Bipolar Disorder Across the Spectrum: Novel Screening Tools and Treatment Options

Bipolar disorder, previously known as manic depression, is a serious mental illness associated with extreme mood swings and manic/hypomanic episodes that interfere with an individual’s ability to fully function on a day-to-day basis. The spectrum of bipolar disorder includes bipolar I disorder, which involves periods of severe mood episodes ranging from mania to depression, and bipolar II disorder, in which patients may alternate between severe depression and hypomania, but do not experience manic symptoms. Identifying patients within the bipolar disorder spectrum is exceptionally challenging, leading to high rates of misdiagnosis with significant consequences for morbidity and mortality. Moreover, screening tools for bipolar disorder have important limitations that can substantially hinder their effectiveness. Treatment of bipolar disorder is no less challenging, and optimal management strategies for patients within differing segments of the spectrum have not yet been identified. To address this challenge, the bipolar disorder treatment armamentarium is evolving, and several agents with novel mechanisms of action are available or under investigation for the management of diverse symptom domains, while others have received critical indication updates that have broadened their treatment potential. Unfortunately, data show that psychiatrists and other healthcare professionals may be unaware of these critical updates to the treatment landscape. Thus, psychiatrists and allied clinicians require continuing education to improve the proper diagnosis of BD and minimize diagnostic delay via enhanced clinician knowledge of disease manifestation across the spectrum as well as the implementation of tools for accurate identification. Additionally, healthcare professionals require education on newly approved and investigational medications for patients who are burdened by bipolar disorder to improve outcomes. This educational curriculum was designed to meet learning objectives associated with bipolar disorder identification and treatment. After completing the education, clinician learners were expected to be able to: • Describe tactics to differentiate and identify bipolar disorder and its manifestations across the spectrum of symptomatology; • Evaluate the benefits and drawbacks of traditional and newer screening scales used for bipolar identification and effectively incorporate appropriate screening scales into clinical care; • Analyze treatment targets for the most recently updated and emerging bipolar disorder medications and their implications for comprehensive patient care; and • Apply updated knowledge regarding bipolar diagnosis and management to real-world treatment plans. Throughout the curriculum, significant increases were demonstrated across survey questions designed to assess knowledge and competence in clinician behavior and practice. Nearly every surveyed learner indicated that the activities increased their knowledge on the topic of bipolar disorder and noted that the activities increased their confidence. In particular, clinician learners increased their knowledge on the identification/diagnosis of bipolar disorder as well as the most recently updated/emerging BD medications and their implications for comprehensive patient care. Overall, the most significant ongoing barriers to optimal bipolar disorder management include the identification/diagnosis and treatment of patients within differing segments of the bipolar disorder spectrum. Clinicians displayed low levels of knowledge regarding the specific symptomology of bipolar I disorder as well as the pharmacology of newer medications, including approved indications of the novel combination agent olanzapine + samidorphan. Nonetheless, after the educational interventions, learners were less likely to indicate a lack of knowledge, potentially indicating some educational success. However, further education on these topics is likely warranted.