Northern and Yorkshire Autumn Conference
Review
30 September 2011 at Darlington Football Club - Bipolar
Disorder
Dr Andrew Lawrie, Elected Member,
Northern and Yorkshire Division
The theme for this
Conference – Bipolar Disorder – was timely. One of the
biggest changes in Adult Community Teams has been the rise in
referrals for the assessment of possible Bipolar Disorder. In
the 1990’s Bipolar Disorder was under-recognised, articles such as
Des Spence’s “Bad medicine” (BMJ) question whether the pendulum has
swung too far such that clinicians are over-diagnosing. This
issue is not confined to professionals – a recent American study
reported that 75% of patients self-diagnosing did not reach
research criteria for Bipolar Disorder. The issue has no
doubt been fuelled by frequent media articles and celebrities
declaring their Bipolar Disorder diagnosis. How to best set
up services to deal with these issues and what treatments to
provide having made a diagnosis are interesting topics for
debate.
The Conference programme
was designed and chaired by Professor Simon Gilbody (Academic
Secretary). Starting off was Professor Jan Scott who provided
an interesting and thought provoking talk on whether early
intervention could be applied to Bipolar Disorder. She
described how preventative strategies have traditionally focused on
patients with Schizophrenia, despite Bipolar Disorder being ranked
above Schizophrenia on the global burden of disease and the
duration of untreated illness in Bipolar Disorder averaging 9.6
years. She discussed different ways services could be
redesigned to address these problems, concluding that replicating
EIP Services for Bipolar Disorder was probably not the solution,
but revisiting referral criteria from Primary Care (e.g. to include
patients with recurrent episodes from an earlier age) could be
helpful. Finally, when a member of the audience asked if it
was okay that they spend more time telling people that they have
not got Bipolar Disorder, Jan somewhat helpfully and reassuringly
answered simply “yes”.
Next to speak was
Professor Heinz Grunze who provided a comprehensive update on the
evidence of pharmacological interventions. He compared the
good evidence base for the rapid and effective treatment of acute
mania with the more limited evidence base for treating Bipolar
Depression. He pointed out the role of anti-depressants in
treating Bipolar Depression remains controversial, but reassuringly
the risks of manic switch are low in the “vast majority”. He
described the evidence base for other treatments for Bipolar
Depression, particularly Quetiapine and the combination of
Olanzapine and Fluoxetine. He then took us through some of
the complexities of maintenance treatment concluding that efficacy
in the acute phase is a good predictor of prevention, that
treatment choice depends on what best fits the individual patient
(with differences in preventing depression versus mania) and that
combination treatment may be superior but requires more
evidence.
In the final lecture, Dr
Daniel Smith (Clinical Senior Lecturer) discussed possible ways
forward in improving the diagnosis of Bipolar Disorder by linking
classification with treatment and he posed the question “are we
under-diagnosing Bipolar Disorder?”. He discussed the
difficulties with current classification systems, pointing out that
very few patients with Bipolar Disorder present “classically” and
that the separation between Unipolar and Bipolar does not reflect
the heterogeneous population we see in clinical practice. He
described three alternative approaches that researchers are
currently developing (staging, system clusters and a dimensional
approach). He went on to present various pieces of evidence
indicating that Bipolar Disorder is indeed under-diagnosed, though
whether this matters with regards to outcome is less clear.
Dr Smith’s talk was most useful in challenging the way we think
about mood disorders.
Feedback from the
audience indicates that the Conference was a great success.
For more information about the speakers and
workshop facilitators please click this
link
For a delegate evaluation of the conference
please click
this link
For copies of presentations please click the
links below. Please note that not all presenters have given
permission to access their presentations. If there is a
particular presentation not available here you may wish to contact
the presenter personally.