Even With Official Diagnosis, There is Uncertainty in the Care BD Patients Receive

Psych Congress Steering Committee Member Rakesh Jain, MD, MPH, and co-authors Mousam Parikh, AbbVie, and Huy-Binh Nguyen, PhD, AbbVie, answer more questions about their research that identified a disconnect between treatment guidelines and the prescribing practices of clinicians treating bipolar disorder.

In Part 2 of this Q&A, the authors explain the practical, clinical implications of their findings, the high variability in treatment patterns, and directions for future research.

The study, “Treatment Patterns Among Patients with Bipolar Disorder in the United States: A Retrospective Claims Database Analysis,” was published online in Advances in Therapy.

Don’t miss Part 1: Real-World Prescribing Patterns for Patients With Newly Diagnosed Bipolar Disorder where the study authors explore practical implications of the study findings, surprising outcomes, and areas of future research.

Question: Are there any other practical applications of your findings for clinicians treating BD?

Answer: Our findings suggested that, even when a diagnosis of bipolar disorder has been established, there is no certainty that recommended treatments will be prescribed to patients with bipolar disorder. This gap between clinical guideline recommendations and actual prescribing patterns suggests that improved adherence to treatment guidelines and evidence-based treatments could potentially improve care for patients with bipolar disorder. This may be particularly true in terms of the number of patients who are inappropriately prescribed antidepressants for bipolar I mania or depression, which evidence suggests can result in poor patient outcomes, such as triggering a manic episode, mood destabilization/treatment-emergent affective switch, or rapid cycling. Educational initiatives and other types of communications, including peer-reviewed studies such as our own, can help inform providers about guideline-congruent treatment, thereby providing them with opportunities to revise their prescribing patterns for patients with bipolar disorder.

Question: Were any outcomes and/or findings from the study different than you expected?

Answer: The substantial amount of variability we saw in the number of treatment patterns used across lines of treatment for patients with bipolar disorder was revealing. This, in addition to the common practice of prescribing benzodiazepines and monotherapy antidepressants for BP-I depression, highlighted a surprising lack of reliance on treatment guidelines among clinicians treating bipolar disorder.

Question: Are you conducting more research in this area, and are there any related studies you feel are needed?

Answer: Given the cost burden associated with bipolar disorder, we are also conducting real-world analyses to evaluate the costs associated with diagnosis and treatment of bipolar disorder. In addition, since many patients with BP seek treatment for depressive symptoms and misdiagnosis as MDD is common, research to identify predictors of guideline-incongruent treatment and misdiagnosis in BP would be valuable.

Question: Any final thoughts?

Answer: Vast heterogeneity in treatment regimens for bipolar disorder, as well as a conspicuous gap between clinical guideline recommendations and prescribing patterns, suggest that there is an opportunity to normalize clinical management of bipolar disorder and improve outcomes through increased use of evidence-based treatments.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr. Jain served a three-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training, by undergoing a two-year fellowship in Child and Adolescent Psychiatry. In addition, Dr. Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.

Mousam Parikh is the lead for AbbVie Psychiatry’s Health Economics and Outcomes Research (HEOR) team. She completed her Bachelors in Pharmacy from Mumbai, India and a Masters focusing on HEOR from Duquesne University, PA. She is focused on generating high-quality evidence by leveraging real-world data to understand unmet needs, treatment patterns and outcomes associated with treatments in the mental health space.

Huy-Binh Nguyen is a Scientific Director at AbbVie leading the Schizophrenia and Bipolar-1 Disorder therapeutic areas within psychiatry US medical affairs. Dr. Nguyen received both his bachelors (physiology) and PhD (neuroscience) degrees from McGill University in Montreal, Quebec, Canada. Among his professional interests are how rates of bipolar-1 depression misdiagnosis may be reduced by improved screening of patients presenting for care with depressive symptoms.