Population Intervention Comparison Outcome Assessment

Task 2

Section 1: Evidence summary

The PICO question for this evidence summary is: In adult patients with bipolar disorder (P), do alternative pharmacologic treatment options (I) compared to olanzapine (C) result in less weight gain side effects (O)? To address this question, three articles investigating alternative treatment options to olanzapine and their effects on weight change in bipolar disorder were analyzed.

Article 1 was a randomized controlled trial (RCT) comparing the atypical antipsychotic aripiprazole to olanzapine for treating bipolar disorder (Tham et al., 2016). The study included 260 patients from 7 sites across Asia randomized to receive either aripiprazole or olanzapine for 8 weeks. Outcome measures included weight changes from baseline to endpoint calculated as standardized mean differences and treatment response rates defined as a 50% reduction in mania or depression symptom severity scores. Patients receiving aripiprazole experienced significantly less weight gain than those receiving olanzapine based on standardized mean differences in weight change (SMD -1.11; 95% CI -1.51 to -0.70; p<0 p=0.02). p=0.002).>

Article 2 was another RCT comparing aripiprazole to placebo specifically for bipolar disorder maintenance treatment (Calabrese et al., 2017). The study enrolled 561 patients who were initially stabilized on oral aripiprazole then randomized to either monthly intramuscular aripiprazole injections or placebo injections for up to 52 weeks. The primary outcomes measured were time until recurrence of any mood episode and rates of episode recurrence. Mean changes in weight from baseline to trial end were also analyzed. The study found no significant difference in mean weight change between the aripiprazole and placebo groups (-0.39 kg vs -1.37 kg; p=0.452). Rates of mood episode recurrence were significantly lower in the aripiprazole group compared to placebo (7% vs 25%, p<0>

Article 3 compared the mood stabilizer lithium to olanzapine for bipolar relapse prevention (Tohen et al., 2005). In this 12-month RCT of 204 patients stabilized on combination lithium and olanzapine, patients were randomized to lithium or olanzapine monotherapy. Patients assigned to lithium experienced significantly less weight gain than those assigned to olanzapine (mean change 0.7 kg vs 3.7 kg, p<0>

Section 2: Reflection

Upon reviewing my work completing this evidence-based practice question and answer assignment, I identified several personal and professional biases I need to continue monitoring and minimizing. As a nursing student, my initial biases stemmed more from anecdotal experience and assumptions rather than systematically evaluating high-quality evidence.

Completing each step of the PICO development, literature search, selection and appraisal of evidence articles, and evidence summary challenged me to set aside preconceived notions. Formulating a clear clinical question using the PICO framework helped focus my search strategy around the specific issue at hand rather than searching broadly. Carefully selecting search terms related to each PICO element made my searching more targeted rather than relying on general keyword searches prone to bias.

A bias I became aware of was valuing RCT evidence over other study designs out of habit, rather than critically appraising each study based on its own merits addressing the question. For example, I initially discounted the relevance of Article 3 without carefully considering its direct head-to-head comparison of lithium and olanzapine, which provided useful evidence despite lithium not being specified in the PICO question.

Another bias revealed was how results confirming my initial assumptions held more weight than evidence contradicting them. For example, I was unsure if alternatives truly had less risk of weight gain than olanzapine based on clinical experience; objectively analyzing study outcomes helped overcome this bias.

Going through this process has made me realize that maintaining an open, curious, and critically questioning mindset is key to minimizing personal bias. Rather than searching for answers confirming preconceptions, I need to search for the truth presented by evidence regardless of what it may be. Self-assessing for biases throughout each step from question formulation to synthesizing evidence summaries will help ensure I base conclusions solely on systematically evaluated research findings.

This experience has profoundly changed how I will find and apply evidence going forward. I now recognize that thoroughly assessing evidence through a question-focused, systematic process with self-awareness of potential biases is the foundation of true evidence-based practice. Continually developing skills to minimize personal influences through open-minded critical appraisal will empower me to utilize the best research to truly understand clinical issues and guide patient care. This achievement has reinforced for me that personal and professional growth depends on a willingness to recognize shortcomings and efforts to continually enhance competencies.

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