Current management of bipolar affective disorder: is it reflective of the BAP guidelines?
In October 2003 the British Association of Psychopharmacology (BAP) published evidence-based guidelines on the management of bipolar disorder. The aim of this study was to assess whether the guidelines could provide the basis for examining clinical decisions and the extent to which practice accords with these guidelines. Case notes of out patients with bipolar disorder were reviewed. Demographic details, and treatment recommendations were determined. The management of affective episodes was evaluated and compared with BAP guidelines. In 84 subjects, 224 affective episodes were identified. Treatment was consistent with BAP guidelines in 72% of episodes. Mania was more likely to be managed in accordance with guidelines than depression or mixed episodes. The use of antidepressant medication was the most likely intervention to deviate from recommendations. Reasons for treatments at odds with the guidelines were identified. Our study demonstrates that clinical practice among a range of psychiatrists broadly reflects the guidelines that have been issued by the British Association of Psychopharmacology (BAP). The BAP guidelines offer a practical and auditable basis for the short- and long-term treatment of bipolar affective disorder.
Farrelly
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N
Harvard Bipolar Clinic and Research Program, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, USA.
Dibben
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C
Hunt
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N
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D005260:Female; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D000077213:Lamotrigine; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014227:Triazines / Q000627:therapeutic use; D006113:United Kingdom
D000928:Antidepressive Agents; D018692:Antimanic Agents; D000077213:Lamotrigine; D008094:Lithium; D017367:Selective Serotonin Reuptake Inhibitors; D014227:Triazines