Faculty

Leslie Citrome, MD, MPH
Clinical Professor of Psychiatry & Behavioral Sciences
New York Medical College
Valhalla, NY

Joseph F. Goldberg, MD
Clinical Professor of Psychiatry
Mount Sinai School of Medicine
New York, New York
Director
Affective Disorders Research Program
Silver Hill Hospital
New Canaan, Connecticut

Terence Ketter, MD
Professor of Psychiatry & Behavioral Sciences
Stanford University School of Medicine
Chief, Bipolar Disorder Clinic
Stanford University Medical Center
Stanford, California

Target Audience

The educational design of this activity addresses the needs of psychiatrists and other health care professionals involved in the treatment of patients with bipolar disorder.

Statement of Need/Program Overview

A progressive and chronic illness, bipolar disorder is one of the leading causes of disability worldwide.1,2 It is a common psychiatric disorder, with a lifetime prevalence of 1% and 1.1% for type I and type II bipolar disorder, respectively.1,2 While the exact etiology and pathogenesis of bipolar disorder are not known, several psychological, social, and biologic determinants have been identified.3 Characterized by unpredictable swings in mood from mania (or hypomania) to depression, affected patients suffer from significant interpersonal, social, and occupational dysfunction.4,5 Although bipolar disorder is often discussed in terms of the hallmark manic periods, patients usually spend more time in depressive phases, which account for majority of the illness burden.6 Moreover, depressive phases are linked to the highest risks for morbidity and suicide.7 Thus, early diagnosis and prompt treatment are critical. Unfortunately, misdiagnosis rates are unacceptably high and patients with bipolar disorder often wait a decade or more before receiving a correct diagnosis.8-10 The most common misdiagnosis is unipolar depression—a particularly inappropriate conclusion given that antidepressants are often ineffective and potentially deleterious when treating bipolar depression. Once an accurate diagnosis of bipolar disorder has been established, the primary goal of treatment is to alleviate acute symptoms as quickly as possible, and then sustain remission and prevent relapse.11 Treatment can be difficult and complex; the spectrum of therapeutic options for bipolar depression has recently grown and additional approaches are in late-stage development, providing a vital area for clinical education.12 This eHealth Source™ will focus on the pathophysiology, differential diagnosis, and long-term management of bipolar disorder, focusing on the profoundly disabling periods of depression. Expert faculty will address recommendations to improve diagnostic accuracy as well as individualization of multimodal treatment regimens that reflect the efficacy, safety, and tolerability of current and emerging therapies for bipolar depression.

References

  1. Murray CJ, Lopez AD. Evidence-based health policy--lessons from the Global Burden of Disease Study. Science. 1996;274:740-743.
  2. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007;64:543-552.
  3. Malhi GS, Adams D, Lampe L, et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand Suppl. 2009:27-46.
  4. Rosa AR, Reinares M, Michalak EE, et al. Functional impairment and disability across mood states in bipolar disorder. Value Health. 2010;13:984-988.
  5. Morgan VA, Mitchell PB, Jablensky AV. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Bipolar Disord. 2005;7:326-337.
  6. Glauser TA, Cerenzia W, Wiley S, Howson A, Thase M. Identifying psychiatrists' practice patterns when managing depression in patients with bipolar I disorder: a descriptive study to inform education needs. Postgrad Med. 2013;125:144-153.
  7. Beyer JL, Kuchibhatla M, Payne ME, et al. Hippocampal volume measurement in older adults with bipolar disorder. Am J Geriatr Psychiatry. 2004;12:613-620.
  8. Hirschfeld RM, Calabrese JR, Weissman MM, et al. Screening for bipolar disorder in the community. J Clin Psychiatry. 2003;64:53-59.
  9. Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, et al. Diagnostic stability of psychiatric disorders in clinical practice. Br J Psychiatry. 2007;190:210-216.
  10. Drancourt N, Etain B, Lajnef M, et al. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatr Scand. 2013;127:136-144.
  11. Proudfoot J, Doran J, Manicavasagar V, Parker G. The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review. J Affect Disord. 2011;133:381-387.
  12. Barnett JH, Smoller JW. The genetics of bipolar disorder. Neuroscience. 2009;164:331-343.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Describe the latest insights into the pathologic mechanisms of bipolar disorder and shifts between mood states
  • Differentially diagnose unipolar and bipolar depression
  • Discuss evidence-based recommendations and emerging options for the treatment of bipolar depression
  • Individualize multimodal therapeutic regimens for bipolar depression that target symptom remission based on comprehensive psychiatric histories, functional impairment, and treatment responses

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Obtaining Credit

In order to receive credit, participants must complete the pre-activity questionnaire, post-test and program evaluation. Participants must also score at least a 70% on the post-test.

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Web browser (Safari, Chrome, FireFox, etc.)

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Web browser (Safari, Chrome, FireFox, etc.)

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Leslie Citrome, MD, MPH
Consultant/Independent Contractor: Alexza, Alkermes, Bristol-Myers Squibb, Eli Lilly, Envivo, Forest, Genentech, Janssen, Lundbeck, Merck, Mylan, Novartis, Noven, Otsuka, Pfizer, Reckitt Benckiser, Sunovion; Speaker's Bureau: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Otsuka, Pfizer, Sunovion; Other/Royalty: Stock: Bristol-Myers Squibb, Eli Lilly, J&J, Merck, Pfizer

Joseph F. Goldberg, MD
Consultant/Independent Contractor: Avanir, Mylan Pharmaceuticals; Honoraria: Medscape, WebMD; Speaker's Bureau: AstraZeneca, Merck, Mylan, Novartis, Sunovion; Other/Royalty: American Psychiatric Publishing, Inc. (Book Royalties)

Terence Ketter, MD
Grant/Research Support: Agency for Healthcare Research and Quality, Sunovion Pharmaceuticals, Teva Pharmaceuticals; Consultant: Teva Pharmaceuticals; Lecture Honoraria: Abbott Laboratories, GlaxoSmithKline, Otsuka Pharmaceuticals; Royalties: American Psychiatric Publishing, Inc. (Book Royalties); Employee: Janssen Pharmaceuticals (Nzeera Ketter, MD, Spouse); Stock: Janssen Pharmaceuticals (Nzeera Ketter, MD, Spouse)

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Ashley Marostica, RN, MSN - Nothing to disclose
Amanda Glazar, PhD - Nothing to disclose
Jim Kappler, PhD - Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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