Reducing Medical Risks in Individuals With Bipolar Disorder - Full Study - Full Text View

Purpose

The primary aim of this project is to understand whether it is possible to reduce medical risk factors in adults with bipolar disorder and, in doing so, to improve psychiatric and functional outcomes. We will examine the role of behavioral risk factors and presumed behavioral mediators and moderators of health risk in individuals suffering from bipolar I disorder. The investigators will employ an innovative behavioral intervention with guideline based psychiatric care ( Integrated Risk Reduction Intervention - IRRI) in order to target modifiable medical risk factors.

Condition	Intervention
Bipolar I Disorder	Behavioral: IRRI Behavioral: PCCM


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Reducing Medical Risks in Individuals With Bipolar Disorder - Full Study

Resource links provided by NLM:

MedlinePlus related topics: Bipolar Disorder

U.S. FDA Resources

Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:

Integrated risk reduction intervention (IRRI), compared with psychiatric care with medical monitoring, will result in a larger decrease in medical risk factors and a greater improvement in sleep/wake and social rhythm disturbances. [ Time Frame: Entry and every 6 months of participation for two years ] [ Designated as safety issue: No ]
Integrated risk reduction intervention compared with psychiatric care with medical monitoring will result in greater improvement in mood symptoms and functioning, particularly employment-related functioning. [ Time Frame: Entry and every 6 months of participation for two years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

The effect of integrated risk reduction intervention on improved mood symptoms and functioning will be mediated by the effect of integrated risk reduction intervention on medical risk factors and on sleep/wake and social rhythm disturbances. [ Time Frame: 6, 12, and 18 month timepoints of participation ] [ Designated as safety issue: No ]
In turn, the effect of integrated risk reduction intervention on medical risk factors and on sleep/wake and social rhythm disturbances will be mediated by the regular participation and adherence of the subject to integrated risk reduction intervention. [ Time Frame: This is assessed by how many missed appointments the subject has for IRRI ] [ Designated as safety issue: No ]


Enrollment:	122
Study Start Date:	September 2008
Study Completion Date:	September 2013
Primary Completion Date:	September 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: IRRI The integrated risk reduction intervention (IRRI) consists of three components: psychiatric treatment by a study psychiatrist assessment, referral, monitoring, and coordination by a certified registered nurse practitioner (CRNP) of medical treatment provided by the subject's own primary care physician a healthy lifestyle behaviors program delivered by a lifestyle coach. The treating psychiatrist will work in collaboration with a CRNP and a lifestyle coach. The CRNP will assess and monitor the subject's medical needs and refer the subject to their primary care physician for care and will follow-up on adherence to the medical treatment recommendations. The CRNP will be responsible for coordinating the psychopharmacological care provided by the psychiatrist, the healthy lifestyle behaviors program that will be delivered by the lifestyle coach, and the medical care provided by the subject's PCP.	Behavioral: IRRI Subjects will remain in their assigned treatment condition for 24 months. IRRI subjects will meet with the lifestyle coach 25-27 times throughout the duration of the study. Other Name: Integrated Risk Reduction Intervention
Experimental: PCCM Psychiatric Care with Medical Monitoring (PCMM) The psychiatric care with medical monitoring condition (PCMM) consists of two components: psychiatric treatment by a study psychiatrist assessment and referral by a psychiatric research nurse for medical treatment provided by the subject's own primary care physician. The treating psychiatrist will be assisted by a psychiatric nurse clinician who will assess and monitor the subject's medical needs and refer the subject to their primary care physician for care.	Behavioral: PCCM Subjects will remain in their assigned treatment condition for 24 months. Other Name: Psychiatric care with medical monitoring condition

Arms

Assigned Interventions

Experimental: IRRI

The integrated risk reduction intervention (IRRI) consists of three components:

psychiatric treatment by a study psychiatrist
assessment, referral, monitoring, and coordination by a certified registered nurse practitioner (CRNP) of medical treatment provided by the subject's own primary care physician
a healthy lifestyle behaviors program delivered by a lifestyle coach. The treating psychiatrist will work in collaboration with a CRNP and a lifestyle coach. The CRNP will assess and monitor the subject's medical needs and refer the subject to their primary care physician for care and will follow-up on adherence to the medical treatment recommendations. The CRNP will be responsible for coordinating the psychopharmacological care provided by the psychiatrist, the healthy lifestyle behaviors program that will be delivered by the lifestyle coach, and the medical care provided by the subject's PCP.

