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Levrat V, Favre S, Richard-Lepouriel H. Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review. Front Psychiatry 2024; 14:1320654. [PMID: 38250257 PMCID: PMC10797008 DOI: 10.3389/fpsyt.2023.1320654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
This review sought to summarize the literature on current practices and forms of psychoeducation in the management of patients with bipolar disorder (BD), including only randomized controlled trials to ensure the best level of evidence. An extensive review of the available literature was conducted using PubMed/MEDLINE, Embase, and PsychInfo databases from inception to April 28th, 2022. The search yielded 381 studies. Seventy articles were included after removing duplicates and applying the inclusion/exclusion criteria. A best-evidence synthesis was used to identify the key results of each study and summarize the outcomes. Eleven descriptive categories were made. They encompass different forms of psychoeducation compared or combined with other psychosocial interventions, varying in setting (individual or group), with or without family members, structured or unstructured, mediated or not by digital tools (smartphone, internet). Globally, these studies show that psychoeducation is important in the treatment of BD, as it leads to a decrease in relapses, mood episodes, hospitalizations, and improved functioning or quality of life. Some studies also showed the benefits of psychoeducation on the patient's level of knowledge of pharmacological treatment and the disorder or compliance with medication, as well as reduced self-stigma. The limitations of this review are linked to the selection of only RCTs and the reliance on their post-hoc analyses. This review confirms the benefit of psychoeducation and psychosocial interventions on the evolution of BD (in different outcomes, including quality of life, relapse, and rehospitalization rates, for example). More recent interventions, such as mindfulness or online psychoeducation, represent an interesting option but more evidence is needed.
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Affiliation(s)
- Vanessa Levrat
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Favre
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Combes-Deslaugiers B, Rodier A, Mignonat A, Gallini A, Saint-Martin F, Jamot N. Évaluation des effets du programme d’éducation thérapeutique Bipolis® sur le parcours de santé des participants entre mars 2009 et juillet 2017. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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A Meta-Analysis of Group Cognitive Behavioral Therapy and Group Psychoeducation for Treating Symptoms and Preventing Relapse in People Living with Bipolar Disorder. Healthcare (Basel) 2022; 10:healthcare10112288. [PMID: 36421612 PMCID: PMC9691241 DOI: 10.3390/healthcare10112288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: This meta-analysis aims to evaluate the treatment outcomes of patients treated with Group cognitive behavioural therapy (GCBT) or group psychoeducation (GPE) as an adjunct to pharmacotherapy. Methods: Systematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 1 March 2022 was conducted. Randomized-controlled-trials (RCTs) comparing GCBT/GPE with controls (treatment-as-usual/individualized therapy) in adults with bipolar disorder were eligible. The outcomes were relapse rates of any depressive or manic episodes and control of depressive and manic symptoms post-intervention. Overall odds-ratio was used to evaluate the relapse rates. Standard Mean Differences were pooled using a random-effects model for the control of depressive and manic symptoms. Results: 25 articles were assessed full-text independently by two members, and 11 studies were included in this meta-analysis. 601 and 590 participants were randomized into group-therapy (GCBT/GPE) and control, respectively. GPE significantly reduces relapse rates at post-intervention with Odds ratio of 0.43 (95% CI = 0.28-to-0.62, p < 0.0001) (I² = 41%) compared to control, however, no significant results were found for GPE on control of depressive or manic symptoms. No significant results were found for GCBT in all outcomes. Conclusion: This meta-analysis provides some evidence that GPE could be an efficacious treatment as an adjunct to treatment-as-usual in reducing the relapse rates of patients with bipolar disorder.
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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Higgins A, Downes C, Murphy R, Barry J, Monahan M, Doyle L, Gibbons P. Factors Influencing Attendees' Engagement with Group Psychoeducation: A Multi-stakeholder Perspective. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:539-551. [PMID: 34989933 PMCID: PMC9233715 DOI: 10.1007/s10488-021-01182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/05/2022]
Abstract
Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.
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Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland.
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- Department of Psychology, National University of Ireland, Maynooth, Kildare, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
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Wittenborn AK, Woods SB, Priest JB, Morgan PC, Tseng CF, Huerta P, Edwards C. Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:129-153. [PMID: 34750834 DOI: 10.1111/jmft.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.
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Affiliation(s)
- Andrea K Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Sarah B Woods
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob B Priest
- Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa, USA
| | - Preston C Morgan
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Chi-Fang Tseng
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Patricia Huerta
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Caitlin Edwards
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Rabelo JL, Cruz BF, Ferreira JDR, Viana BDM, Barbosa IG. Psychoeducation in bipolar disorder: A systematic review. World J Psychiatry 2021; 11:1407-1424. [PMID: 35070785 PMCID: PMC8717031 DOI: 10.5498/wjp.v11.i12.1407] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disorder characterized by mood swings. Psychosocial interventions, such as psychoeducation, play an essential role in promoting social rehabilitation and improving pharmacological treatment.
AIM To investigate the role of psychoeducation in BD.
METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed. A systematic literature search was performed using the Medline, Scopus, and Lilacs databases. No review articles or qualitative studies were included in the analysis. There were no date restriction criteria, and studies published up to April 2021 were included.
RESULTS A total of forty-seven studies were selected for this review. Thirty-eight studies included patients, and nine included family members. Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations. Psychoeducational interventions with patients are associated with improved adherence to drug treatment. The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality. Psychoeducational interventions with family members do not alter patients' adherence to pharmacotherapy.
CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes, length of hospital stay and adherence to drug therapy.
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Affiliation(s)
- Juliana Lemos Rabelo
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Breno Fiuza Cruz
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | | | - Bernardo de Mattos Viana
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Izabela Guimarães Barbosa
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
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Zyto S, Jabben N, Schulte PFJ, Regeer EJ, Goossens PJJ, Kupka RW. A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers. Int J Bipolar Disord 2020; 8:26. [PMID: 32869118 PMCID: PMC7459037 DOI: 10.1186/s40345-020-00190-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Background Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. Methods Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. Results There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. Conclusions This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands.
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Affiliation(s)
- Susan Zyto
- Mental Health Service Organisation North Holland North, Center for Psychosomatic Medicine, Hoorn, The Netherlands. .,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Nienke Jabben
- Department of Psychiatry, Zuyderland Medical Center, Sittard, The Netherlands
| | - Peter F J Schulte
- Mental Health Service Organisation North Holland North, Alkmaar, The Netherlands
| | - Eline J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Peter J J Goossens
- Dimence Group Mental Health Care Center, Deventer, The Netherlands.,University Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ralph W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
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Maurin KD, Girod C, Consolini JL, Belzeaux R, Etain B, Cochet B, Leboyer M, Genty C, Gamon L, Picot MC, Courtet P, Olié DE. Use of a serious game to strengthen medication adherence in euthymic patients with bipolar disorder following a psychoeducational programme: A randomized controlled trial. J Affect Disord 2020; 262:182-188. [PMID: 31668996 DOI: 10.1016/j.jad.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although psychoeducation programmes are the gold-standard intervention in bipolar disorder (BD), more innovative tools are needed to broaden and consolidate their effects, especially on treatment adherence. Serious games could be an option. METHODS We carried out a two-arm open randomized controlled trial to compare the add-on use of the serious game BIPOLIFE® for one month (n = 20) vs. treatment as usual (TAU; n = 21) following the completion of a psychoeducation programme in euthymic adults with BD. The primary outcome was the percentage of adherent patients (i.e., patients with a Medication Adherence Rating Scale, MARS, total score >7) at 4 months after the end of the psychoeducation programme. We also measured the changes in therapeutic adherence and beliefs on pharmacological treatments (Drug Attitude Inventory, DAI) between study inclusion and the 1-month (end of BIPOLIFE® use) and 4-month visits, healthcare use during the study period, and BIPOLIFE® acceptability. RESULTS The percentage of adherent patients was lower in the BIPOLIFE® group than in the TAU group at inclusion (p = 0.02). Conversely, the absolute variation of the MARS and DAI scores was higher in the BIPOLIFE® than in the TAU group at the 1-month visit (p = 0.03 and p = 0.002, respectively) but not at the 4-month visit (p = 0.22 and p = 0.07, respectively). LIMITATIONS Small sample size, and low frequency of connexion to BIPOLIFE® declared by the patients. CONCLUSION BIPOLIFE® may help patients with BD to increase their confidence in medications, if used regularly.
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Affiliation(s)
| | - Chloé Girod
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
| | - Julia Lou Consolini
- APHM, Department of psychiatry, INT-UMR7289, CNRS Aix Marseille University, Marseille, France
| | - Raoul Belzeaux
- APHM, Department of psychiatry, INT-UMR7289, CNRS Aix Marseille University, Marseille, France; Fondamental Foundation, Créteil, France
| | - Bruno Etain
- Université de Paris, INSERM UMRS1144 and Assistance Publique des Hopitaux de Paris - Hôpital Fernand Widal, Paris, France; Fondamental Foundation, Créteil, France
| | - Barbara Cochet
- Assistance Publique des Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Creteil, France
| | - Marion Leboyer
- Assistance Publique des Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Creteil, France; Fondamental Foundation, Créteil, France
| | - Catherine Genty
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lucie Gamon
- Department of Medical Information CHRU Montpellier, France
| | | | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; Fondamental Foundation, Créteil, France
| | - Dr Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; Fondamental Foundation, Créteil, France.
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Novick DM, Swartz HA. Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:238-248. [PMID: 32047369 DOI: 10.1176/appi.focus.20190004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
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Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
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L’éducation thérapeutique : un levier pour modifier les perceptions du trouble bipolaire chez les aidants familiaux. Encephale 2019; 45:239-244. [DOI: 10.1016/j.encep.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/29/2018] [Accepted: 11/11/2018] [Indexed: 12/20/2022]
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Pan YJ, Kuo KH, Chan HY, Yeh LL. Cost-effectiveness and cost-utility analysis of outpatient follow-up frequency in relation to three-year mortality in discharged patients with bipolar disorder. Psychiatry Res 2019; 272:61-68. [PMID: 30579183 DOI: 10.1016/j.psychres.2018.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/15/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
There is a lack of clarity in terms of cost-effectiveness and cost-utility comparisons across different outpatient (OPD) follow-up patterns in discharged patients with bipolar disorder (BD). In this study, adult patients hospitalised for BD treatment (n = 1,591) were identified from the National Health Insurance Research Database in Taiwan. With survival as the effectiveness measure and quality-adjusted life years (QALYs) as the utility measure, a cost-effectiveness and cost-utility analysis was conducted over the 3-year follow-up period by post-discharge frequency of OPD visits. Compared to those making 1-7, 8-12 and 18 or more OPD visits, BD patients making 13-17 OPD visits within the first year after discharge had the lowest psychiatric and total healthcare costs over the follow-up period. With survival status as the effectiveness outcome, making 13-17 OPD visits was more likely to be the cost-effective option, as revealed by incremental cost-effectiveness ratios. Cost-utility analysis demonstrated that having 13-17 OPD visits was probably the more cost-effective option when considering QALYs; for instance, if society was willing to pay NTD1.5 million for one additional QALY, there was a 75.2% (psychiatric costs) to 77.4% (total costs) likelihood that 13-17 OPD visits was the most cost-effective option. In conclusion, post-discharge OPD appointments with a frequency of 13-17 visits within the first year were associated with lower psychiatric and total healthcare costs in the subsequent 3 years. Having an adequate outpatient follow-up frequency was likely to be cost-effective in the management of discharged patients with BD in this real-world setting.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Kuei-Hong Kuo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Medical Image, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
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13
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Chen R, Zhu X, Capitão LP, Zhang H, Luo J, Wang X, Xi Y, Song X, Feng Y, Cao L, Malhi GS. Psychoeducation for psychiatric inpatients following remission of a manic episode in bipolar I disorder: A randomized controlled trial. Bipolar Disord 2019; 21:76-85. [PMID: 29578271 DOI: 10.1111/bdi.12642] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of psychoeducation for bipolar I inpatients following remission of a manic episode in a Chinese population. METHOD The study recruited currently medicated bipolar I patients, aged 18-60 years, who were in remission from a manic episode, as determined using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Patients were randomized (1:1) to either eight sessions of group-based psychoeducation (active treatment group) or regular free discussions (control group). The primary outcomes were the rates of any type of recurrence and rehospitalization following treatment. The secondary outcomes were changes in mood symptoms, medication adherence, global functioning, as well as treatment response (as measured using the Clinical Global Impression scale). Subjects were assessed at baseline and then at 2 weeks, and 1, 2, 3, 5, 7, 9, and 12 months following treatment. RESULTS At 1 year, patients receiving the psychoeducation treatment demonstrated significantly less recurrence. Those in the treatment group also showed a significant reduction in mania recurrence but not depressive recurrence, and psychoeducation increased time to remission. Notably, lower rates of rehospitalization were found in the active treatment group. Those receiving the psychoeducation treatment also revealed higher change from baseline on measures of depression (17-item Hamilton Rating Scale for Depression), mania (Young Mania Rating Scale), global functioning (Clinical Global Impression-severity scale and World Health Organization Disability Assessment Schedule) (P<.05). However, there were no significant group differences for the medication adherence scores. CONCLUSION This preliminary evidence suggests that short, group-based psychoeducation benefits currently medicated inpatients following the remission of mania in bipolar I disorder. This intervention warrants further investigation, especially in other Chinese populations. If future studies confirm its benefits, group-based psychoeducation could be incorporated into routine psychiatric inpatient care for bipolar patients in China.
