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Drs. Craighead and Muralidharan provide a thoughtful analysis of our chapter, and make several important suggestions that we address in this response. First, they identify that use of post-test and follow-up measures may serve to strengthen confidence in the treatment. Incoporating scales longitudinally to track patient wellness over time is indeed a helpful tool. Unlike unipolar depression, for which validated patient-rated scales such as the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) (available for free at http://www.ids-qids.org), and the Beck Depression Inventory can track symptom severity over time, bipolar disorder lacks such instruments. A clinician-rated measure that we have implemented in our bipolar clinic is the Clinician Global Improvement-Severity (CGI-S) scale, a seven-item scale that condenses the patient’s symptom burden and impairment in important life domains to a single-digit number (1–7) representing the status of his or her overall condition. Rating the CGI-S from visit to visit provides a simple yet meaningful way to gauge improvements over a wide time frame and assess the efficacy of the treatments offered. During Janice’s last several clinic visits, her CGI-S scores ranged from 1 to 2, indicating minimal symptom burden and role dysfunction, and an effective treatment regimen with enduring impact. Follow-up measures and post-test assessments can also provide value through ensuring diagnostic accuracy. For patients with psychiatric histories suggestive of bipolar disorder but with uncertainty arising from hypomanic episodes that may have failed to meet full symptom number or duration criteria, asking patients questions from the past hypomanic episode sections of the SCID or the LIFE at each subsequent visit may capture between-visit episodes of full-criteria hypomania that may confirm the bipolar diagnosis.
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