Two DoM-led research teams are working to identify and rank important gaps in knowledge for treatment regimens of two diverse conditions: bipolar disorder among adolescents and early breast tumors in women. For both conditions, diagnosis is often not clear-cut, while typical treatments come with a trade-off of benefits and serious side effects. Both teams had articles published this week in the Annals of Internal Medicine.
In the case of bipolar disorder among adolescents and young adults, the Duke researchers noted that establishing this diagnosis is particularly complex, and the condition can be difficult to distinguish from other behavioral disorders, including attention deficit hyperactivity disorder. Yet the use of antipsychotic drugs for this condition has increased dramatically over the past two decades, and carries with it a high risk of weight gain, diabetes and other problems.
“This is clearly an important area of clinical uncertainty that will benefit from more research,” said Matthew J. Crowley, MD, assistant professor of medicine (Endocrinology, Metabolism and Nutrition) and lead author of the study addressing research priorities for adolescents with bipolar disorder.
Likewise with ductal carcinoma in situ – tiny breast lesions detected via mammography – considerable uncertainty has evolved over whether to treat the condition as cancer. Many of the lesions may never progress to life-threatening invasive cancer, while treatment plans call for mastectomy, lumpectomy and radiation.
“We don’t have a good handle on how to distinguish between the cases that will develop into invasive cancers, and those that are harmless,” said Jennifer Gierisch, PhD, assistant professor of medicine (General Internal Medicine) and lead author of the breast cancer paper. “There is a lot of uncertainty about what a diagnosis means and how to proceed around a diagnosis. Our goal is to identify research priorities to address these questions and reduce the uncertainty for both patients and doctors.”
Read the full Duke Health release. For more information on the studies, read the papers published Feb. 25 in the Annals of Internal Medicine by lead authors Crowley and Gierisch.