title: Enhancing outcomes in patients with bipolar disorder: results from the Bipolar Disorder Center for Pennsylvanians Study.
abstract: BACKGROUND
  We developed models of Specialized Care for Bipolar Disorder (SCBD) and a psychosocial treatment [Enhanced Clinical Intervention (ECI)] that is delivered in combination with SCBD. We investigated whether SCBD and ECI + SCBD are able to improve outcomes and reduce health disparities for young and elderly individuals, African Americans, and rural residents with bipolar disorder.
  
  
  METHODS
  Subjects were 463 individuals with bipolar disorder, type I, II, or not otherwise specified, or schizoaffective disorder, bipolar type, randomly assigned to SCBD or ECI + SCBD and followed longitudinally for a period of one to three years at four clinical sites.
  
  
  RESULTS
  Both treatment groups significantly improved over time, with no significant differences based on age, race, or place of residence, except for significantly greater improvement among elderly versus adult subjects. Improvement in quality of life was greater in the ECI + SCBD group. Of the 299 participants who were symptomatic at study entry, 213 achieved recovery within 24 months, during which 86 of the 213 subjects developed a new episode. No significant difference was found for race, place of residence, or age between the participants who experienced a recurrence and those who did not. However, the adolescent patients were less likely than the adult and elderly patients to experience a recurrence.
  
  
  CONCLUSIONS
  This study demonstrated the effectiveness of SCBD and the additional benefit of ECI independent of age, race, or place of residence. It also demonstrated that new mood episodes are frequent in individuals with bipolar disorder who achieve recovery and are likely to occur in spite of specialized, guideline-based treatments.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fagiolini
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
authors.forename: David E
authors.initials: DE
authors.lastname: Curet
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: Ariel G
authors.initials: AG
authors.lastname: Gildengers
authors.forename: Tina
authors.initials: T
authors.lastname: Goldstein
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Grochocinski
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Mary G
authors.initials: MG
authors.lastname: Stofko
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Thompson
authors.forename: Scott R
authors.initials: SR
authors.lastname: Turkin
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult