CQAIMH - center for quality assessment and improvement in mental health


PREVIOUS MEASURE

Measure:

Bipolar Disorder: Recommending adjunctive psychosocial interventions

Summary:

This measure assesses the percentage of patients with bipolar disorder who receive a recommendation for an adjunctive psychosocial intervention, including evidence-based therapies, within 12 weeks of initiating treatment.

Clinical Rationale:

The Role of Psychosocial Interventions

  • Psychotherapy is a critical component of bipolar disorder treatment in addition to pharmacotherapy (1)
  • Evidence-based psychosocial interventions have been found to improve treatment adherence, reduce likelihood of recurrence and extend time to new episodes (1)
  • Initially focusing on issues relating to medication adherence, psychosocial strategies are now recommended to include broader strategies to promote mood stability, address comorbid conditions, improve understanding in support of treatment adherence, recognition of relapse and collaborative self-management (2,3,4)
  • Interventions that support return to role functioning and that address stressors and interpersonal communications are considered beneficial for remission and recovery (2,3)

Types of Psychosocial Interventions

  • Evidence-based: Family-focused therapy (FFT); Cognitive behavioral therapy (CBT), formal psychoeducation, and Interpersonal Therapy (IPT) with or without a social rhythm component (IPSRT) have been supported through well developed clinical trials (5,6,7,8,9) and are incorporated into guideline recommendations (1,2,3)
  • Brief supportive and group psychotherapy are also suggested, as alternative strategies (2)

Denominator Population:

Patients diagnosed and treated for bipolar disorder

Data Sources:

  • Administrative data
  • Medical Record

Numerator Population:

Patients with a recommendation for psychosocial intervention within 12 weeks of initiating treatment

Data Source:

  • Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder
ICD9CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13

References:

  1. Practice Guideline for the Treatment of Patients with Bipolar Disorder (2002 Revision);  American Psychiatric Association; Am J Psychiatry 159:4, April 2002 Supplement; AND 2006 Guideline Watch update, Hirschfeld RM, American Psychiatric Association
  2. Keck PE, Perlis R, Otto M, Carpenter D, Ross R, Docherty J, Treatment of Bipolar Disorder 2004; The Expert Consensus Guideline Series, Postgraduate Medicine – A Special Report, December 2004
  3. Yatham LN, Kennedy, SH, et al.; Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies, Bipolar Disorders 2005: 7(Suppl. 3): 5-69
  4. Vieta E, et al.; Evidence-based Research on the Efficacy of Psychologic Interventions in Bipolar Disorders: A Critical Review,  Current Psychiatry Reports; 2005, 7:449-455
  5. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder,  Arch Gen Psychiatry 2003; 60:904-912
  6. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003; 60:145-152
  7. Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement,  J Clin Psychiatry 2003; 64:1101-1105
  8. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission,  Arch Gen Psychiatry 2003; 60:402-407
  9. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder, Arch Gen Psychiatry; 62:996-1004

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