Chapter 2 48 Patients were included if they met the selection criteria of having bipolar I disorder, bipolar II disorder or bipolar disorder not otherwise specified (NOS) of the diagnostical and statistical manual of mental disorders IV text revised (DSM-IV–TR (American Psychiatric Association 2000)). Exclusion criteria were the inability to provide written informed consent due to inability to communicate, intellectual disability (IQ below 70), poor cognition (Mini Mental State Examination (MMSE) < 18 (Folstein et al. 1975)), or current compulsory admission. The study was approved by the Medical Ethics Committee of VU University Medical Center, Amsterdam, The Netherlands. Medical records of 139 potential participants were screened for exclusion criteria by a psychiatrist in accordance with local regulations before contacting patients to request consent. Eligible patients were asked by their psychiatrist to provide written informed consent for participation in the study. Inclusion diagnosis and additional psychiatric diagnoses were confirmed through the Mini-International Neuropsychiatric Interview Plus (MINI) (Sheehan et al. 1998). The psychiatrist who was treating the patient during the study period administered the MINI. Of a total of 139 patients screened, 25 were excluded (Figure 1). Of the 114 eligible patients, 78 (fully participating) were able and willing to provide written informed consent and another 23 (partially participating) patients restricted consent to a review of their medical records. To assess the needs we used the CANE (Reynolds et al. 2000) as it is commonly employed (Hancock et al. 2003; Houtjes et al. 2011; Iliffe et al. 2004; Kaiser et al. 2010; Meesters et al. 2013; Passos et al. 2012; Sultan et al. 2011; van der Roest et al. 2008; Walters et al. 2000) to assess the separate points of view of patients and staff and reveal unknown differences. The caregivers perspective in the CANE was not included as the majority of patients did not consent for a caregiver’s interview. 2.2.2 Measurements Demographic data (Table 1) were derived from patients’ medical records and confirmed during the interviews. The age of onset was obtained from the MINI interview. The duration of illness was calculated as the number of years since the first mood episode fulfilling DSM-IV criteria. The Global Assessment of Functioning (GAF) scores (American Psychiatric Association, 2000) were reported by the patient’s psychiatrist. The Young Mania Rating Scale (YMRS) (Young et al. 1978) and the Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff 1977) were used to evaluate mood symptoms.
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