Presentation on theme: "An Update on Bipolar Disorder NARSAD 2008 Andrew A. Nierenberg, MD Medical Director Harvard Bipolar Clinic and Research Program, Massachusetts General."— Presentation transcript:
An Update on Bipolar Disorder NARSAD 2008 Andrew A. Nierenberg, MD Medical Director Harvard Bipolar Clinic and Research Program, Massachusetts General Hospital Director, NIMH Bipolar Trials Network Professor of Psychiatry, Harvard Medical School
Thank you NARSAD Thilo Deckersbach, PhD Christina Dording, MD Aude Henin, PhD Dan Iosifescu, MD Andrew A. Nierenberg, MD Michael J. Ostacher, MD, MPH Janet Witte, MD
Update on Bipolar Disorder Update on Bipolar basics STEP-BD LiTMUS
Lizzie Simon Time Magazine Aug 11, 2002 "Everything was perfect... and then I went insane"
Goya Portrait of Don Gaspar Melchor de Jovellanos
Bipolar Disorder Prevalence: –BPI and II: 1.1% of the workforce 2.6% of the general population Mean age of onset: 17.4 years Kessler et al. Arch Gen Psychiatry. 2005;62:617-627. Kessler et al. Am J Psychiatry. 2006;163:1561-1568.
Bipolar Disorder Recurrent and chronic disorder –Manic or hypomanic episodes –Major depressive episodes and symptoms Major burden –Inter-episodic symptoms Dysfunction: –65.5 lost days of work per year Kessler et al. Arch Gen Psychiatry. 2005;62:617-627. Kessler et al. Am J Psychiatry. 2006;163:1561-1568.
STEP-BD Systematic Treatment Enhancement Program for Bipolar Disorder www.stepbd.org Evidence guided treatment Specialty bipolar clinics Integration of measurement and management Embedded randomized trials
Collaborative Care: Integration of Measurement and Management Shared measurement –Symptoms Depression Mania/hypomania Anxiety Irritability –Stress, alcohol, weight –Side effects –Functioning Nierenberg AA. J Clin Psychiatry. 2006;67 Suppl 11:3-7. www.manicdepressive.org (see Resources section) Clinical Self-report Form Clinical Monitoring Form
Collaborative Care: Integration of Measurement and Management Mood monitoring Medication concordance Non-concordance open for discussion Negotiate –Goals –Medication changes Menu of reasonable choices Collaborative Care Workbook
With systematic treatment, 30% of STEP-BD participants achieved recovery and then stayed recovered over 1 year
Anxiety: more difficult to recover from bipolar depressive episode Otto et al., Br J Psychiatry 2006 Jul;189:20-5. without anxiety with anxiety
Anxiety: higher risk of depressive relapse Otto et al., Br J Psychiatry 2006 Jul;189:20-5. without anxiety with anxiety
Higher bipolar relapse rate with residual symptoms Perlis et al., Am J Psychiatry. 2006 Feb;163(2):217-24. Without residual symptoms With residual symptoms Without residual symptoms With residual symptoms
No benefit with antidepressants for bipolar depression with manic symptoms Goldberg et al. Am J Psychiatry 2007:164:1348-1355