Measure:

Bipolar Disorder: Monitoring change in symptom complex

Summary:

This measure assesses the percentage of patients diagnosed and treated for bipolar disorder who are monitored for change in their symptom complex within 12 weeks of initiating treatment.

Clinical Rationale:

Acute Treatment Phase and Remission

• Recovery includes remission of symptomatology, functional recovery, prevention of relapse or recurrence and improved quality of life (1)
• The 2002 APA Practice Guideline for the Treatment of Patients with Bipolar Disorder states that the goal of acute treatment is stabilization of the episode with the goal of remission, defined as “a complete return to baseline level of functioning and a virtual lack of symptoms”

Bipolar Disorder and Response to Treatment

• The mood episodes of bipolar disorder are delineated in DSM-IV by symptomatology; therefore, diagnosing and assessing response to treatment involves symptom monitoring
• As defined by Tohen (2)  improvement in bipolar disorder involves two concepts involving symptoms; syndromal recovery, a sustained symptomatic recovery lasting for 8 weeks and symptomatic remission, a more stringent concept that is defined as a more symptom-free state (1,2)

Monitoring Symptomatology

• Recognizing and monitoring signs and symptoms of manic and depressive symptoms is critical in assessing patient status (3)
• The use of a graphic display or timeline of mood symptoms can be helpful in identifying early or recurrent signs or symptoms and in involving the patient in treatment (4)

Denominator Population:

Patients diagnosed and treated for bipolar disorder

Data Sources:

• Administrative data
• Medical Record

Numerator Population:

Patients who were assessed for change in their symptom complex, using a validated tool or a monitoring form, within 12 weeks of initiating treatment for bipolar disorder

Data Source:

• Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder
ICD9-CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13

STABLE Resource Toolkit:

The following tools are recommended by the STABLE National Coordinating Council for use in assessing the risk of suicide.  The tools are available in the corresponding section of the STABLE Resource Toolkit.

• Altman Self Rating Scale for Mania – Clinician scored instrument
• Self Report Form for Mood Episodes – “Waiting Room” self-report tool, includes symptoms
• Symptom Monitoring Flow Chart: Brief documentation tool for office-based practice

References:

1. Harvey P, Defining and Achieving Recovery From Bipolar Disorder, J Clin Psychiatry 2006; 67 (suppl 9) 14-18
2. Tohen M, Zarate CA Jr, Hennen J, et al.; The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J psychiatry 2003; 160: 2099-2107
3. Keck PE, Defining and Improving Response to Treatment in Patients With Bipolar Disorder; J Clin Psychiatry 2004; 65 (suppl 15) 25-29
4. Post RM, Roy-Byrne PP, Uhde TW: Graphic representation of the life course of illness in patients with affective disorder. AM J Psychiatry 1988; 145: 844-848