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Abstract：
The impact of guideline concordance on naturalistic maintenance treatment outcomes in BD is not known. We sought to evaluate the effect of guideline-concordant care on symptomatic, course and functional outcomes in youth with early-stage BD-I.
In this file audit study, we examined the prospective course of 64 clients with first treatment seeking manic episode of BD-I. Eighteen-month outcome measures included Clinical Global Impressions Scale - Bipolar Version (CGI-BP), Social and Occupational Functioning Assessment Scale (SOFAS) and number of relapses. Correlations and hierarchical linear regressions were used to examine the relationships between guideline concordance and outcomes, while controlling for potential confounders.
Although higher guideline-concordant care in the maintenance phase was associated with a higher discharge CGI-BP score and thus worse outcome, baseline CGI-BP and insight were more predictive of illness severity at follow-up than guideline concordance. There was no association with SOFAS and guideline-concordant care at follow-up. Greater concordance with maintenance medication guideline statements was also associated with greater number of relapses even after controlling for sex, medication adherence, duration of care and baseline illness severity.
This study was limited by sample size and its single pool of clients which may limit generalizability.
Contrary to our hypotheses, higher guideline concordance was associated with worse outcomes, although this relationship was moderated by the client\'s illness characteristics, severity and insight. More unwell youth with poor insight, greater severity, and mixed/rapid cycling features may need other interventions or modified guidelines.
In this file audit study, we examined the prospective course of 64 clients with first treatment seeking manic episode of BD-I. Eighteen-month outcome measures included Clinical Global Impressions Scale - Bipolar Version (CGI-BP), Social and Occupational Functioning Assessment Scale (SOFAS) and number of relapses. Correlations and hierarchical linear regressions were used to examine the relationships between guideline concordance and outcomes, while controlling for potential confounders.
Although higher guideline-concordant care in the maintenance phase was associated with a higher discharge CGI-BP score and thus worse outcome, baseline CGI-BP and insight were more predictive of illness severity at follow-up than guideline concordance. There was no association with SOFAS and guideline-concordant care at follow-up. Greater concordance with maintenance medication guideline statements was also associated with greater number of relapses even after controlling for sex, medication adherence, duration of care and baseline illness severity.
This study was limited by sample size and its single pool of clients which may limit generalizability.
Contrary to our hypotheses, higher guideline concordance was associated with worse outcomes, although this relationship was moderated by the client\'s illness characteristics, severity and insight. More unwell youth with poor insight, greater severity, and mixed/rapid cycling features may need other interventions or modified guidelines.
摘要：
指南一致性对BD自然维持治疗结果的影响尚不清楚。我们试图评估指南一致护理对症状，早期BD-I青年的课程和功能成果
在此文件审核研究中，我们检查了64位寻求BD-I躁狂发作的首次治疗患者的预期病程。18个月的结果测量包括临床全球印象量表-双极版本（CGI-BP），社会和职业功能评估量表(SOFAS)和复发次数。相关性和分层线性回归用于检查指南一致性和结果之间的关系，同时控制潜在的混杂因素。
尽管在维持阶段较高的指南一致性护理与较高的出院CGI-BP评分相关，因此预后较差，基线CGI-BP和自知力在随访时比指南一致性更能预测疾病严重程度.随访时与SOFAS和指南一致的护理没有关联。即使在控制性别之后，与维持药物指南声明的更大一致性也与更多的复发有关。药物依从性,护理持续时间和基线疾病严重程度。
这项研究受到样本量及其单一客户群的限制，这可能会限制其普遍性。
与我们的假设相反，较高的指南一致性与较差的结果相关，虽然这种关系是由客户的疾病特征调节的，严重性和洞察力。更多的年轻人，缺乏洞察力，更严重，和混合/快速循环功能可能需要其他干预措施或修改指南。
在此文件审核研究中，我们检查了64位寻求BD-I躁狂发作的首次治疗患者的预期病程。18个月的结果测量包括临床全球印象量表-双极版本（CGI-BP），社会和职业功能评估量表(SOFAS)和复发次数。相关性和分层线性回归用于检查指南一致性和结果之间的关系，同时控制潜在的混杂因素。
尽管在维持阶段较高的指南一致性护理与较高的出院CGI-BP评分相关，因此预后较差，基线CGI-BP和自知力在随访时比指南一致性更能预测疾病严重程度.随访时与SOFAS和指南一致的护理没有关联。即使在控制性别之后，与维持药物指南声明的更大一致性也与更多的复发有关。药物依从性,护理持续时间和基线疾病严重程度。
这项研究受到样本量及其单一客户群的限制，这可能会限制其普遍性。
与我们的假设相反，较高的指南一致性与较差的结果相关，虽然这种关系是由客户的疾病特征调节的，严重性和洞察力。更多的年轻人，缺乏洞察力，更严重，和混合/快速循环功能可能需要其他干预措施或修改指南。
