The University of Texas Health Science Center at San Antonio proposes to establish an Advanced Center for Interventions and/or Service Research to conduct research that will personalize community based treatment of bipolar disorders to improve outcomes. We will investigate interactions of cultural factors, adherence and engagement, behavioral domains and biological factors with outcomes, thereby providing a model that can transform current diagnostic and treatment paradigms for bipolar disorder. A major aim of this application is to better develop our understanding of bipolar disorder in the Hispanic American population, in particular the impact of acculturation on adherence to treatment programs. This program will train researchers to work more effectively with this largest U.S. minority population, particularity Mexican Americans who form the majority of Hispanics in the U.S. We will disseminate the knowledge and methodologies we develop to the larger U.S. Hispanic American community, as well as clinicians providing care for persons with bipolar disorder. The studies of the Center will enroll patients who are representative of the full spectrum of patients who receive care in community settings. These projects will contribute to development of more cost effective treatment regimens that are personalized to the characteristics of the patient and weigh tolerability as highly as efficacy. We will develop and promulgate study designs addressing sustained benefit and functional outcomes, sensitive assessments of the fundamental symptom domains in bipolar disorder, and statistical approaches that emphasize patient function. These efforts will be facilitated by our group of nationally recognized leaders in bipolar studies, an experienced scientific staff, the majority of whom are also Hispanic, and national leaders of research on diverse aspects of bipolar disorder. These efforts will equip us to serve as a national resource to advance the NIMH mission of reducing the burden of bipolar illness and improve outcomes through the efforts of research about treatments and their acceptability to patients, and broadly disseminate this research for the purposes of improving clinical care, public education and public health planning.
Bipolar disorders start early in life and persist through it, and are one of the 10 major causes of disability in the world. This program of clinical research will personalize treatments to individual characteristics that can yield sustained good outcomes. These aims will be achieved by improving early, accurate diagnosis, tailoring drug and counseling to specific patient needs, recognizing and providing culturally competent care, with a particular emphasis in the Hispanic American population.