Bakırköy Research and Training Hospital for Psychiatry, Neurology & Neurosurgery, Raşit Tahsin Mood Disorders Outpatient Unit, Istanbul, Turkey.
Psychiatr Danub. 2011 Jun;23(2):189-93.
Bipolar patients spend up to one third of their lives in depression however, acute treatment guidelines mainly focused on the manic phase of illness. With recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have emerged to aid clinicians in clinical decision making. Here, we aim to measure concordance with the Turkish Psychiatric Association Treatment Guideline for Bipolar Disorders (TPATGBD) for the depressive phase of illness.
Bipolar patients attending the Rasit Tahsin Mood Disorders Outpatient Unit of Istanbul Bakırköy Research and Training Hospital for Psychiatry, Neurolgy & Neurosurgery, were assessed using standardized forms based on a nation-wide mood disorders follow-up program. Concordance of implementations with the TPATGBD were evaluated step by step for each level of depression severity.
Concordance rates with the first step recommendations of the guideline were 29.4%, 27.4% and 87.5% for mild-moderate, moderate-severe (without psychosis) and severe depression (with psychosis), respectively. Concordance rates with the second step recommendations of the guideline were lower for bipolar depressions without psychosis. Overall, adherence to the guideline did not impact on time to remission (p=0.19).
Despite considerable efforts to develop and disseminate evidence-based guidelines, they are not widely followed by clinicians and important opportunities clearly exist to educate clinicians about the feasibility and utility of clinical guidelines for bipolar disorder. Systematic studies in the future are required to clarify our understanding of clinicians' attitudes to the use of guidelines and to explain the discrepancy between guidelines and clinical practice.
躁郁症患者有三分之一的时间处于抑郁状态，然而，急性治疗指南主要集中在疾病的躁狂阶段。随着精神病学中对循证医学重要性的关注，出现了许多治疗指南，以帮助临床医生做出临床决策。在这里，我们旨在衡量与土耳其精神病学协会躁郁症治疗指南（TPATGBD）对疾病抑郁阶段的一致性。
伊斯坦布尔 Bakırköy 精神病学、神经病学和神经外科研究和培训医院 Rasit Tahsin 情绪障碍门诊的双相情感障碍患者使用基于全国性情绪障碍随访计划的标准化表格进行评估。根据抑郁严重程度的各个级别，逐步评估实施与 TPATGBD 的一致性。
与指南第一步建议的一致性率分别为 29.4%、27.4%和 87.5%，分别为轻度中度、中度重度（无精神病）和重度抑郁（有精神病）。无精神病的双相抑郁患者对指南第二步建议的一致性率较低。总体而言，遵循指南并未影响缓解时间（p=0.19）。
尽管为制定和传播循证指南做出了相当大的努力，但临床医生并未广泛遵循这些指南，显然有必要向临床医生传授关于双相情感障碍临床指南的可行性和实用性的知识。未来需要进行系统研究，以澄清我们对临床医生使用指南的态度的理解，并解释指南与临床实践之间的差异。
