title: Randomized trial of a population-based care program for people with bipolar disorder.
abstract: BACKGROUND
  Despite the availability of efficacious medications and psychotherapies, care of bipolar disorder in everyday practice is often deficient. This trial evaluated the effectiveness of a multi-component care management program in a population-based sample of people with bipolar disorder.
  
  
  METHODS
  Four hundred and forty-one patients treated for bipolar disorder during the prior year were randomly assigned to continued usual care or usual care plus a systematic care management program including: initial assessment and care planning, monthly telephone monitoring including brief symptom assessment and medication monitoring, feedback to and coordination with the mental health treatment team, and a structured group psychoeducational program--all provided by a nurse care manager. Blinded quarterly assessments generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation.
  
  
  RESULTS
  Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period (Z= 2.44, p=0.015) and approximately one-third less time in hypomanic or manic episode (2.59 weeks v. 1.69 weeks). Mean depression ratings across the entire follow-up period did not differ significantly between the two groups, but the intervention group showed a greater decline in depression ratings over time (Z statistic for group-by-time interaction = 1.98, p = 0.048).
  
  
  CONCLUSIONS
  A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months. Preliminary results suggest a growing effect on depression over time, but longer follow-up will be needed.
authors.affiliation: Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. simon.g@ghc.org
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.forename: Belinda
authors.initials: B
authors.lastname: Operskalski
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D011159:Population Surveillance; D011613:Psychotherapy / Q000379:methods; D014481:United States