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Affiliation(s)
- Runsen Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Xuequan Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Huijun Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jiong Luo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yingjun Xi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiuping Song
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yancun Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Liuzhong Cao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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14
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Dean OM, Gliddon E, Van Rheenen TE, Giorlando F, Davidson SK, Kaur M, Ngo TT, Williams LJ. An update on adjunctive treatment options for bipolar disorder. Bipolar Disord 2018; 20:87-96. [PMID: 29369487 DOI: 10.1111/bdi.12601] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/19/2017] [Accepted: 12/15/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. METHODS Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e-Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. RESULTS A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. CONCLUSIONS Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder.
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Affiliation(s)
- Olivia M Dean
- IMPACT Strategic Research Centre, Deakin University, Geelong, Vic., Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia
| | - Emma Gliddon
- IMPACT Strategic Research Centre, Deakin University, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia.,Centre for Mental Health, Swinburne University, Melbourne, Vic., Australia.,Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Vic., Australia
| | - Francesco Giorlando
- Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia
| | - Sandra K Davidson
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Vic., Australia
| | - Manreena Kaur
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Vic., Australia
| | - Trung T Ngo
- Mater Research Institute-UQ, Faculty of Medicine, The University of Queensland and Translational Research Institute, Brisbane, Qld, Australia.,Genetic Epidemiology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Lana J Williams
- IMPACT Strategic Research Centre, Deakin University, Geelong, Vic., Australia
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15
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Wilson L, Crowe M, Scott A, Lacey C. Psychoeducation for bipolar disorder: A discourse analysis. Int J Ment Health Nurs 2018; 27:349-357. [PMID: 28299858 DOI: 10.1111/inm.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Psychoeducation has become a common intervention within mental health settings. It aims to increase people's ability to manage a life with a long-term illness. For people with bipolar disorder, psychoeducation is one of a range of psychosocial interventions now considered part of contemporary mental health practice. It has taken on a 'common sense' status that results in little critique of psychoeducation practices. Using a published manual on psychoeducation and bipolar disorder as its data, Foucauldian discourse analysis was used in the present study for a critical perspective on psychoeducation in order to explore the taken-for-granted assumptions on which it is based. It identifies that the text produces three key subject positions for people with bipolar disorder. To practice self-management, a person must: (i) accept and recognize the authority of psychiatry to know them; (ii) come to see that they can moderate themselves; and (iii) see themselves as able to undertake a reflexive process of self-examination and change. These findings highlight the circular and discursive quality to the construct of insight that is central to how psychoeducation is practiced. Using Foucault's construct of pastoral power, it also draws attention to the asymmetrical nature of power relations between the clinician and the person with bipolar disorder. An effect of the use of medical discourse in psychoeducation is to limit its ability to work with ambivalence and contradiction. A critical approach to psychotherapy and education offers an alternate paradigm on which to basis psychoeducation practices.
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Affiliation(s)
- Lynere Wilson
- Department of Psychological Medicine and Māori, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine and Māori, University of Otago, Christchurch, New Zealand
| | - Anne Scott
- Department of Social and Political Sciences, University of Canterbury, Christchurch, New Zealand
| | - Cameron Lacey
- Indigenous Health Institute, University of Otago, Christchurch, New Zealand
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16
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17
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A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders. J Affect Disord 2017; 222:28-31. [PMID: 28668712 DOI: 10.1016/j.jad.2017.06.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorders are ranked amongst the top ten causes of global disability and cause high health care costs. Previous studies have showed that mood stabilizing drug therapy combined with psychological treatments lead to significantly fewer relapses and a reduction in hospitalization rates. However, there is a wide spectrum of psychosocial intervention methods for individuals and groups which have been insufficiently examined on a scientific basis. METHODS Studies published between 2003 and 2015 on different types of adjuvant psychosocial group interventions in the MESH database were reviewed and evaluated for their efficacy on patients with bipolar disorder related to the relapse ratio by a meta-analysis. RESULTS The meta-analysis included 24 intervention groups and showed that 75% of treated groups under medication and psychosocial therapy had a lower risk of a relapse than the control groups which only received medication therapy. LIMITATIONS The meta-analysis includes a number of trials with participants in different phases of disease course and study designs, the number of studies in each analyzed intervention group was not balanced and many studies focused on recovery and recurrence of episodes, precluding identification of the impact on subsyndromal symptoms CONCLUSIONS: Adjuvant psychosocial interventions seem to be indispensable for patients, their relations as well as for saving costs in the health care system. Nevertheless, an evaluation of effectiveness and impact factors of different psychosocial intervention methods needs further research.
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18
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Chatterton ML, Stockings E, Berk M, Barendregt JJ, Carter R, Mihalopoulos C. Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis. Br J Psychiatry 2017; 210:333-341. [PMID: 28209591 DOI: 10.1192/bjp.bp.116.195321] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/17/2022]
Abstract
BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive-behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
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Affiliation(s)
- Mary Lou Chatterton
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Emily Stockings
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Jan J Barendregt
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Rob Carter
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Cathrine Mihalopoulos
- Mary Lou Chatterton, PharmD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria; Emily Stockings, PhD, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW; Michael Berk, PhD, Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, and Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria; Jan J. Barendregt, PhD, Epigear International Pty Ltd, Sunrise Beach, and School of Public Health, University of Queensland, Brisbane, Queensland; Rob Carter, PhD, Cathrine Mihalopoulos, PhD, Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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19
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Fountoulakis KN, Yatham L, Grunze H, Vieta E, Young A, Blier P, Kasper S, Moeller HJ. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. Int J Neuropsychopharmacol 2017; 20:121-179. [PMID: 27816941 PMCID: PMC5409012 DOI: 10.1093/ijnp/pyw100] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/29/2016] [Accepted: 11/03/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. MATERIAL AND METHODS The PRISMA method was used in the literature search with the combination of the words 'bipolar,' 'manic,' 'mania,' 'manic depression,' and 'manic depressive' with 'randomized,' and 'algorithms' with 'mania,' 'manic,' 'bipolar,' 'manic-depressive,' or 'manic depression.' Relevant web pages and review articles were also reviewed. RESULTS The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. CONCLUSIONS A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department Ludwig Maximilians University, Munich, Germany
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Rahmani F, Ebrahimi H, Ranjbar F, Razavi SS, Asghari E. The Effect of Group Psychoeducation Program on Medication Adherence in Patients with Bipolar Mood Disorders: a Randomized Controlled Trial. J Caring Sci 2016; 5:287-297. [PMID: 28032073 PMCID: PMC5187549 DOI: 10.15171/jcs.2016.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/13/2016] [Indexed: 01/28/2023] Open
Abstract
Introduction: Medication nonadherence is highly prevalent in
patients with bipolar disorders and often results in worsening disease prognosis. The
purpose of this study was to investigate the effect of group psychoeducation on medication
adherence in female patients with bipolar mood disorder type I. Methods: This randomized controlled trial was conducted on
76 patients with bipolar mood disorder admitted in female psychiatric wards of Razi
teaching hospital, Tabriz, Iran. The participants were selected by convenience sampling
method and were randomly assigned to experimental and control groups. Patients in
experimental group received 10 continuous 90 minutes sessions of psychoeducation, two
times a week. Medication adherence was measured using the medicine check list and
medication adherence rating scale (MARS) before and after intervention. Data analysis was
performed with SPSS ver.13. Results: There was no significant difference between two
groups regarding medication adherence before the intervention. After the study
intervention, the mean scores of medication adherence check list and medication adherence
rating scale in the experimental group were significantly higher than the control
group. Conclusion: Since group psychoeducation was effective in
improving patients' medication adherence, it could be recommended for psychiatric nurses
to apply this intervention in the clinical setting.
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Affiliation(s)
- Farnaz Rahmani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Ebrahimi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ranjbar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Sajjad Razavi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Asghari
- Department of Medical Surgical Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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An Open Trial of a Smartphone-assisted, Adjunctive Intervention to Improve Treatment Adherence in Bipolar Disorder. J Psychiatr Pract 2016; 22:492-504. [PMID: 27824786 PMCID: PMC5119543 DOI: 10.1097/pra.0000000000000196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We evaluated the feasibility and acceptability of a novel, 12-week, adjunctive, smartphone-assisted intervention to improve treatment adherence in bipolar disorder. Eight participants completed 4 in-person individual therapy sessions over the course of a month, followed by 60 days of twice-daily ecological momentary intervention (EMI) sessions, with a fifth in-person session after 30 days and a sixth in-person session after 60 days. Perceived credibility of the intervention and expectancy for change were adequate at baseline, and satisfaction on completion of the intervention was very high. Participants demonstrated good adherence to the intervention overall, including excellent adherence to the in-person component and fair adherence to the smartphone-facilitated component. Qualitative feedback revealed very high satisfaction with the in-person sessions and suggested a broad range of ways in which the EMI sessions were helpful. Participants also provided suggestions for improving the intervention, which primarily related to the structure and administration of the EMI (smartphone-administered) sessions. Although this study was not designed to evaluate treatment efficacy, most key outcome variables changed in the expected directions from pretreatment to posttreatment, and several variables changed significantly over the course of the in-person sessions or during the EMI phase. These findings add to the small but growing body of literature suggesting that EMIs are feasible and acceptable for use in populations with bipolar disorder.
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22
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Pan YJ, Yeh LL, Chen YC, Chan HY. Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder. Gen Hosp Psychiatry 2016; 43:32-37. [PMID: 27796255 DOI: 10.1016/j.genhosppsych.2016.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Whether the early treatment pattern in people with bipolar disorder (BD) could influence later mortality remains to be determined. We aimed to explore the potential effects of early hospitalization and number of outpatient clinic visits on the 3-year mortality in patients with newly diagnosed BD. METHOD Adult participants with newly diagnosed BD were identified in Taiwan's National Health Insurance Research Database in 2008. Survival analyses were performed with this national cohort to examine the associations between the first-year treatment pattern (hospitalization and number of outpatient clinic visits) and mortality over a follow-up period of 3 years (2008-2011). RESULTS A total of 15,254 participants were included. The mean age was 44.9 (S.D.=16.7) years and around 39.9% were male. The average follow-up time was 1055 days. Compared to BD patients with ≥7 times outpatient clinic visits within the first year, the risk of mortality was found elevated [hazard ratio=1.74; 95% confidence interval (CI), 1.40-2.15] for those who needed inpatient treatment. Number of outpatient clinic visits within the first year was found to be negatively associated with later mortality. Besides cancer (hazard ratio=2.14; 95% CI, 1.74-2.63), diabetes mellitus (hazard ratio=1.61; 95% CI, 1.38-1.89) and renal disease (hazard ratio=1.65; 95% CI, 1.36-2.00) were associated with the highest risk of mortality among the physical comorbidities. Substance use disorder stood out as the single comorbid mental illness associated with the highest mortality risk (hazard ratio=1.74; 95% CI, 1.37-2.21). CONCLUSIONS Early treatment pattern, including hospitalization and number of outpatient clinic visits, was associated with later mortality in BD patients. Special care should be given to enhance treatment adherence and to give psychoeducation to those with certain comorbid mental/physical illnesses to reduce health harming behavior and to improve health outcome.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Effectiveness of a psychoeducation program on the quality of life in patients with coronary heart disease: A clinical trial. Appl Nurs Res 2016; 33:36-41. [PMID: 28096020 DOI: 10.1016/j.apnr.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/21/2022]
Abstract
AIM The present study was conducted to evaluate effectiveness of a psychoeducation program (PEP) on the quality of life in patients with coronary heart disease (CHD). BACKGROUND CHD affects patients' quality of life. PEPs may be useful to help patients reach maximum functional health. METHODS A pretest-posttest controlled clinical trial was conducted on a study population of 70 CHD patients, who were selected through convenience sampling and randomly allocated to either the intervention or the control group. The MacNew Quality of Life Questionnaire in heart disease was completed by participants twice: first as a pretest, and then in a follow-up posttest. RESULTS After the intervention, the quality of life (QOL) score was 157.97±25.51 in the intervention group and 105.03±8.38 in the control group, making for a significant difference (p<0. 05). CONCLUSION Based on the findings, PEPs helped CHD patients improve their quality of life through reducing tension, relieving their negative emotions, and improving their social relationships.
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Salcedo S, Gold AK, Sheikh S, Marcus PH, Nierenberg AA, Deckersbach T, Sylvia LG. Empirically supported psychosocial interventions for bipolar disorder: Current state of the research. J Affect Disord 2016; 201:203-14. [PMID: 27243619 DOI: 10.1016/j.jad.2016.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocial interventions for bipolar disorder. METHODS We conducted a search of the literature to examine recent (2007-present), randomized controlled studies of the following psychotherapy interventions for bipolar disorder: psychoeducation (PE), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and family therapies such as family focused therapy (FFT). RESULTS All of the psychotherapy interventions appear to be effective in reducing depressive symptoms. Psychoeducation and CBT are associated with increased time to mood episode relapse or recurrence. MBCT has demonstrated a particular effectiveness in improving depressive and anxiety symptoms. Online psychotherapy interventions, programs combining one or more psychotherapy interventions, and targeted interventions centering on particular symptoms have been the focus of recent, randomized controlled studies in bipolar disorder. CONCLUSIONS Psychotherapy interventions for the treatment of bipolar disorder have substantial evidence for efficacy. The next challenge will to disseminate these psychotherapies into the community.
