Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial

• Published in: British journal of psychiatry 2013-03, Vol.202 (3), p.212-219
• Main Authors: Kessing, Lars Vedel, Hansen, Hanne Vibe, Hvenegaard, Anne, Christensen, Ellen Margrethe, Dam, Henrik, Gluud, Christian, Wetterslev, Jørn
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Affective disorders; Aged; Ambulatory Care - economics; Ambulatory Care - methods; Ambulatory Care Facilities; Antimanic Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Antipsychotics; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - economics; Bipolar Disorder - therapy; Clinical research; Clinical trials; Clinics; Decentralization; Dementia; Denmark; Discharged; Emotional disorders; Female; Follow-Up Studies; Health Care Costs; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Hospitals, Psychiatric; Humans; Illnesses; Interdisciplinary aspects; Intervention; Male; Mania; Medical prognosis; Mental depression; Mental disorders; Middle Aged; Mood; Mood disorders; Outcome Assessment (Health Care) - statistics & numerical data; Patient admissions; Patient Discharge; Patient Education as Topic; Patient Satisfaction - statistics & numerical data; Patients; Psychiatry; Psychotherapy, Group - methods; Readmission; Recurrence; Time-to-Treatment; Validity; Young Adult
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.112.113548

Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. To assess the effect of treatment in a specialised out-patient mood disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. A total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37-0.97, P = 0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care. Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.