Bipolar Disorder: Differential Diagnosis and Evidence-based Treatment Strategies (CME/Physicians)
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This CME/CPE activity is jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, the College of Psychiatric and Neurologic Pharmacists (CPNP), and Asante Communications, LLC.
This supplement was submitted by Albert Einstein College of Medicine, Montefiore Medical Center, CPNP, and Asante Communications, LLC, and supported by educational grants from Eli Lilly and Company and Janssen, Division of Ortho-McNeil- Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs. It was peer reviewed by Current Psychiatry.
PLEASE NOTE: For instructions to complete the posttest and evaluation for print journal supplement version of the Bipolar Disorder: Differential Diagnosis and Evidence-based Treatment Strategies, please see “Method of Participation” below.
The goal of this knowledge-based activity is to update healthcare professionals on current strategies for the accurate differential diagnosis, evidence-based treatment, and management of patients with bipolar disorder (BD).
This activity is intended for physicians, pharmacists, and other healthcare professionals who diagnose and treat patients with BD.
There are no prerequisites for this educational activity.
Statement of Need
BD is a chronic illness requiring long-term treatment to avoid relapse of symptoms and to improve quality of life. The assessment and diagnosis of BD present distinct challenges to psychiatrists. It is estimated that 69% of people with BD have been misdiagnosed; most notably, patients with BD have received a mean of 3.5 other diagnoses and have consulted 4 physicians before being accurately diagnosed.1
Adequate assessment and diagnosis of BD is a pressing area of educational need. Overdiagnosis, or unnecessary diagnosis of BD in patients who do not actually have the disorder, is also a problem. In one survey of patients with BD, more than one-third of patients reported waiting for 10 years or more before receiving a correct diagnosis.1 An oversight of diagnostic criteria may also contribute to the inaccurate diagnoses and thus inappropriate treatment of affected individuals. Indeed, these gaps represent a clear need for further education.
BD is a common and serious condition that can be managed with appropriate multimodal treatment; however, patients often receive inadequate treatment. Several guidelines have been published, but a recent survey suggests that 34% of psychiatrists do not use treatment guidelines when managing this patient population and that 24% misinterpret the results of clinical trials.2 Healthcare professionals could thus benefit from clinical education on the importance of appropriate diagnosis, early intervention, evidence-based strategies for nonpharmacologic and pharmacologic treatment, and long-term multidisciplinary management of patients. Accordingly, this multimedia educational activity was designed to place clinicians, pharmacists, and related healthcare providers in a better position to improve outcomes for patients with BD.
Growing evidence suggests that early, accurate diagnosis of BD and appropriate pharmacologic intervention can improve patient outcomes and provide neuroprotective benefits. Clinicians can benefit from a review of current and emerging nonpharmacologic and pharmacologic treatment options for BD, with an emphasis on use of guidelines and evidence-based recommendations. Further, knowledge of pharmacokinetic and pharmacodynamic profiles of different agents will help clinicians individualize patient therapy. Information on monitoring for efficacy, safety, adherence, function, and comorbidities is also critical to effective long-term management. Focused educational efforts in diagnosis and therapeutic treatment can help optimize healthcare provider performance and improve patient function and quality of life.
At the completion of this initiative, participants should be better prepared to:
- Conduct a differential diagnosis of BD based on a comprehensive and ongoing patient assessment
- Discuss the importance of early diagnosis and pharmacologic intervention
- Design and implement individualized, multimodal, patient-centered treatment plans that draw from available guidelines and evidence, as well as the pharmacokinetic and pharmacodynamic characteristics of available medications
- Monitor and adjust patient-based treatment plans over time to optimize treatment adherence and response
- Identify, monitor, and manage adverse effects
Accreditation Statement and Credit Designation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine, Montefiore Medical Center, the College of Psychiatric and Neurologic Pharmacists (CPNP), and Asante Communications, LLC. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education (CME) for physicians.
Albert Einstein College of Medicine designates this educational activity for a maximum of 1.25 American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity.
Online Activity Instructions: To qualify for a certificate of CME credit for this activity, please follow the 5-step Activity Progress menu above:
- Review the accompanying CME information and activity instructions. Click “Continue Activity” below the faculty listings at right to proceed.
- Complete the 5-question pre-questionnaire by selecting the most accurate answers. These questions are not graded. Click “Continue” at page bottom to proceed.
