Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

Tremain, Hailey; Fletcher, Kathryn; Murray, Greg

doi:10.1111/bdi.12872

Cited by 24 publications

(22 citation statements)

References 105 publications

(142 reference statements)

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“…There is evidence that risk of recurrence increases with the number of prior episodes of bipolar disorder and a greater number of episodes is also associated with more chronic symptoms, and functional impairment (Tremain et al, 2020b). Number of episodes may also moderate the response to treatments, particularly adjunctive psychosocial treatments.…”

Section: Management Of Bipolar Disordermentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

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322

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Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

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Section: Management Of Bipolar Disordermentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

Self Cite

322

365

View full text Add to dashboard Cite

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“…Increasing the understanding of the experiences of those within later stage is a step toward precision psychiatry. A benefit of this approach to adding granularity to staging over reliance on clinical history is avoiding validity and reliability concerns resulting from the recall and measurement‐related issues assessment of distal and often distressing events inherently involves 41 . Indeed, data about current symptoms, functioning, quality of life, and medication effectiveness are routinely collected as part of clinical assessment.…”

Section: Discussionmentioning

confidence: 99%

Conceptualizing the later stage of bipolar disorder: Descriptive analyses from the ORBIT trial

2020

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Objectives This study aimed to investigate the features of later stage bipolar disorder (BD) and specifically, factors underlying later stage BD and potential subgroups within this stage, to understand more about the later stage group and contribute to the measurement of stage. Methods An exploratory factor analysis was conducted using variables relating to current phenomenological aspects of illness, followed by cluster analyses based on the identified factors. Finally, the resultant clusters were compared based on course of illness variables. Results Fourteen extracted factors explained 57 percent of the variance. Latent structures aligned with current depressive symptoms, energy and interest, independence, occupational functioning, symptoms of anxiety, pain, elevated symptoms, interpersonal functioning, anger, perceptions of social connections, and perceptions of current medication effectiveness, cognitive issues, sleep issues, and sense of isolation. Two clusters were identified which differed significantly on each of these factors, and on a range of course of illness features including lifetime number of episodes, duration of illness and number of depressive hospitalizations. Conclusions Latent phenomenological features relevant to individuals in the later stage of BD were identified. Two clusters of individuals in later stage BD differ based on these features as well as course of illness, suggesting that there are distinct subgroups of individuals in the later stage of BD, distinguishable based on current phenomenology and illness history. However, findings are exploratory and therefore require confirmation before they can be applied clinically.

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“…While no model of clinical staging in BD has been empirically validated, an International Society for Bipolar Disorders task force review concluded that there is sufficient evidence at this time supporting two stages of established BD, distinguishable based on number of episodes (NoE 11 ) and functioning. 12 The task force also proposed that such a dichotomization is likely to be of heuristic value in the treatment of BD, despite lack of validated boundaries or definitions at this time.…”

Section: Staging Models In Bipolar Disordermentioning

confidence: 99%

“…Most commonly, NoE has been used. [15][16][17][18][19] While a potentially useful and plausible proxy, 1 NoE alone cannot fully capture the complexity of the proposed staging phenomenon, 5,9,11 and in particular does not speak to the notion of disease extension. It has been proposed that analogues of physical disease progression in mental disorders may be functional impairment or disability, and cognitive functioning, 3,6,9,20 while proxies such as medical comorbidities and some psychiatric comorbidities better reflect disease extension.…”

Section: Proxies Of Stage In Established Bdmentioning

confidence: 99%

The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review

et al. 2020

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Objectives The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non‐symptom) outcomes following psychosocial intervention. Methods A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data‐based convergent synthesis. Results A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage‐related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. Conclusions A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three‐way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low‐quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.

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Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

Cited by 24 publications

References 105 publications

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Conceptualizing the later stage of bipolar disorder: Descriptive analyses from the ORBIT trial

The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review

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