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Affiliation(s)
- Stephanie Salcedo
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - Alexandra K Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sana Sheikh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, Suffolk University, Boston, MA, USA
| | - Peter H Marcus
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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MacDonald L, Chapman S, Syrett M, Bowskill R, Horne R. Improving medication adherence in bipolar disorder: A systematic review and meta-analysis of 30 years of intervention trials. J Affect Disord 2016; 194:202-21. [PMID: 26851552 DOI: 10.1016/j.jad.2016.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Medication non-adherence in bipolar disorder is a significant problem resulting in increased morbidity, hospitalisation and suicide. Interventions to enhance adherence exist but it is not clear how effective they are, or what works and why. METHODS We systematically searched bibliographic databases for RCTs of interventions to support adherence to medication in bipolar disorder. Study selection and data extraction was performed by two investigators. Data was extracted on intervention design and delivery, study characteristics, adherence outcomes and study quality. The meta-analysis used pooled odds ratios for adherence using random effects models. RESULTS Searches identified 795 studies, of which 24 met the inclusion criteria, 18 provided sufficient data for meta-analysis. The pooled OR was 2.27 (95% CI 1.45-3.56) equivalent to a two-fold increase in the odds of adherence in the intervention group relative to control. Smaller effects were seen where the control group consisted of an active comparison and with increasing intervention length. The effects were robust across other factors of intervention and study design and delivery. LIMITATIONS Many studies did not report sufficient information to classify intervention design and delivery or judge quality and the interventions were highly variable. Therefore, the scope of moderation analysis was limited. CONCLUSIONS Even brief interventions can improve medication adherence. Limitations in intervention and study design and reporting prevented assessment of which elements of adherence support are most effective. Applying published guidance and quality criteria for designing and reporting adherence interventions is a priority to inform the implementation of cost-effective adherence support.
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Affiliation(s)
| | - Sarah Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, UK
| | - Michel Syrett
- The Roffey Park Institute & Lancaster University (Spectrum Centre for Mental Health Research), UK
| | - Richard Bowskill
- Brighton and Sussex Medical School, UK & Sussex Partnership NHS Foundation Trust, UK
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, UK.
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Oud M, Mayo-Wilson E, Braidwood R, Schulte P, Jones SH, Morriss R, Kupka R, Cuijpers P, Kendall T. Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry 2016; 208:213-22. [PMID: 26932483 DOI: 10.1192/bjp.bp.114.157123] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychological interventions may be beneficial in bipolar disorder. AIMS To evaluate the efficacy of psychological interventions for adults with bipolar disorder. METHOD A systematic review of randomised controlled trials was conducted. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE method. RESULTS We included 55 trials with 6010 participants. Moderate-quality evidence associated individual psychological interventions with reduced relapses at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48-0.92) and follow-up (RR = 0.74, 95% CI 0.63-0.87), and collaborative care with a reduction in hospital admissions (RR = 0.68, 95% CI 0.49-0.94). Low-quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psychoeducation with reduced symptoms of depression and mania. CONCLUSIONS There is evidence that psychological interventions are effective for people with bipolar disorder. Much of the evidence was of low or very low quality thereby limiting our conclusions. Further research should identify the most effective (and cost-effective) interventions for each phase of this disorder.
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Affiliation(s)
- Matthijs Oud
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Evan Mayo-Wilson
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ruth Braidwood
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Peter Schulte
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Steven H Jones
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Richard Morriss
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ralph Kupka
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Pim Cuijpers
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Tim Kendall
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
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Reinares M, Bonnín CM, Hidalgo-Mazzei D, Sánchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev 2016; 43:47-57. [PMID: 26691629 DOI: 10.1016/j.cpr.2015.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/01/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022]
Abstract
The reciprocal relationship between bipolar disorder (BD) and the family system highlights the importance of adjunctive family intervention. However, its implementation in clinical practice is not widespread. To update the knowledge in this field and identify areas of uncertainty this manuscript present a comprehensive overview of the bidirectional relationship between BD and family variables, and a systematic review of the evidence-based studies published up to March 2015 on the efficacy of adjunctive family intervention in BD. Findings show that not only specific family's attitudes/interactions affect the course of BD but that equally the illness itself has a strong impact on family functioning, caregivers' burden and health. Regarding family intervention, there are methodological differences between studies and variability in the sample characteristics and the intervention used. Most evidence-based studies support the efficacy of adjunctive family treatment in the illness outcomes, both in youth and adult population, as well as benefits for caregivers. The results emphasize the need to involve caregivers in the therapeutic management of BD through tailored interventions based on patients' characteristics and family needs.
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Affiliation(s)
- M Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
| | - C M Bonnín
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - D Hidalgo-Mazzei
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - J Sánchez-Moreno
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - F Colom
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - E Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Bashiri Z, Aghajani M, Masoudi Alavi N. Effects of Psychoeducation on Mental Health in Patients With Coronary Heart Disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25089. [PMID: 27437125 PMCID: PMC4939236 DOI: 10.5812/ircmj.25089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/24/2014] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
Abstract
Background Patients with coronary heart disease are at high risk for mental health disorders, such as depression and anxiety. Psychoeducation is a well-known intervention for psychiatric patients, but its use has been limited in other health conditions, such as coronary heart disease. Objectives The aim of this study was to evaluate the effect of psychoeducation on mental health in coronary heart disease patients. Patients and Methods This randomized clinical trial included 70 patients with coronary heart disease at Shahid Beheshti hospital, in Kashan, Iran, in 2014. The patients were randomly assigned into two groups: the experimental group, which received eight sessions of psychoeducation, and the control group, which received routine care. Data were collected with the Goldberg mental health questionnaire (GHQ) and were analyzed using independent and paired t-tests performed with SPSS version 16. Results The means of overall GHQ scores were significantly decreased post-test in the intervention group, and the differences between the two groups were statistically significant in the overall GHQ scores (P = 0.0001). A significant difference was observed between the mean GHQ scores of the intervention group prior to and after the psychoeducational program (PEP) intervention (30 ± 4.66 vs. 20.50 ± 3.30) (P = 0.0001). No significant changes were observed in the control group pre- and post-test (P = 0.07). Conclusions Psychoeducation resulted in improved mental health in patients with coronary heart disease. Therefore, it is recommended that this approach be performed as a complementary, effective, non-invasive, low-cost nursing intervention to reduce psychological problems in these patients.
