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Cerimele JM, Franta G, Blanchard BE, Leasure W, Fortney JC. Bipolar Disorder Symptom Monitoring Measures: A Mixed-Methods Study of Patient Preferences. J Acad Consult Liaison Psychiatry 2024; 65:148-156. [PMID: 37967752 PMCID: PMC11032232 DOI: 10.1016/j.jaclp.2023.11.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To determine the perceived acceptability and helpfulness of bipolar disorder symptom measures and rank the measures in order of preference among individuals with bipolar disorder. METHODS We recruited 20 participants 18 years of age or older with any type of bipolar disorder from a primary care clinical site and a national advocacy organization. We used a simultaneous complementary mixed-method design involving completion of symptom measures, a semistructured interview, and numerical ranking of measures. Participants completed three symptom measures or combination of measures: 1) Affective Self-Rating Scale; 2) combination Patient Mania Questionnaire-9 (PMQ-9) and Patient Health Questionnaire-9 (PHQ-9); and 3) combination Altman Self-Rating Mania Rating Scale and PHQ-9. A semistructured interview was conducted, and participants ranked their preferences for measures. Interviews focused on participants' rationale for measuring preferences. Interviews were analyzed by two psychiatrist-investigators using content analysis, and themes were determined. Average rank of each measure was determined. RESULTS The average rank for each measure was 1.48 for the combination PMQ-9 and PHQ-9, 1.68 for the Affective Self-Rating Scale, and 2.85 for the combination Altman Self-Rating Mania Rating Scale and PHQ-9, indicating that the combination PMQ-9 and PHQ-9 (top-ranked measure by 55% of participants) was the most preferred among the three measures. Major themes that emerged from the data were: 1) measure format; 2) patient experience; 3) clinical practice; and 4) therapeutic effects. CONCLUSIONS Individuals with bipolar disorder preferred the combination PMQ-9 and PHQ-9 for use in monitoring treatment due to perceived strengths such as format, ease of completion and interpretation, accurate description of experiences, and feasibility of use in practice.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
| | - Gabriel Franta
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - William Leasure
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
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Dembek C, Mackie D, Modi K, Zhu Y, Niu X, Grinnell T. The economic and humanistic burden of bipolar disorder in adults in the United States. Ann Gen Psychiatry 2023; 22:13. [PMID: 36964564 DOI: 10.1186/s12991-023-00440-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/25/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Bipolar disorder is associated with functional impairment and diminished health-related quality of life (HRQoL). The purpose of this study was to estimate the annual per patient direct healthcare costs, indirect costs, and HRQoL of patients with bipolar disorder by depressive symptom severity and overall compared to the general population in the US. METHODS This cross-sectional study used self-reported data from the 2020 US National Health and Wellness Survey. Adult respondents who reported bipolar disorder symptoms in the past 12 months and/or a diagnosis of bipolar disorder were identified (bipolar disorder cohort) and were further classified by depressive symptom severity based on Patient Health Questionnaire (PHQ-9) scores (none/mild = 0-9, moderate = 10-14, severe = 15-27). Annualized direct healthcare costs and indirect costs were calculated from 6-month healthcare resource utilization and work productivity, respectively. A general population cohort was constructed using 2:1 propensity score matching. Multivariate regression models of all-cause hospitalizations in the past 6 months, annualized direct healthcare costs, annualized indirect costs, and HRQoL (eg, EuroQol 5-Dimension Health Questionnaire (EQ-5D)) controlled for confounders (demographic and clinical characteristics). RESULTS Of 3583 adults meeting pre-specified criteria for bipolar disorder, 1401 (39.1%) reported none/mild, 889 (24.8%) moderate, and 1293 (36.1%) severe depressive symptom severity. Additionally, 3285 (91.7%) were matched to 6570 adults in the general population. Compared to the general population, adjusted mean hospitalizations (0.53 vs. 0.30), annualized per patient direct healthcare costs ($20,846 vs. $11,391), and indirect costs ($14,795 vs. $9274) were significantly greater for the bipolar disorder cohort (all p < 0.001); adjusted HRQoL (EQ-5D: 0.69 vs. 0.79) was significantly worse (p < 0.001). By depressive symptom severity, adjusted mean hospitalizations (none/mild = 0.30, moderate = 0.50, severe = 0.46), direct healthcare costs ($14,389, $22,302, $21,341), and indirect costs ($10,799, $17,109, $18,470) were significantly greater for moderate and severe compared to none/mild depressive symptom severity (all p < 0.01); adjusted HRQoL (EQ-5D: 0.77, 0.67, 0.59) was significantly worse (p < 0.001). CONCLUSIONS Among respondents with bipolar disorder, those with moderate to severe depression had greater direct healthcare costs and indirect costs as well as worse HRQoL than those with mild or no depressive symptoms. Treatment targeting reduction in depressive symptoms may reduce the economic and humanistic burden of bipolar disorder.
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Affiliation(s)
- Carole Dembek
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| | | | | | - Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
| | - Xiaoli Niu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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