A psychiatrist with the Providence Veterans Affairs Medical Center and Brown Medical School has found that a new care model for treating bipolar disorder in the elderly was successful in reducing the number of maniac episodes suffered by them. In a randomized, controlled trial, the researchers proved that the new treatment model did not add to the costs of treating people with bipolar disorder, which affects nearly 6 million Americans each year. The findings of the study are published in Psychiatric Services, a journal of the American Psychiatric Association.
"We applied the same symptom management approaches found in interventions for diabetes and asthma to the treatment of bipolar disorder and found that people with serious mental illness can help take control of their care," said Mark S. Bauer, M.D., staff psychiatrist with the Providence V.A. Medical Center and professor of psychiatry and human behavior at Brown Medical School. "This finding should reduce the stigma of helplessness that so often is associated with these disorders, and it will open new avenues for the treatment of bipolar disorder."
Bauer oversaw the clinical trial and is the lead author of both journal articles.
The new model was developed and tested in veterans with bipolar disorder at the Providence V.A. Medical Center. During the trial, 306 veterans were enrolled at 11 V.A. centers located in Arizona, California, Colorado, Georgia, Indiana, Maryland, Ohio, Pennsylvania, Tennessee and Texas. Each veteran was randomly assigned to a study group. One group got usual care through their psychiatrist. The other group received treatment under the new model.
Developed by Bauer and colleagues, the model brings together psychiatrists and nurses as a team to treat the patients. Psychiatrists monitored symptoms and handled medications. Nurse care coordinators worked with veterans during group education sessions.
During the weekly group sessions, nurses discussed topics such as medication side effects and early warning signs for symptoms, which in bipolar disorder range from racing speech, bursts of optimism and impulsive behavior during manic episodes to fatigue, social withdrawal and suicidal thoughts during depressive episodes. During the sessions, patients discussed coping skills, got feedback from the group and created personal action plans.
The intervention was tested for three years. The results: Under the new model, patients saw a significant reduction in symptoms, including five fewer weeks experiencing mania during the three-year study period. Patients also felt happier and healthier, reporting more productive time at work, better relationships with family, and more satisfaction with their care.
The new model was less expensive - an average of $61,398 for three years of direct treatment costs compared with $64,379 for usual care - although the difference was not statistically significant.
"The bottom line is that we saw improvements in patients' symptoms, function and quality of life with no change in net costs," Bauer said.
The results mirror those from a simultaneous trial testing a similar team-based approach for bipolar disorder that Bauer also helped to develop. That approach was tested in 441 patients enrolled in a Washington state health maintenance organization. Results from that trial were published in May in the Archives of General Psychiatry.
"We now have results from more than 700 patients, cared for in very different health systems, that show this collaborative approach works," Bauer said. "Just like anyone with a chronic illness, people with bipolar disorder can work with medical professionals to manage their symptoms and manage their lives."
The Department of Veterans Affairs' Cooperative Studies Program funded the work.