Use of an Analog Scale in the Treatment of Patients With Bipolar Disorder to Optimize Assessment and Clinical Outcome.

This column explains how a clinician can use an analog scale for patients with bipolar disorder: (1) to elucidate the course of the illness in a specific patient and (2) to assess response to treatment. This scale complements other standardized rating scales, such as the Young Mania Rating Scale, because its anchors are tailored to each specific patient in terms of the worst depressive or hypomanic/manic episode (ie, a -10 or +10, respectively) the person has ever experienced. The scale also allows clinicians to track how the individual patient's episodes have responded to treatment in the past, including whether the patient ever has achieved a full remission (ie, score of 0) following the initial onset of the disorder. The scale can then be used to assess how the patient in an acute or chronic active episode responds to new treatment, whether somatic and/or psychotherapeutic, and how that compares with historical responses to previous treatments. Going forward, the scale can be used to assess the course of the patient's illness (eg, episodic with full recovery or chronic with more severe episodes and increasing residual symptoms). Through use of this analog scale, the patient also develops a better understanding of his or her illness, including how episodes develop and resolve and whether there are factors (eg, interpersonal relationships, inflammatory processes, substance use) that either aggravate and/or are aggravated by the disorder. This simple scale thus fulfills many purposes including history gathering, monitoring the usefulness of different treatment interventions, and patient education.