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Evidence Based Practice

Evidence based practice in general means that the care and interventions used by practitioners to treat a medical, psychological, or psychiatric disorder are determined by the outcomes of reputable research. Such evidence also greatly influences the interpretation of Best Practices. We have looked into a few different treatment psychotherapeutic modalities and adjunct therapies for bipolar disorder in many of my previous posts. So, what exactly are the standard evidenced based practices as concluded by the scientific community for the treatment of Bipolar disorder? Here we will take a look at this.

The remaining content of this post is a summary of what is found in the Primary Care Companion for CNS Disorders [i] We will review the Evidenced Based Practice that influences what is considered Best Practice for the treatment of bipolar disorder by covering the main clinical points in this post. We will review the basic treatment recommendations in our net post.

First, the study that was used to adopt guidelines for evidence based practice were chosen based on data from well-conducted naturalistic trials; randomized, controlled trials; and meta-analyses. All research/data used were published since 2005. Below are the 4 basic guidelines restated directly from the report:

· Mania should be treated first-line with lithium, divalproex, or an atypical antipsychotic medication.

· Mixed episodes should be treated first-line with divalproex or an atypical antipsychotic.

· Bipolar depression should be treated with quetiapine, olanzapine/fluoxetine combination, or lamotrigine.

· All patients should be offered group or individual psychoeducation. Additionally, recommendations for therapeutic drug monitoring are presented due to their importance for patient safety, particularly for the primary care physician, although these are based on consensus guidelines.

The paper concluded that the primary care physician’s role is vital in improving patient quality of life and that the management of acute mood episodes should focus on safety first. Psychiatric consultation should occur as soon as possible, and that an evidenced –based treatment should be implemented. This evidence-based treatment that may be continued into the maintenance phase. Long-term management would focuses on maintenance of euthymia (normal non-depressed, reasonably positive mood), and would most likely require ongoing medication. Finally, the individual with bipolar may benefit from adjunctive psychotherapy.

Below are some clinical points that I have summarized from the report. Most doctors will follow Evidence Based Clinical Points and Guidelines which is standard treatment. After reading this post, you have a good idea of what your doctor is likely using to guide him or her in providing your treatment. If they suggestions do not seem to be congruent with these, you might want to research their approach yourself. Below are the stated Clinical Points:

Lithium, divalproex, or atypical antipyschotics are suggested for mania and it is suggested that quetiapine olanzapine/fluixetine combination, or lamotrigine be considered for treating bipolar depression. Once an episode is successfully treated, then the doctor should be prescribing continued medication for maintenance of normal mood. Individuals who are being treated for bipolar disorder should be offered individual or group psycho-education to prevent relapse and to improve treatment adherence.

Our next post will look at issues  Emergent and Urgent Care suggestions made from Evidence Based Practice Guidelines including recommendations for psychosocial treatment. By being informed of what the guidelines that are considered standard care by your primary physician and your psychiatrist, you will be empowered to incorporate that awareness into your own, overall personalized Wellness Plan. (Read the entire report by using the link below.)


[i] Prim Care Companion CNS Disord. 2011; 13(4): PCC.10r01097.

doi:  10.4088/PCC.10r01097

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219517/ (retrieved 5/25/2015)

Photo by Damon Sacks