The Long‐Term Course and Clinical Management of Bipolar I and Bipolar II Disorders

Judd, Lewis L.; Schettler, Pamela J.

doi:10.1002/9780470661277.ch3

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…With the emphasis on community care for people with mental health problems, close family and friends often have a primary responsibility for supporting an adult with bipolar disorder. These caregivers may face many challenges given that people with bipolar disorder commonly spend at least half their time actively symptomatic, particularly with disabling depressive symptoms, have a high suicide risk and can engage in risky manic behavior [3,4]. Negative social, occupational and financial illness consequences can affect both the patient and their caregiver [5,6].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

Berk

Dodd

et al. 2013

BMC Med

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BackgroundBipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, http://www.bipolarcaregivers.org.MethodsVisitors to the website responded to an initial online survey about the usefulness of the information (N = 536). A more detailed follow-up feedback survey was emailed to web users who were adult caregivers of adults with bipolar disorder a month later (N = 121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved.ResultsThe majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits.ConclusionsOverall, http://www.bipolarcaregivers.org was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

Berk

Dodd

et al. 2013

BMC Med

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“…According to Judd's study, the episode duration of depression and hypomania is at the ratio of 37:1, i.e., for every 37 days of time suffered from depression patient runs through only 1 day in the hypomanic episode. [ 8 ] Such brief “episodes” with a description of “without marked sociooccupational dysfunction” is the clinical scenario described in the literature for BD-II. In such a scenario are we justified in advising, initiating, and maintaining long-term prophylaxis as per the algorithms described, very similar to BD I?…”

Section: Bipolar Disorder-iimentioning

confidence: 99%

Bipolar Disorder: Clinical Conundrums 1

Reddy¹,

Vijay²,

Reddy³

2017

Indian Journal of Psychological Medicine

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“…Bipolar disorder often starts in adolescence or early adulthood and typically runs an episodic course (Angst and Sellaro, 2000), but many patients do not remit completely and continue to have persistent mood symptoms (Judd and Schettler, 2010). Over the course of a lifetime, the illness is associated with significant disability and high suicide risk (Malhi et al, 2018a).…”

Section: Introductionmentioning

confidence: 99%

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

Reddy

Jhanwar

Nagpal³

et al. 2019

Aust N Z J Psychiatry

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Objective: The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. Method: In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. Results: For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. Limitations: The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to selfreport and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Conclusion: Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists' practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

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The Long‐Term Course and Clinical Management of Bipolar I and Bipolar II Disorders

Cited by 7 publications

References 60 publications

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

Bipolar Disorder: Clinical Conundrums 1

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder

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