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Expanded Treatment Options and Addressing Unmet Needs in the Diagnosis and Treatment of Bipolar Disorder
Overview
Bipolar disorder presents on a spectrum, with bipolar depression on one end and bipolar I on the other and a host of other presentations in between. In addition to its many permutations and the difficulty of differentiating between diagnoses, comorbidities, incorrect treatment, and low self-report contribute to delayed diagnoses and inappropriate or delayed treatment. Once a diagnosis is reached, the latest evidence of the safety and efficacy profiles of existing and emerging treatments adds to the complexity when developing treatment strategies for patients with bipolar disorder. As guidelines are updated and new treatments become available, developing individualized treatment regimens is key and collaboration between clinician and patient and family is critical in optimizing patient outcomes. New treatment options can reduce some of the side effect burdens associated with treating bipolar disorder, and clinicians should use measurement-based care to assess whether treatment changes are necessary, which requires engaging with the patient to monitor efficacy and manage side effects. It is important to ensure that the patient and family understand the information to foster informed decision making and create a better therapeutic alliance. Involving patients in designing their own treatment strategies according to their tolerability criteria can help combat the 90% nonadherence rate, and ultimately lead to better patient care.
Learning Objectives
After studying this article, you should be able to:
- Screen patients with major depressive episodes for bipolar I and II disorder (bipolar depression)
- Accurately diagnose patients with bipolar I disorder with manic or mixed episodes
- Select a treatment regimen (monotherapy or combination treatment) to alleviate bipolar depression without causing the patient an undue side effect burden
- Use measurement-based care in long-term bipolar disorder management
- Provide efficacious and tolerable treatment for acute episodes of bipolar I disorder
- Evaluate evidence-based treatments available for the maintenance of bipolar I disorder, including mood stabilizers, psychotherapy, and novel therapies
Target Audience
Psychiatrists & psychiatry NPs and PAs; primary care physicians, NPs, and PAs
Part of the Bipolar Disorder Education Collection
Support Statement
Supported by educational grants from Alkermes, Inc. and Intra-Cellular Therapies, Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Screen patients with major depressive episodes for bipolar I and II disorder (bipolar depression)
- Accurately diagnose patients with bipolar I disorder with manic or mixed episodes
- Select a treatment regimen (monotherapy or combination treatment) to alleviate bipolar depression without causing the patient an undue side effect burden
- Use measurement-based care in long-term bipolar disorder management
- Provide efficacious and tolerable treatment for acute episodes of bipolar I disorder
- Evaluate evidence-based treatments available for the maintenance of bipolar I disorder, including mood stabilizers, psychotherapy, and novel therapies
Release, Review, and Expiration Dates
This CME activity was published in November 2022 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2023. The latest review of this material was October 2022.
Statement of Need and Purpose
Accurate diagnosis of bipolar I disorder is often delayed by years, while patients either go untreated or receive inappropriate treatment. Given the substantial illness burden, misdiagnosis is a critical unmet need. Additionally, treatment options for bipolar I disorder have expanded. The importance of certain side effects to patients should be discussed to improve the therapeutic alliance and their adherence.
Clinicians need education on clinical presentations, the use of screening tools, and differential diagnosis of bipolar I disorder. Education is also needed about evidence on the efficacy and tolerability of treatments for bipolar I disorder to enable clinicians to select a regimen that alleviates a patient’s symptoms without causing an undue burden of side effects.
Clinicians too often misdiagnose bipolar depression. Accurate diagnosis is often delayed by years, while patients either go untreated or receive inappropriate treatment. When bipolar disorder is treated, many clinicians fail to use measurement-based care to assess whether treatment changes are necessary. New treatments are on the horizon, and clinicians need education on:
- Recognition of bipolar depression, e.g., risk factors, signs, assessment strategies
- Latest evidence on safety and efficacy of existing & emerging treatments for bipolar depression
- Selection and implementation of monotherapy versus combination therapies based on guidelines and expert recommendations
- Ongoing measurement-based care for bipolar depression to monitor efficacy and side effects and offer individualized treatment regimens
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter
© Copyright 2022 Physicians Postgraduate Press, Inc.
Faculty
Joseph F. Goldberg, M.D.
Clinical Professor of Psychiatry
Icahn School of Medicine at Mount Sinai
New York, NY
Holly A. Swartz, M.D.
Professor of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, PA
Melissa P. DelBello, MD, MS
Professor of Psychiatry and Pediatrics
Dr. Stanley and Mickey Kaplan Professor and Chair
Department of Psychiatry and Behavioral Neuroscience
University of Cincinnati College of Medicine
Cincinnati, OH
Financial Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Dr Goldberg has served as a consultant for BioXcel, Intracellular Therapies, Jazz Pharmaceuticals, Lundbeck, Otsuka, Sunovion; received honoraria from Abbvie, Alkermes, Intracellular Therapies, Sunovion; has served on speaker/advisory boards for Jazz Pharmaceuticals, Lundbeck; and receives royalties from American Psychiatric Association Publishing and Cambridge University Press. Dr DelBello has served as a consultant for Medscape, CME Inc., Sage, Myriad, and Alkermes; received grant/research support from Shire, Alkermes, Acadia, Pfizer, Lundbeck, Johnson and Johnson, and Otsuka; and served on speakers/advisory boards for Myriad, Assurex, Sage, Alkermes, and Johnson and Johnson. Dr Swartz received honoraria from Medscape; has served on speaker/advisory boards for Intracellular Therapeutics; and receives royalties from Wolters Kluwer and American Psychiatric Association Publishing.
Marlene P. Freeman, MD, Editor in Chief, Boston, MA, has received research funding from JayMac and Sage; has been a member of the Independent Data Safety and Monitoring Committee for Janssen (Johnson & Johnson), Novartis, and Neurocrine; and has served on advisory boards for Eliem and Sage. As an employee of Massachusetts General Hospital (MGH), Dr Freeman works with the MGH National Pregnancy Registry, which receives funding from Alkermes, Aurobindo, AuroMedics, Johnson & Johnson/Janssen, Otsuka, Sage, Sunovion, Supernus, and Teva, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. Dr Freeman has also received royalties through MGH for the Massachusetts General Hospital Female Reproductive Lifecycle and Hormones Questionnaire.
Michael R. Page, PharmD, RPh, Independent Medical Director/Medical Writer, Plainsboro, New Jersey, serves as a consultant for BioCentric, Inc., and American Medical Communications, Inc.
None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation