Abstract
Bipolar disorder often goes undetected and undertreated in clinical practice. Recently, consensus guidelines have been published in many countries for the better recognition and management of the illness [1],[2]. Expert opinions are hoped to compensate for the gaps in the empirical database.
In Finland, a national consensus guideline for bipolar disorder is in preparation. Earlier, a nationwide questionnaire survey on treatment practices of bipolar disorder was carried out. In the questionnaire, 41 items focused on maintenance treatment. The questionnaires were mailed to all clinicians employed in adult psychiatry in Finnish psychiatric hospitals. A 3-month response time was set, and two reminders were sent during this period.
The effective response rate was 62% (139/225). Of the responders, 77 (55%) were female, 59 (43%) were psychiatric residents, 56 (40%) psychiatrists and 24 (17%) general practitioners. The mean (SD, range) length of experience in clinical practice was 12 (7.8, 0–30) years and in psychiatry 7.7 (6.9, 0–30) years. The mean age (SD, range) was 39.5 years (7.9, 24–60) for the responders and 42.6 years (8.9, 22–63) for the non-responders (p = 0.007). No statistically significant gender difference between the two groups was found. Both the responders and the non-responders were evenly distributed over the different hospital districts in Finland.
Twenty-one per cent of clinicians recommended a mood stabilizer after one manic episode (54%, if the patient had positive family history), 67% after two manic episodes and 2% after three manic episodes. In bipolar II disorder, only 31% of clinicians suggested that a mood stabilizer should be used almost always with an illness history of several hypomanias and bipolar depressions. If the patient had a positive family history and rapid cycling or induction of hypomania/mania associated with the use of an antidepressant, 26, 42 and 24% of clinicians favoured a mood stabilizer, respectively.
Finnish psychiatrists seem to have a moderate formal knowledge of the contemporary guideline recommendations, which is a reason for concern. Our bipolar patients seem to be at risk of a low levelofadequate pharmacotherapy. The continuous education of clinicians is needed to narrow the gap between guideline recommendations, research evidence and clinical practices.