The Changing Face of Bipolar Care: Initial Results of the MedRisk Study

Study looks at an integrated care model for treating bipolar depression that incorporates a multidisciplinary care team, individualized lifestyle interventions, focused patient education, weight loss and nutrition counseling, and efforts to promote treatment adherence.

One thing is clear when it comes to bipolar patients: they need some kind of treatment in order to live a more peaceful life. Unfortunately, as noted by Ellen Frank, PhD, Distinguished Professor of Psychiatry and Psychology, Department of Psychiatry, University of Pittsburgh School of Medicine, bipolar patients are at high risk for a variety of comorbid diseases, including heart disease, diabetes, and high blood pressure, that can shorten their life span by as much as 25 years. While it is unclear how large an impact genetics has in bipolar individuals or the extent to which it affects the medications for bipolar disorder those patients take, Frank theorizes both can contribute to the medical comorbidities that are being seen in bipolar patients across the board.

Frank believes the answers to treating not only bipolar disorder but also the medical diseases associated with it may be found in a new integrated care model designed from the MedRisk study. The model, the study in which it was created, and the first round of initial results were presented for the first time during a morning session of the second day at the 2013 NEI Psychopharmacology Congress.

The model is simple. Clinicians participate in a multi-disciplinary treatment team that includes a certified registered nurse practitioner (CRNP), an internist, a lifestyle coach, and a psychiatrist. Frank particularly stressed the importance of having a CRNP as highly useful in helping bipolar patients communicate with their primary care doctor. The integrated care model also addresses, “individualized lifestyle interventions,” aimed at reducing the risk factors for medical diseases by providing healthy sleep-wake and social rhythm practices, more bipolar disorder psychoeducation, weight loss support through proper nutrition and activity and decreased caloric intake, as well as smoking cessation when indicated.

However, Frank warned clinicians to tread extremely carefully should they ever encourage their patients to stop smoking due to the fact that withdrawal from smoking can trigger a rapid decline in patients and an increase in suicidality. Frank said there was also an increased effort by clinicians in the integrated care model to get bipolar patients to adhere to both medical and psychiatric treatments.

The MedRisk study enrolled 114 euthymic patients with Bipolar 1 disorder and randomly assigned them to either an integrated care experimental group (IRRI) or the control group (PCMM) in which patients simply received psychiatric care with medical monitoring. To be eligible for participation, patients had to have a BMI of 25 or greater and have been in remission (YMRS <7) for at least four weeks. Acute intervention was assessed at six months and follow-up care results will be taken at the end of 18 months. The initial assessment by researchers at six months already illustrates positive lifestyle changes happening to bipolar patients. While participants in either the experimental or control group did not differ in regards to depression level, mania level, or functioning at six months, the experimental IRRI group was associated with a larger reduction in BMI allowing them to lose a moderate amount of weight.

While results and assessments for the study are still being compiled, Frank said she hopes the future of bipolar care is to have a, “psychopharmacological management that takes risks and diseases into account,” in terms of a whole-patient bipolar approach.