Clinical Inertia May Explain Lack of Medication Adjustment Despite Indications in Bipolar Disorder

Clinical inertia may play a role in clinicians’ lack of regimen adjustment recommendations despite indications in patients with bipolar disorder, according to a study published in the Journal of Affective Disorders. Additional causes could also include watchful waiting.

This study included 457 individuals with bipolar I or II disorder who were displaying symptoms. Participants were treated with either lithium or quetiapine. Clinicians recommended regimen adjustment during 53% of all visits and during 63% of visits where 1 of the study’s set of indications was present. There was a higher likelihood of clinicians issuing an adjustment recommendation when patients were not responding or reported side effects, when participants had started on quetiapine instead of lithium, or if patients were women, married, employed, or had higher levels of education.

This study drew from the Bipolar CHOICE comparative effectiveness study. The set of indicators used included at least 1 acute side effect or at least 2 moderate side effects; treatment non-response; an increase in or incidence of delusions, ideas of persecution, or impaired insight; and a new severe episode of depression or mania/hypomania. Data regarding indications and whether the clinician gave a particular medication adjustment recommendation were collected from 3094 visits. Hierarchical logistic mixed effects models and bivariate tests were used to examine correlations between indications and recommended adjustments.

The researchers concluded that “[this] study found a substantial proportion of bipolar disorder treatment visits with possible clinical inertia, in the sense that no adjustment was recommended despite apparent indications for adjustment. Future work could build on this finding by refining the measurement of indications for adjustment, and by assessing whether apparent inertia is related to subsequent clinical outcomes.”

Reference

Hodgkin D, Stewart MT, Merrick EL, et al. Prevalence and predictors of physician recommendations for medication adjustment in bipolar disorder treatment. J Affect Disord. 2018; 238:666-673. doi: 10.1016/j.jad.2018.06.012