Current management of bipolar affective disorder: Is it reflective of the BAP guidelines?
N. Farrelly1,
Claire Dibben2,
Neil Hunt2*
1 Harvard Bipolar Clinic and Research Program, Massachusetts General
Hospital, 50 Staniford Street, Suite 580, Boston MA 02114, USA.
2 George McKenzie House, Fulbourn Hospital, Cambridge CB1 5EF, UK.
* To whom correspondence should be addressed.
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Abstract |
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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.
Key Words:
bipolar disorder, mania, depression, evidence-based guidelines, clinical practice