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Affiliation(s)
- Zahra Bashiri
- Student Research Committee, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Aghajani
- Department of Psychiatric Nursing, Infectious Disease Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Mohammad Aghajani, Department of Psychiatric Nursing, Infectious Disease Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Negin Masoudi Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Abstract
The objective was to evaluate the effect of psychoeducation on biological rhythm and in the reduction of depressive, anxious, and manic symptoms at 12 months' follow-up. This was a randomized clinical trial with young adults aged 18 to 29 years, diagnosed with bipolar disorder. Biological rhythm was assessed with the Biological Rhythm Interview Assessment in Neuropsychiatry (BRIAN). Participants were randomized for combined intervention (psychoeducation plus medication) or treatment-as-usual (medication alone). The sample consisted of 61 patients (29 TAU; 32 combined intervention). Although it failed to separate by a marginal difference, the combined intervention seems to be more effective than TAU in relation to improvement of depressive symptoms at post-intervention (p = 0.074) and regulation of sleep/social domain at 6 months' follow-up (p = 0.057). Improvement of depressive symptoms as well as regulation of sleep and social activities are known to prevent episode onset and thus improve long-term outcomes.
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30
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Chatzidamianos G, Lobban F, Jones S. A qualitative analysis of relatives', health professionals' and service users' views on the involvement in care of relatives in Bipolar Disorder. BMC Psychiatry 2015; 15:228. [PMID: 26403843 PMCID: PMC4582817 DOI: 10.1186/s12888-015-0611-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/17/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Relatives of people with bipolar disorder report that services do not meet their own needs, despite clinical recommendations for the development of care plans for relatives, provision of information regarding their statutory entitlements, and formal involvement in decision making meetings. Further, there is now conclusive evidence highlighting the benefits of relatives' involvement in improving outcomes for service users, relatives, and the health system as a whole. This qualitative study explored the views of relatives of people with bipolar disorder, service users and healthcare professionals regarding the barriers and the facilitators to relatives' involvement in care. METHODS Thirty five people were interviewed (12 relatives, 11 service users and 12 healthcare professionals). Audio recordings were transcribed verbatim and common themes in participants' narratives emerged using framework analysis. RESULTS Participants' accounts confirmed the existence of opportunities for relatives to be involved. These, however, were limited and not always accessible. There were three factors identified that influenced accessibility namely: pre-existing worldviews, the quality of relationships and of communication between those involved, and specific structural impediments. DISCUSSION These themes are understood as intertwined and dependent on one another. People's thoughts, beliefs, attitudes, cultural identifications and worldviews often underlie the ways by which they communicate and the quality of their relationship. These, however, need to be conceptualised within operational frameworks and policy agendas in health settings that often limit bipolar relatives' accessibility to opportunities for being more formally involved. CONCLUSIONS Involving relatives leads to clear benefits for relatives, service users, healthcare professionals, and the health system as a whole. Successful involvement of relatives, however, depends on a complex network of processes and interactions among all those involved and requires strategic planning from policy makers, operational plans and allocation of resources.
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Affiliation(s)
- Gerasimos Chatzidamianos
- Doctorate in Clinical Psychology, Division of Health Research, Faculty of Health and Medicine, Lancaster University, C38, Furness Building, Lancaster, LA1 4YG, UK.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
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Wenze SJ, Gaudiano BA, Weinstock LM, Tezanos KM, Miller IW. Adjunctive psychosocial intervention following Hospital discharge for Patients with bipolar disorder and comorbid substance use: A pilot randomized controlled trial. Psychiatry Res 2015; 228:516-25. [PMID: 26117247 PMCID: PMC4532639 DOI: 10.1016/j.psychres.2015.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 01/18/2023]
Abstract
Bipolar disorder and substance use disorders are highly debilitating conditions, and especially when co-occurring, are associated with a variety of negative outcomes. Surprisingly, there is a relative lack of research on feasible and effective psychosocial treatments for individuals with comorbid bipolar and substance use disorder (BD-SUD), and a dearth of literature examining interventions designed specifically to improve outcomes such as symptoms, functioning, and treatment engagement/adherence following psychiatric hospitalization in this population. In the current paper, we report results of a pilot randomized controlled trial (n=30), comparing the recently developed Integrated Treatment Adherence Program, which includes individual and telephone sessions provided to patients and their significant others, versus Enhanced Assessment and Monitoring for those with BD-SUD. Participants who received the Integrated Treatment Adherence Program demonstrated significantly faster and greater improvements in depression, mania, functioning, and values-consistent living than participants randomized to Enhanced Assessment and Monitoring, and there was a trend for increased treatment adherence over time. Results are discussed in light of existing literature and study limitations, and suggestions for future research are proposed.
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Affiliation(s)
- Susan J. Wenze
- Department of Psychology, Lafayette College, Easton, PA, USA,Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brandon A. Gaudiano
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Psychosocial Research, Butler Hospital, Providence, RI, USA
| | - Lauren M. Weinstock
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Psychosocial Research, Butler Hospital, Providence, RI, USA
| | - Katherine M. Tezanos
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Psychosocial Research, Butler Hospital, Providence, RI, USA
| | - Ivan W. Miller
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Psychosocial Research, Butler Hospital, Providence, RI, USA
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Pedersen P, Søgaard HJ, Labriola M, Nohr EA, Jensen C. Effectiveness of psychoeducation in reducing sickness absence and improving mental health in individuals at risk of having a mental disorder: a randomised controlled trial. BMC Public Health 2015; 15:763. [PMID: 26253219 PMCID: PMC4529726 DOI: 10.1186/s12889-015-2087-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/24/2015] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the effect of psychoeducation on return to work as an adjunct to standard case management in individuals on sick leave at risk of having a mental disorder. The participants could have different diagnoses but were all at risk of having a mental disorder. Methods Between 2012 and 2014, 430 participants on sick leave were randomly allocated to either an intervention or control group. The psychoeducation consisted of 2-h sessions once a week for 6 weeks. The sessions focused on stress and work life and was based on problem-solving techniques and coping strategies. The main outcome, the relative risk (RR) of a full return to work based on register data from the job centres, was determined during the first 3 and 6 months after participation in the psychoeducation programme. At baseline and at 3 and 6 months after the intervention, the participants received a questionnaire on psychological symptoms, mental health-related quality of life, and locus of control. Results During the first 6 months after inclusion, the two groups had almost the same RR of a full return to work (RR:0.97, 95 % CI: 0.78;1.21), but during the first 3 months, the individuals in the intervention group had a significantly higher risk of not having fully returned to work (RR:0.68, 95 % CI:0.47;0.98). The individuals in the intervention group who had participated in at least four of the six psychoeducational sessions returned to work considerably slower at both time points than did the control group. The intervention did not decrease the level of psychological symptoms or improve mental health-related quality of life; however, individuals in the intervention group improved their scores on internal locus of control at both 3 and 6 months. Conclusion Offering psychoeducation to individuals on sick leave at risk of having a mental disorder had no influence on the chance of a full return to work during the first 6 months; however, it did result in a higher relative risk of not returning to work after 3 months. Therefore, we do not recommend offering psychoeducation in this form to facilitate return to work. Trial registration Clinical Trial.gov NCT01637363. Registered 6 July 2012.
