Adherence to Turkish psychiatric association guidelines for bipolar depression treatment in a specialised mood disorders out-patient mood clinic

Background: 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. Subjects and Methods: 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. Results: Concordance rates with the first step recommendations of the guideline were 29.4%, 27.4% and 87.5% for mildmoderate, 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). Conclusions: 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.