ABSTRACT
The aim of the current cross-sectional study was to estimate the prevalence of religious and spiritual (R/S) experiences and their perceived lasting influence in outpatients with bipolar disorder (BD; n = 196). A questionnaire with a range of R/S was constructed, building on the results of an earlier qualitative study. Experiences of horizontal transcendence (not necessarily referring to the divine) such as the experience of "intense happiness, love, peace, beauty, freedom" (77%) or "meaningful synchronicity" (66%) were the most prevalent. The experience of "divine presence" (vertical transcendence, referring to the divine) had a prevalence of 44%. Perceived lasting influence of the experiences was 20% to 67% of the total frequency, depending on the type. Most positive R/S experiences were significantly more related to BD I and mania, and on average, persons with BD I had more R/S experiences (mean = 4.5, SD = 2.6) than those with BD II (mean = 2.8, SD = 2.4, p = 0.000). Patient-reported R/S experiences in BD can have both R/S and pathological features.
Subject(s)
Bipolar Disorder/physiopathology , Religion and Psychology , Adult , Bipolar Disorder/epidemiology , Cross-Sectional Studies , Female , Hospitals, Psychiatric , Humans , Male , Middle Aged , Netherlands/epidemiology , Outpatient Clinics, Hospital , PrevalenceABSTRACT
BACKGROUND: Bipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands. METHODS/DESIGN: The study concerns a two-armed cluster randomised clinical trial to evaluate the effectiveness of Collaborative Care (CC) in comparison with Care as usual (CAU) in outpatient clinics for bipolar disorder or mood disorders in general. Collaborative Care includes individually tailored interventions, aimed at personal goals set by the patient. The patient, his caregiver, the nurse and the psychiatrist all are part of the Collaborative Care team. Elements of the program are: contracting and shared decision making; psycho education; problem solving treatment; systematic relapse prevention; monitoring of outcomes and pharmacotherapy. Nurses coordinate the program. Nurses and psychiatrists in the intervention group will be trained in the intervention. The effects will be measured at baseline, 6 months and 12 months. Primary outcomes are psychosocial functioning, psychiatric symptoms, and quality of life. Caregiver outcomes are burden and satisfaction with care. DISCUSSION: Several ways to enhance the quality of this study are described, as well as some limitations caused by the complexities of naturalistic treatment settings where not all influencing factors on an intervention and the outcomes can be controlled. TRIAL REGISTRATION: The Netherlands Trial Registry, NTR2600.
Subject(s)
Ambulatory Care Facilities/organization & administration , Bipolar Disorder/drug therapy , Bipolar Disorder/therapy , Cooperative Behavior , Mental Health Services/organization & administration , Adolescent , Adult , Aged , Caregivers/psychology , Clinical Protocols , Cost-Benefit Analysis , Humans , Male , Middle Aged , Mood Disorders/drug therapy , Mood Disorders/therapy , Netherlands , Outcome and Process Assessment, Health Care/methods , Patient Education as Topic , Patient Participation , Psychiatric Status Rating Scales , Secondary PreventionABSTRACT
BACKGROUND: The aim of this study is to examine both long-term efficacy of electroconvulsive therapy (ECT) and the predictive value of adequate pre-ECT pharmacotherapy and the presence of delusions in relation to post-ECT relapse in patients who suffered from DSM-III-R major depression. METHOD: Forty responders (a decrease in Hamilton Rating Scale for Depression score > or = 50%) to ECT were followed for 1 year, the majority (N = 28) prospectively and the remainder (N = 12) retrospectively. Relapse was defined as readmission, an obvious decline in social functioning, or a change of antidepressant medication caused by a clear worsening of depressive symptoms. RESULTS: Both 6- and 12-month post-ECT relapse was significantly lower in patients with delusional depression compared with nondelusional patients: 3/24 (12%) versus 8/15 (53%) and 5/24 (21%) versus 11/15 (73%), respectively. Relapse rates for the whole sample were 11/39 (28%) at 6 months and 16/39 (41%) at 12 months. Regarding the impact of adequate pre-ECT antidepressant trials on relapse, our data are inconclusive, because only a few patients did not receive adequate pharmacotherapy prior to ECT. CONCLUSION: The remarkable finding of the present study is the favorable 1-year outcome for patients with delusional depression. The relapse rate for patients adequately pretreated with anti-depressants (45% over 1 year) is somewhat more favorable than expected.
