Improving medical and psychiatric outcomes among individuals with bipolar disorder: A Randomized controlled trial

Objectives: Comorbid medical conditions, notably cardiovascular disease, occur disproportionately among persons with bipolar disorder; yet the quality and outcomes of medical care for these individuals are suboptimal. This pilot study examined a bipolar disorder medical care model ( BCM) and determined whether, compared with usual care, individuals randomly assigned to receive BCM care had improved medical and psychiatric outcomes. Methods: Persons with bipolar disorder and cardiovascular disease-related risk factors were recruited from a large Department of Veterans Affairs mental health facility and randomly assigned to receive BCM or usual care. BCM care consisted of four self-management sessions on bipolar disorder symptom control strategies, education and behavioral change related to cardiovascular disease risk factors, and promotion of provider engagement. Primary outcomes were physical and mental health-related quality of life; secondary outcomes included functioning and bipolar symptoms. Results: Fifty-eight persons participated. Twentyseven received BCM care, and 31 received usual care. The mean +/- SD age was 55 +/- 8 years, 9% were female, 90% were white, and 10% were African American. Repeated-measures analysis was used, and significant differences were observed between the two groups in change in scores from baseline to six months for the 12-Item Short-Form Health Survey ( SF-12) subscale for physical health ( t=2.01, df= 173, p=. 04), indicating that the usual care group experienced a decline in physical health over the study period. Change in SF- 12 scores also indicated that compared with the usual care group, the BCM group showed improvements in mental health - related quality of life over the six-month study period; however, this finding was not significant. Conclusions: Compared with usual care, BCM care may have slowed the decline in physical health - related quality of life. Further studies are needed to determine whether BCM care leads to longterm positive changes in physical and mental health - related quality of life and reduced risk of cardiovascular disease among persons with bipolar disorder.