Concordance with Treatment Guidelines for Bipolar Disorder: Data from the Systematic Treatment Enhancement Program for Bipolar Disorder

Background: Concordance with evidence-based guidelines in the treatment of chronic mental disorders is typically low. This study assessed the degree of concordance with published treatment guidelines for bipolar disorder in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Potential demographic and clinical predictors of adherence were also examined.

Methods: STEP-BD psychiatrists participated in extensive training in evidence-based pharmacological management, focusing on published clinical practice guidelines. Recommended medications and dosing for each specific mood episode were extracted from published guidelines and combined into a Composite Guideline. Prescribed medication information for patients at the first visit of a prospectively observed new-onset mood episode (depressive, mixed, or hypomanic/manic) was then compared with guideline recommendations.

Results: The study included 964 STEP-BD patients, observed over 2 years, who experienced a prospectively observed episode (n = 716 depressive; n = 182 hypomanic/manic; n = 66 mixed). Guideline-concordant treatments were prescribed in 81.8% of mixed episodes, 81.9% of hypomanic/manic episodes, and 83.4% of depressive episodes—rates exceeding those previously reported in randomized controlled trials of guideline implementation. Younger age of onset and receipt of adequate pharmacotherapy at STEP-BD entry predicted higher likelihood of receiving guideline-concordant care.

Conclusions: The use of guideline-concordant pharmacological treatments in STEP-BD was substantially higher than previously reported, suggesting that structured training and systematic approaches may improve adherence to evidence-based practices.