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Affiliation(s)
- Pernille Pedersen
- Psychiatric Research Unit West, Regional Psychiatric Services West, Central Denmark Region, Gl. Landevej 49, 7400, Herning, Denmark. .,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark. .,Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark.
| | - Hans Jørgen Søgaard
- Psychiatric Research Unit West, Regional Psychiatric Services West, Central Denmark Region, Gl. Landevej 49, 7400, Herning, Denmark. .,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
| | - Merete Labriola
- Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark. .,Section of Clinical Social Medicine and Rehabilitation, School of Public Health, University of Aarhus, Aarhus, Denmark.
| | - Ellen A Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Chris Jensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. .,National Centre for Occupational Rehabilitation, Rauland, Norway.
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Relapse rate and outcome correlates in Egyptian patients with bipolar disorder treated with behavioural family psychoeducation. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000466278.16335.8f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gumus F, Buzlu S, Cakir S. Effectiveness of individual psychoeducation on recurrence in bipolar disorder; a controlled study. Arch Psychiatr Nurs 2015; 29:174-9. [PMID: 26001717 DOI: 10.1016/j.apnu.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 12/19/2022]
Abstract
This research was conducted as an controlled experimental study which aimed to determine the effectiveness of individual psychoeducation program on recurrence rate during 1year follow up period. The study included eighty-two patients who had been diagnosed with bipolar disorder. There were no hospitalizations in intervention group, while 7.3% of control patients experienced hospitalizations; recurrence rates were 18.9% in the intervention group patients and 34.1% in the control group patients, but statistical significant difference between the groups was not found. Four sessions of individual psychoeducation may have some positive effects but seem to be ineffective for preventing recurrences in patients with bipolar disorder during one year prospective follow up.
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Affiliation(s)
- Funda Gumus
- Diyarbakır Atatürk School of Health Services, Dicle University, Diyarbakır, Turkey.
| | - Sevim Buzlu
- Florence Nightingale Nursing Faculty, Department of Mental Health and Psychiatric Nursing, Istanbul University, Istanbul, Turkey.
| | - Sibel Cakir
- Istanbul Medical School, Department of Psychiatry, Mood Disorders Unit, Istanbul University, Istanbul, Turkey.
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Bond K, Anderson IM. Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar Disord 2015; 17:349-62. [PMID: 25594775 DOI: 10.1111/bdi.12287] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/03/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Previous reviews have concluded that interventions including psychoeducation are effective in preventing relapse in bipolar disorder, but the efficacy of psychoeducation itself has not been systematically reviewed. Our aim was to evaluate the efficacy of psychoeducation for bipolar disorder in preventing relapse and other outcomes, and to identify factors that relate to clinical outcomes. METHODS We employed the systematic review of randomized controlled trials of psychoeducation in participants with bipolar disorder not in an acute illness episode, compared with treatment-as-usual, and placebo or active interventions. Pooled odds ratios (ORs) for non-relapse into any episode, mania/hypomania, and depression were calculated using an intent-to-treat (ITT) analysis, assigning dropouts to relapse, with a sensitivity analysis in which dropouts were assigned to non-relapse (optimistic ITT). RESULTS Sixteen studies were included, eight of which provided data on relapse. Although heterogeneity in the data warrants caution, psychoeducation appeared to be effective in preventing any relapse [n = 7; OR: 1.98-2.75; number needed to treat (NNT): 5-7, depending on the method of analysis] and manic/hypomanic relapse (n = 8; OR: 1.68-2.52; NNT: 6-8), but not depressive relapse. Group, but not individually, delivered interventions were effective against both poles of relapse; the duration of follow-up and hours of therapy explained some of the heterogeneity. Psychoeducation improved medication adherence and short-term knowledge about medication. No consistent effects on mood symptoms, quality of life, or functioning were found. CONCLUSIONS Group psychoeducation appears to be effective in preventing relapse in bipolar disorder, with less evidence for individually delivered interventions. Better understanding of mediating mechanisms is needed to optimize efficacy and personalize treatment.
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Affiliation(s)
- Kirsten Bond
- Specialist Service for Affective Disorders, Manchester Mental Health and Social Care Trust, Manchester, UK
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Miziou S, Tsitsipa E, Moysidou S, Karavelas V, Dimelis D, Polyzoidou V, Fountoulakis KN. Psychosocial treatment and interventions for bipolar disorder: a systematic review. Ann Gen Psychiatry 2015; 14:19. [PMID: 26155299 PMCID: PMC4493813 DOI: 10.1186/s12991-015-0057-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic disorder with a high relapse rate, significant general disability and burden and with a psychosocial impairment that often persists despite pharmacotherapy. This indicates the need for effective and affordable adjunctive psychosocial interventions, tailored to the individual patient. Several psychotherapeutic techniques have tried to fill this gap, but which intervention is suitable for each patient remains unknown and it depends on the phase of the illness. METHODS The papers were located with searches in PubMed/MEDLINE through May 1st 2015 with a combination of key words. The review followed the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement. RESULTS The search returned 7,332 papers; after the deletion of duplicates, 6,124 remained and eventually 78 were included for the analysis. The literature supports the usefulness only of psychoeducation for the relapse prevention of mood episodes and only in a selected subgroup of patients at an early stage of the disease who have very good, if not complete remission, of the acute episode. Cognitive-behavioural therapy and interpersonal and social rhythms therapy could have some beneficial effect during the acute phase, but more data are needed. Mindfulness interventions could only decrease anxiety, while interventions to improve neurocognition seem to be rather ineffective. Family intervention seems to have benefits mainly for caregivers, but it is uncertain whether they have an effect on patient outcomes. CONCLUSION The current review suggests that the literature supports the usefulness only of specific psychosocial interventions targeting specific aspects of BD in selected subgroups of patients.
