Med Services Update
Magellan Approves Guidelines for Bipolar and Panic Disorders
Magellan recently reviewed and re-adopted American Psychiatric Association (APA) clinical practice guidelines (CPG) for the treatment of panic disorder and bipolar disorder. Also, Magellan adopted the corresponding APA Guideline Watch: Practice Guideline for the Treatment of Patients with Panic Disorder (April 2006) and APA Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder (November 2005). You can find links to the guidelines and Magellan’s introductions on the Clinical Practice Guidelines page on this website.
Panic Disorder CPG
The APA’s Practice Guideline for the Treatment of Patients with Panic Disorder (May 1998) and the APA Guideline Watch: Practice Guideline for the Treatment of Patients with Panic Disorder (April 2006), both provide a thorough overview of panic disorder assessment and treatment with the augmentation of more recently published literature.
Among the tools provided in the CPG and Guideline Watch are the following:
- Updated information on safety issues related to the use of nefazodone and antidepressants. (APA Guideline Watch)
- Lifetime prevalence rates for each clinical subtype of this condition
- List of prescription medications that may be causal agents in substance abuse disorders; this adds specificity in differential diagnosis of panic attacks with other conditions that may have panic attacks as associated features
- A more detailed definition on member education and family education
- Psycho-education as a clinical component of interpersonal therapy for panic disorder
- A summary of research on the comparative efficacy of three classes of drugs – selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and benzodiazepines used to treat the condition
- New information on the use of benzodiazepines for short-term and early relief of symptoms, with a cautionary note on their use in patients with substance use disorder, personality disorder and chronic pain
- Guidance on a maintenance drug regimen, as well as a clarified definition of treatment-resistant cases in panic disorder.
Bipolar Disorder CPG
Magellan re-adopted the APA’s Practice Guideline for the Treatment of Patients with Bipolar Disorder, Second Edition (April 2002) and adopted the APA Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder (November 2005). Magellan recognized that, like other APA practice guidelines, this guideline and its companion document both provide a thorough overview of bipolar disorder assessment and treatment. However, since the publication in 2002 of the Practice Guideline for the Treatment of Bipolar Disorder, 2nd Edition, new options for the acute treatment of manic, mixed, or depressive episodes have emerged. These include information on controlled treatment studies on aspects of bipolar disorder such as:
- Use of second-generation (atypical) antipsychotics as monotherapy and as adjunctive treatment with more traditional mood stabilizers for the acute treatment of mania
- Use of antiepileptic agents for acute treatment of mania
- Use of new medications for the acute treatment of bipolar depression
- Psychosocial interventions for maintenance.
Knowledge of pharmacological and psychosocial interventions for maintenance has increased. The Guideline Watch defines the lifetime prevalence rates of bipolar I and II disorders and summarizes recent developments in the use of various modalities to treat bipolar disorder.
Accessing and Commenting on CPGs
Magellan’s adoption of industry-standard APA CPGs is intended to reduce the administrative burden on our network clinicians, who may serve on multiple managed care panels and thus be required to learn and use several guidelines for one disorder. Also, the APA guidelines typically contain thorough introductions to, and evidence-based clinical updates in, assessment and treatment of psychiatric disorders.
Magellan encourages network clinicians to familiarize themselves with all Magellan CPGs. We welcome feedback on our CPGs. Submit your comments to your local Magellan medical director or to Kathleen Frampton at kkframpton@MagellanHealth.com.