    Bright, J
    Wright, K
    Kerr, N
    Parr-Davis, G
    Sham, P
    [J]. ARCHIVES OF GENERAL PSYCHIATRY, 2003, 60 (02) : 145 - 152
  • [30] Achieving guidelines for the treatment of depression in primary care - Is physician education enough?
    Lin, EHB
    Katon, WJ
    Simon, GE
    VonKorff, M
    Bush, TM
    Rutter, CM
    Saunders, KW
    Walker, EA
    [J]. MEDICAL CARE, 1997, 35 (08) : 831 - 842