- Review the written compendium (full-screen viewing available). Please note that review of the accompanying video commentaries is optional and not required for CME credit; these case study commentaries by the program faculty are provided strictly to supplement the written compendium content. Click “Continue” at page bottom to proceed.
- Complete the 5-question post-activity questionnaire by selecting the most accurate answers. These questions are not graded. Click “Continue” at page bottom to proceed.
- Complete the 10-question multiple-choice posttest by selecting the most accurate answers. To receive a CME certificate of credit, a score of 70% or greater correct answers is required. If your initial score is less than 70%, you will automatically have a second opportunity to review the compendium content and retake the posttest. Upon successful completion of the post-test, you will be prompted to complete an activity evaluation form and then indicate the total time required to complete the activity (maximum of 1.25 hours/credits is available) and generate/print your CME certificate for your records. A copy of your certificate will be retained in your online profile (accessible at upper right of webpage after logging on).
Print Journal Supplement Instructions: Participants who have reviewed the printed journal supplement version of this activity should complete the following steps of the Activity Progress menu above to qualify for a certificate of CME credit:
- Review the CME information, activity instructions and written content for the printed journal supplement version of this compendium. To qualify for a certificate of credit, log on to this web page and proceed to step two below.
- Click on the “Get Credit” icon in the Activity Progress menu above. Complete the 10-question multiple-choice posttest by selecting the most accurate answers. To receive a CME certificate of credit, a score of 70% or greater correct answers is required. If your initial score is less than 70%, you will automatically have a second opportunity to review the compendium content and retake the posttest. Upon successful completion of the post-test, you will be prompted to complete an activity evaluation form and then indicate the total time required to complete the activity (maximum of 1.25 hours/credits is available) and generate/print your CME certificate for your records. A copy of your certificate will be retained in your online profile (accessible at upper right of webpage after logging on).
Conflict of Interest Statement
The Conflict of Interest Disclosure Policies of Albert Einstein College of Medicine and CPNP require that faculty participating in any CME/CPE activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Faculty whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to participate.
Albert Einstein College of Medicine and CPNP also require that faculty participating in any CME/CPE activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
Faculty and reviewers of this program have indicated the following disclosure information:
Christoph U. Correll, MD Has provided consultant services for Actelion Pharmaceuticals US, Inc., AstraZeneca, Boeheringer Ingelheim, Bristol-Myers Squibb, Cephalon, Inc., Eli Lilly and Company, GlaxoSmithKline plc, Hoffmann La-Roche Ltd., Intra-Cellular Therapies Inc., Janssen Pharmaceutica LP, Johnson & Johnson, Lundbeck A/S, Medicure Inc., Otsuka America Pharmaceutical Inc., Pfizer Inc, Schering-Plough Corporation, Sepracor/Sunovion Pharmaceuticals Inc., Supernus Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, and Vanda Pharmaceuticals.
Matthew A. Fuller, PharmD, BCPS, BCPP, FASHP Has no conflict of interest(s) to report.
Roger S. McIntyre, MD, FRCPC Has provided consultant and/or advisory board services for AstraZeneca, Biovail Corporation, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline plc, Janssen-Ortho Inc., Lundbeck A/S, Organon International, Pfizer Inc, Schering-Plough Corporation, Shire, and Solvay/Wyeth. He has received research grant support from Eli Lilly and Company, Janssen-Ortho Inc., and Shire. He has participated in the speakers’ bureaus for AstraZeneca, Biovail Corporation, Eli Lilly and Company, Janssen-Ortho Inc., Lundbeck A/S, and Wyeth.
The staff of Albert Einstein College of Medicine and Montefiore Medical Center, Center for Continuing Medical Education (CCME), the staff of CPNP, and the staff of Asante Communications, LLC, have no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
Adrienne Drinkwater, PhD, scientific consultant for Asante Communications, LLC, has no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
Steven Jay Feld of Albert Einstein College of Medicine, or a member of his household, owns securities in Bioheart, Inc., Chelsea Therapeutics, Inc., and Pharmacopeia, Inc.
© 2010 Albert Einstein College of Medicine, Montefiore Medical Center, the College of Psychiatric and Neurologic Pharmacists, and Asante Communications, LLC. All rights reserved. No part of this syllabus may be used or reproduced in any manner without written permission except in the case of brief quotations embedded in articles or reviews.
1. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161-174.
2. Perlis RH. Use of treatment guidelines in clinical decision making in bipolar disorder: a pilot survey of clinicians. Curr Med Res Opin. 2007;23:467-475.