Sample Abstract
Abstract below is several years old
Enhanced Clinical Intervention (ECI): A manualized disease management
strategy for bipolar disorder. First results from the Bipolar Disorder Center for
Pennsylvanians study
a a b a a a a
E Frank , A Fagiolini , S Turkin , PR Houck , A Fasiczka , W Thompson , VJ Grochocinski , I
a a a
Soreca , H Cheng , DJ Kupfer
a
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA,
b
USA, Dubois Regional Medical Center, Dubois, PA, USA
Introduction: The Bipolar Disorder Center for Pennsylvanians (BDCP) study is a multi-center
randomized controlled study involving subjects with bipolar disorders of age 12 to 84, conducted between
2003 and 2007. The purpose of BDCP is to investigate ways to reduce health disparities related to
bipolar disorder, with special attention to those populations, such as African American patients, who are
at higher risk of not being appropriately diagnosed or treated.
Methods: The BDCP study tested the effectiveness of a new manualized disease management
intervention for Bipolar Disorder: the Enhanced Clinical Intervention (ECI). ECI is a manualized system of
education and clinical management and consists of consists of 10 basic components. 1) education about
the mood disorder itself, 2) education about medications used to treat the disorder, 3) education about
basic sleep and social rhythm hygiene and 4) education regarding the use of rescue medication. 5)
careful review of symptoms, 6) a careful review of side effects, 7) medical and behavioral management of
side effects, 8) discussion of early-warning signs of impending episodes, 9) 24-hour on-call service and
10) non specific support. This paper reports on the change in Clinical Global Impression-Bipolar Disorder
score that we observed in the first 348 subjects who completed one year of treatment as part of the
BDCP study after being randomized to either pharmacotherapy alone or pharmacotherapy plus ECI.
Results: An ordinal logistic model using cumulative logits modeling CGI score after 1 year of ECI or non-
ECI treatment, covarying for baseline CGI score, found a significant race by treatment interaction
(p=.027), with the non-Caucasian patients showing a particularly favorable response to ECI, and found a
significant age by treatment interaction (p=.0084), with the adult patients showing the most benefit from
ECI. Of note, 90% of the study non-Caucasian patients were African American (73%) or biracial (17%).
Discussion: Enhanced Clinical Intervention, delivered on a background of standardized
pharmacotherapy, appears to be particularly beneficial to African American patients and to the adult
population.
Key Words: Bipolar, Psychotherapy, Enhanced Clinical Intervention, Psychosocial