In this interview, Gary Sachs, MD, internationally recognized as a leading expert in bipolar disorder, gives important tips about how to get better outcomes in treating persons with bipolar disorder. In this brief interview, Dr. Sachs addresses the following key issues about the mindset that clinicians should have.
1. What does it mean to “start with concordance”?
2. Does the readiness-for-change model often used in addictions also apply to bipolar disorder?
3. What is a “Menu of Reasonable Options” that we should set out before the patient?
4. What if the person asks for treatments that we don’t agree with?
5. What is a “Janus-faced approach”? Why is it extremely important to “look forwards” in the patient’s treatment?
6. How can we integrate measurement into the management as an iterative process?
Please leave your comments and questions at the bottom of this page.
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I listened to this interview once again, as it had a lot of new material which I could not assimilate on the first listening.
The discussion was about improving outcome in Bipolar Disorder. For the most part it focused on engaging the reluctant patient — who does not agree either with the diagnosis, or with the treatment recommendations. Are you implying that poor insight and compliance are ‘the’ most common reasons for poor outcome, or that they are one of the important reasons, and that you chose to focus on them in this discussion?
What I got out of the interview was this:
1. Start with whatever goals you can agree on.
2. Offer a range of treatment options and keep the patient involved.
3. Make sure you have an objective outcome criteria.
4. Discuss the progress through the course of treatment.
5. It is very important to get a friend/ family member involved.
I often struggle with another common scenario when the patient is very compliant, puts all the trust in me, and expects to be a passive participant in the treatment. In those cases, I try to emphasize the limits of my ability (and the ability of the science itself), and the role the patient can play in the treatment. The principles you discussed in the interview can be applied in that scenario too, but in a different way.
Rajnish Mago, MD says
Thanks, Pankaj, for your comment! I agree with you — in your example of the opposite situation too we have to aim to build a collaborative approach and encourage viewing treatment as something to bet tested empirically going forward. That is, let’s monitor the outcomes to see what effect the treatment has on them.
We need better monitoring tools though!