Vol. 22, No. 04 / November 2010

Introduction

Associate Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, New York, Medical Director, Recognition and Prevention (RAP) Program Director, Adverse Events Assessment and Prevention Unit, Advanced Center for Intervention and Services Research, The Zucker Hillside Hospital, Center for Translational Psychiatry, Glen Oaks, New York, The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, New York 

Clinical Pharmacy Specialist, Psychiatry, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Brecksville, Ohio, Clinical Associate Professor of Psychiatry, Clinical Instructor of Psychology, Case Western Reserve University, Cleveland, Ohio, Adjunct Associate Professor of Clinical Pharmacy, The University of Toledo, Toledo, Ohio 

Associate Professor of Psychiatry and Pharmacology, University of Toronto, Head, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada 

Bipolar Disorder (BD) ranks high among the most prevalent and frequently underdiagnosed and undertreated affective disorders in the United States. Characterized by recurrent episodes of mania, depression, and mixed states, the annual economic burden of BD—including healthcare costs and lost productivity of patients and their caregivers—was estimated at $24 billion in the United States in 1998.^1-4 Despite the growth in research in recent years, an estimated 69% of people with BD have been misdiagnosed; most notably, patients with BD had received a mean of 3.5 other diagnoses and have consulted 4 physicians before being accurately diagnosed.⁵ BD increases the risk for suicide and is associated with several psychiatric and medical comorbidities, including substance misuse, anxiety disorders, cardiovascular disease, metabolic syndrome, and hypertension.^1,6-8 An increasing body of evidence suggests that when appropriate pharmacotherapeutic interventions are initiated early in the course of the disorder, the ultimate prognosis is substantially improved.^5,9 Longitudinal data on the management of patients with BD, including monitoring for efficacy, safety, adherence, and comorbidities, are available to provide practical, clinically applicable information.

While knowledge about the diagnosis and treatment of BD has grown in recent years, it is not yet fully integrated within clinical practice. Several guidelines have been published on the treatment of BD; however, a pilot survey suggests that 34% of psychiatrists do not use treatment guidelines and that 24% misinterpret the results of clinical trials.¹⁰

We designed this multimedia resource compendium to educate healthcare professionals about recent developments in the differential diagnosis and medical management of BD, with focus on a patient-centered, individualized approach to treatment. Psychiatrists and neurologists, as well as pharmacists, primary care physicians, and other multidisciplinary team members, may find this compendium of particular value as a clinical reference tool to help improve care and outcomes of their patients with BD. In addition to this print compendium, this multimedia continuing education activity will be available online via the PSYCHClinician.com Web site.

In Chapter 1, Dr. Roger McIntyre reviews current strategies for distinguishing BD from other disorders such as major depressive disorder (MDD) or attention deficit hyperactivity disorder (ADHD) that have similar clinical presentations. In Chapter 2, Dr. Matthew Fuller focuses on some of the major classes of medications (eg, antipsychotics and mood stabilizers) used to treat BD and their mechanisms of action. Of signal importance to good practice parameters and ultimately to effective patient-centered treatment of BD is Dr. Fuller’s review of drug-metabolizing pathways, drug-drug interactions, and dose adjustment strategies deemed essential for personalized care. In Chapter 3, Dr. Christoph Correll discusses important elements of longitudinal treatment effectiveness, such as re-evaluating depressive and manic symptoms and assessing remission and residual symptoms. Key information is provided on potential complications associated with the use of antipsychotics and mood stabilizers, with a discussion on strategies for managing treatment-related side effects and optimizing treatment for an individual patient.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision, DSM-IV-TR™. Washington, DC: American Psychiatric Association; 2000.
2. Cousins DA, Young AH. The armamentarium of treatments for bipolar disorder: a review of the literature. Int J Neuropsychopharmacol. 2007;10:411–431.
3. Berns GS, Nemeroff CB. The neurobiology of bipolar disorder. Am J Med Genet C Semin Med Genet. 2003;123C:76–84.
4. Begley CE, Annegers JF, Swann AC, et al. The lifetime cost of bipolar disorder in the US: an estimate for new cases in 1998. Pharmacoeconomics. 2001;19:483–495.
5. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161–174.
6. Slama F, Bellivier F, Henry C, et al. Bipolar patients with suicidal behaviour: toward the identification of a clinical subgroup. J Clin Psychiatry. 2004;65:1035–1039.
7. Berk M, Berk L, Moss K, Dodd S, Malhi GS. Diagnosing bipolar disorder: how can we do it better? Med J Aust. 2006;184:459–462.
8. McIntyre RS, Konarski JZ, Soczynska JK, et al. Medical comorbidity in bipolar disorder: implications for functional outcomes and health service utilization. Psychiatr Serv. 2006;57:1140–1144.
9. Berk M, Hallam K, Lucas N, et al. Early intervention in bipolar disorders; opportunities and pitfalls. Med J Aust. 2007;187(suppl):S11–S14.
10. Perlis RH. Use of treatment guidelines in clinical decision making in bipolar disorder: a pilot survey of clinicians. Curr Med Res Opin. 2007;23:467–475.

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