Behavioral: IRRI

Subjects will remain in their assigned treatment condition for 24 months. IRRI subjects will meet with the lifestyle coach 25-27 times throughout the duration of the study.

Other Name: Integrated Risk Reduction Intervention

Experimental: PCCM

Psychiatric Care with Medical Monitoring (PCMM)

The psychiatric care with medical monitoring condition (PCMM) consists of two components:

psychiatric treatment by a study psychiatrist
assessment and referral by a psychiatric research nurse for medical treatment provided by the subject's own primary care physician.

The treating psychiatrist will be assisted by a psychiatric nurse clinician who will assess and monitor the subject's medical needs and refer the subject to their primary care physician for care.

Behavioral: PCCM

Subjects will remain in their assigned treatment condition for 24 months.

Other Name: Psychiatric care with medical monitoring condition

Detailed Description:

IRRI is aimed at improving sleep/wake and social rhythm disturbance and achieving modest weight reduction by increasing physical activity and improving nutrition and dietary habits, while at the same time providing optimal psychiatric care and medical monitoring. This will allow us to investigate the role that improvements in sleep/wake and social rhythm regularity, diet, and physical activity have in improving psychiatric and functional outcomes. In order to examine another set or possible pathways (i.e., that it is the amelioration or psychiatric symptoms that leads to the improvements in physical health), we will contrast outcomes of subjects receiving IRRI with those of subjects receiving psychiatric care with medical monitoring (PCMM), which incorporates the same optimal psychiatric care plus monitoring of medical conditions. These aims will be achieved in a 24-month randomized treatment trial of 144 adult subjects with bipolar I disorder.

Eligibility


Ages Eligible for Study:	18 Years to 55 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age 18 to 55 years
Body mass index (BMI) >25
Meets DSM-IV criteria for lifetime bipolar I disorder
Is in remission (with possible sub-threshold symptoms), i.e., as a HRDS-25 < or equal to 10, YMRS < or equal to 8, and CGI-BP-S <3 for two weeks
Able to give basic informed consent
Current diagnosis or past history of anxiety disorder, eating disorder, or other psychiatric comorbidities will not be exclusion criteria for participation, except those listed in the exclusion criteria below

Exclusion Criteria:

Ultra-rapid cycling (>8 episodes per year) bipolar I disorder
Presence of pervasive developmental disorder, antisocial personality disorder, current substance dependence or abuse, and organic mental disorder
Unstable and severe medical illness that requires immediate and intensive medical attention, for instance, a subject with a terminal illness or a subject with severe and unstabilized coronary artery disease; these subjects will be immediately referred to the most appropriate medical and psychiatric treatment. When appropriate, the subjects can be reconsidered for inclusion in the study if/when their medical condition becomes compatible with participation in a protocol-driven research study
Unwilling or unable to comply with study requirements (i.e., complete forms, attend scheduled evaluations)
Not competent to provide informed consent in the opinion of the investigator
Women who are planning to become pregnant, currently pregnant, or breast-feeding

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00746343

Locations


United States, Pennsylvania
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15213

Sponsors and Collaborators

University of Pittsburgh

National Institute of Mental Health (NIMH)

Investigators


Principal Investigator:	David J Kupfer, M.D.	University of Pittsburgh

More Information

No publications provided


Responsible Party:	University of Pittsburgh
ClinicalTrials.gov Identifier:	NCT00746343 History of Changes
Other Study ID Numbers:	PRO08020071, R01MH081003
Study First Received:	September 3, 2008
Last Updated:	December 11, 2013
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Pittsburgh:


Bipolar I Disorder Medical Risks Integrated Risk Reduction Intervention Currently in Remission BMI

Additional relevant MeSH terms:


Bipolar Disorder Disease Affective Disorders, Psychotic	Mental Disorders Mood Disorders Pathologic Processes

ClinicalTrials.gov processed this record on March 01, 2015

Reducing Medical Risks in Individuals With Bipolar Disorder - Full Study (MedRisk)