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Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD.

Publication ,  Journal Article
Young, RC; Schulberg, HC; Gildengers, AG; Sajatovic, M; Mulsant, BH; Gyulai, L; Beyer, J; Marangell, L; Kunik, M; Ten Have, T; Bruce, ML ...
Published in: Bipolar Disord
February 2010

AIM: This report considers the conceptual and methodological concerns confronting clinical investigators seeking to generate knowledge regarding the tolerability and benefits of pharmacotherapy in geriatric bipolar disorder (BD) patients. METHOD: There is continuing need for evidence-based guidelines derived from randomized controlled trials that will enhance drug treatment of geriatric BD patients. Therefore, we present the complex conceptual and methodological choices encountered in designing a multisite clinical trial and the decisions reached by the investigators with the intention that study findings be pertinent to, and can facilitate, routine treatment decisions. RESULTS: Guided by a literature review and input from peers, the tolerability and antimanic effects of lithium and valproate were judged to be the key mood stabilizers to investigate with regard to treating bipolar I disorder manic, mixed, and hypomanic states. The patient selection criteria are intended to generate a sample that not only experiences common treatment needs but also represents the variety of older patients seen in university-based clinical settings. The clinical protocol guides titration of lithium and valproate to target serum concentrations, with lower levels allowed when necessitated by limited tolerability. The protocol emphasizes initial monotherapy. However, augmentation with risperidone is permitted after three weeks when indicated by operational criteria. CONCLUSIONS: A randomized, controlled trial that both investigates commonly prescribed mood stabilizers and maximizes patient participation can meaningfully address high-priority clinical concerns directly relevant to the routine pharmacologic treatment of geriatric BD patients.

Duke Scholars

Published In

Bipolar Disord

DOI

EISSN

1399-5618

Publication Date

February 2010

Volume

12

Issue

1

Start / End Page

56 / 67

Location

Denmark

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Randomized Controlled Trials as Topic
  • Psychiatry
  • Patient Selection
  • Multicenter Studies as Topic
  • Humans
  • Guidelines as Topic
  • Geriatrics
  • Evidence-Based Medicine
 

Citation

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Chicago
ICMJE
MLA
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Young, R. C., Schulberg, H. C., Gildengers, A. G., Sajatovic, M., Mulsant, B. H., Gyulai, L., … Alexopoulos, G. S. (2010). Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord, 12(1), 56–67. https://doi.org/10.1111/j.1399-5618.2009.00779.x
Young, Robert C., Herbert C. Schulberg, Ariel G. Gildengers, Martha Sajatovic, Benoit H. Mulsant, Laszlo Gyulai, John Beyer, et al. “Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD.Bipolar Disord 12, no. 1 (February 2010): 56–67. https://doi.org/10.1111/j.1399-5618.2009.00779.x.
Young RC, Schulberg HC, Gildengers AG, Sajatovic M, Mulsant BH, Gyulai L, et al. Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord. 2010 Feb;12(1):56–67.
Young, Robert C., et al. “Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD.Bipolar Disord, vol. 12, no. 1, Feb. 2010, pp. 56–67. Pubmed, doi:10.1111/j.1399-5618.2009.00779.x.
Young RC, Schulberg HC, Gildengers AG, Sajatovic M, Mulsant BH, Gyulai L, Beyer J, Marangell L, Kunik M, Ten Have T, Bruce ML, Gur R, Marino P, Evans JD, Reynolds CF, Alexopoulos GS. Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord. 2010 Feb;12(1):56–67.
Journal cover image

Published In

Bipolar Disord

DOI

EISSN

1399-5618

Publication Date

February 2010

Volume

12

Issue

1

Start / End Page

56 / 67

Location

Denmark

Related Subject Headings

  • Treatment Outcome
  • Research Design
  • Randomized Controlled Trials as Topic
  • Psychiatry
  • Patient Selection
  • Multicenter Studies as Topic
  • Humans
  • Guidelines as Topic
  • Geriatrics
  • Evidence-Based Medicine