Development of a decision tool for early identification of adult patients with severe and complex bipolar disorder psychopathology in need of highly specialized care

Bipolar disorder is a complex and severe mental disorder. Despite evidence-based pharmacological and psychosocial interventions, complete stability is only reached by a small proportion of people who have BD, with over 90% of BD patients relapsing into new mood episodes during their lifetime. However, tools to differentiate patients who benefit sufficiently from standardized guideline treatment from patients who need more intensive or highly specialized treatment are lacking. The aim of the current study is to develop a decision tool for bipolar disorder that aids clinicians in early identification of a complex disease course in patients with bipolar disorder that are in need of highly specialized tertiary treatment. An earlier literature review led to the identification of 37 factors associated with a more unfavorable and complex disease course. Based on two expert rounds, using the Delphi method seven items were selected for the final tool: insufficient symptomatic recovery,...Show moreBipolar disorder is a complex and severe mental disorder. Despite evidence-based pharmacological and psychosocial interventions, complete stability is only reached by a small proportion of people who have BD, with over 90% of BD patients relapsing into new mood episodes during their lifetime. However, tools to differentiate patients who benefit sufficiently from standardized guideline treatment from patients who need more intensive or highly specialized treatment are lacking. The aim of the current study is to develop a decision tool for bipolar disorder that aids clinicians in early identification of a complex disease course in patients with bipolar disorder that are in need of highly specialized tertiary treatment. An earlier literature review led to the identification of 37 factors associated with a more unfavorable and complex disease course. Based on two expert rounds, using the Delphi method seven items were selected for the final tool: insufficient symptomatic recovery, comorbid personality problems, rapid cycling pattern, trauma, somatic comorbidity, psychiatric comorbidity, (the wish to become) pregnant. The pilot validation study indicated that the tool demonstrated good validity to identify patients for highly specialized tertiary care. A total score of ≥3 was found to represent an optimal cut-off point for identifying bipolar patients in need of highly specialized care. The currently developed decision tool could aid clinicians in identifying complex and severe pathology in bipolar disorder in early stages of diagnoses and treatment and subsequently allocating patients to highly specialized treatment. Validation in larger samples sizes is needed to make this tool generalizable to healthcare systems where early identification of severe cases is needed, across and beyond the Netherlands.Show less

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Development of a decision tool for early identification of adult patients with severe and complex bipolar disorder psychopathology in need of highly specialized care