Adding a nurse-based intervention programme to usual care improves manic symptoms in people with bipolar disorder

摘要

Treatments demonstrated to be efficacious for bipolar disorder in clinical trials deliver disappointing results when applied in general practice. Rather than searching for a more efficacious molecule, Simon ef 0/ conducted a well powered randomised controlled trial comparing outcomes over a 12 month period for bipolar patients continuing usual care or adding a multicomponent systematic care management programme coordinated by a specialised nurse.The results indicate that tightening up the intervention-measurement-management feedback loop is beneficial. The programme consistently produced a statistically significant reduction in average mania severity scores and a modest reduction in depression over time. Both groups, however, enjoyed rather striking reductions in symptom severity. As the authors point out, this is unlikely to represent regression to the mean, because the sample was not selected for high symptom acuity at study entry. Thus participation in study procedures probably had a salutary effect on the course of bipolar illness. It is plausible that serial independent outcome assessments represent an active intervention-enhancing effectiveness. Benefit might be derived from other study procedures or leakage of improved approaches to usual care.The results are consistent with non-specific effects observed in clinical trials and encourage us to integrate more coordination and measurement into our management of bipolar disorder while we wait for research to clarify the active components. Although a nurse specialist implementing the full systematic care programme might best serve this function, the identification of a care partner, appointment reminders, and quarterly independent assessment might represent a feasible set of core interventions for nearly all mental health settings.