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Affiliation(s)
- Stella Miziou
- Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | | | - Vangelis Karavelas
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | - Dimos Dimelis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | | | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
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Pedersen P, Søgaard HJ, Yde BF, Labriola M, Nohr EA, Jensen C. Psychoeducation to facilitate return to work in individuals on sick leave and at risk of having a mental disorder: protocol of a randomised controlled trial. BMC Public Health 2014; 14:1288. [PMID: 25516423 PMCID: PMC4300682 DOI: 10.1186/1471-2458-14-1288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Abstract
Background Sickness absence due to poor mental health is a common problem in many Western countries. To facilitate return to work, it may be important to identify individuals on sick leave and at risk of having a mental disorder and subsequently to offer appropriate treatment. Psychoeducation alone has not previously been used as a return to work intervention, but may be a promising tool to facilitate return to work. Therefore, the aim of the study is to evaluate the effectiveness of psychoeducation designed specifically to facilitate return to work for individuals on sick leave and at risk of having a mental disorder. The psychoeducation was a supplement to the various standard offers provided by the job centres. Methods/Design The study is a randomised controlled trial, in which individuals on sick leave either receive psychoeducation and standard case management or standard case management alone. Participants were individuals with mental health symptoms, who had been on sick leave from part-time or full-time work or unemployment for about 4–8 weeks. The psychoeducational intervention was group-based and the course consisted of 2 hour sessions once a week for 6 weeks. The course was given by psychiatric nurses, a psychologist, a social worker, a physiotherapist and a person who had previously been on sick leave due to mental health problems. The sessions focused on stress and work life, and the purpose was to provide individuals on sick leave the skills to understand and improve their mental functioning. The primary outcome is the duration of sickness absence measured by register data. Secondary outcomes include psychological symptoms, mental health-related quality of life, and locus of control. These outcomes are measured by questionnaires at the start of the intervention and at 3 and 6 months follow-up. Discussion On the basis of this trial, the effect of psychoeducation for individuals on sick leave and at risk of having a mental disorder will be studied. The results will contribute to the continuing research on sickness absence and mental health. It will primarily show whether psychoeducation can lead to faster and sustainable return to work. Trial Registration Clinical Trial.gov NCT01637363. Registered 6 July 2012.
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Affiliation(s)
- Pernille Pedersen
- Psychiatric Research Unit West, Regional Psychiatric Services West, Central Denmark Region, Gl, Landevej 49, 7400 Herning, Denmark.
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Vargas-Huicochea I, Huicochea L, Berlanga C, Fresán A. Taking or not taking medications: psychiatric treatment perceptions in patients diagnosed with bipolar disorder. J Clin Pharm Ther 2014; 39:673-9. [PMID: 25252225 DOI: 10.1111/jcpt.12210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 08/25/2014] [Indexed: 01/18/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Bipolar disorder is a common and disabling condition. Although its negative impact may be limited in some way by the use of different treatment options, lack of adherence to psychiatric treatment is still an obstacle to overcome. Because there are many factors involved in non-adherence to treatment, in this study, we sought to examine the subjective aspect of this phenomenon. We analysed perceptions of both the disease and the treatment in a group of patients with bipolar disorder. METHODS We incorporated a qualitative design that included 50 outpatients diagnosed with bipolar disorder type 1. Through semi-structured interviews, we explored patients' perceptions of bipolarity and psychiatric medication management. RESULTS AND DISCUSSION The participants reported the use of medications as one of the most troubling aspects of having bipolar disorder. The fear of becoming addicted to psychiatric drugs was repeatedly mentioned among the patients as an argument for abandoning treatment. The main expectation of treatment was to achieve stable mood, but the patients considered that drugs were not the only way to be euthymic. WHAT IS NEW AND CONCLUSIONS The patients expressed ambivalence between the need to take medication to remain stable and the fear of negative consequences of using psychiatric drugs. Personal beliefs and environmental influences seem to determine each individual's final choice of whether to maintain or discontinue treatment; so, in everyday clinical practice, it would be necessary to discuss perceptions of the disease with patients and their families.
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Affiliation(s)
- I Vargas-Huicochea
- Sub-dirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente", Mexico City, Mexico
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Reinares M, Sánchez-Moreno J, Fountoulakis KN. Psychosocial interventions in bipolar disorder: what, for whom, and when. J Affect Disord 2014; 156:46-55. [PMID: 24439829 DOI: 10.1016/j.jad.2013.12.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic condition with a high relapse rate, morbidity and psychosocial impairment that often persist despite pharmacotherapy, highlighting the need for adjunctive psychosocial treatments. It is still unclear which populations are most likely to benefit from which approach and the best timing to implement them. METHODS A review was conducted with the aim to determine what the efficacious psychological treatments are, for whom and when. Randomized-controlled trials and key studies in adults with BD published until June 2013 were included RESULTS The adjunctive psychological treatments most commonly tested in BD were cognitive-behavioral therapy, psychoeducation, interpersonal and social rhythm therapy, and family intervention. The efficacy of specific adjunctive psychosocial interventions has been proven not only in short- but also long-term follow-up for some treatments. Outcomes vary between studies, with most trials focused on clinical variables like recurrence prevention or symptom reduction and less attention, although gradually expanding, paid to other aspects such as psychosocial functioning. The samples were usually in remission or with mild symptoms when recruited but there were a few studies with acute patients, which resulted in discrepant findings. The efficacy of psychological interventions seems to differ depending on the characteristics of the subjects and the course of the illness. Different approaches, such as functional remediation and mindfulness-based cognitive therapy, have begun to be tested in BD. LIMITATIONS Heterogeneity of comparison groups. CONCLUSIONS Adjunctive psychological treatments can improve BD outcomes. Although several moderators and mediators have been identified, more research is needed to design shorter but effective interventions tailored to the characteristics of the target population. Ideally, the treatment should be introduced as soon as possible, although it does not mean that more complex patients would not benefit from psychotherapy.
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Affiliation(s)
- María Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain.
| | - José Sánchez-Moreno
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain
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Morokuma I, Shimodera S, Fujita H, Hashizume H, Kamimura N, Kawamura A, Nishida A, Furukawa TA, Inoue S. Psychoeducation for major depressive disorders: a randomised controlled trial. Psychiatry Res 2013; 210:134-9. [PMID: 23835139 DOI: 10.1016/j.psychres.2013.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022]
Abstract
Various psychological therapies have been shown to be effective for the treatment of mood disorders. Among them, family psychoeducation has demonstrated efficacy in reducing symptom severity and extending the time to relapse. We tested the efficacy of adding psychoeducation focussed on how to deal with the family's expressed emotion to treatment as usual (TAU) to prevent relapse among patients with remitted major depression. A total of 34 patients with major depressive disorders in full or partial remission were randomised to receive either group psychoeducation over six sessions, each consisting of a didactic lecture and group problem-solving (n=19), plus TAU or TAU alone (n=15). The primary outcome was relapse by Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Masked raters administered the Hamilton Rating Scale for Depression-17 (HRSD-17). As many as 18 patients in the intervention group and 14 patients in the control group completed the study. Time to relapse was significantly longer in the intervention group than in the control group, with a risk ratio (RR) of relapse by 9 months of 0.12. At 9 months, there was a significantly greater decrease in the HRSD-17 score in the intervention group than in the control group. We demonstrated the effectiveness of patient psychoeducation on the course and outcome of major depressive disorders.
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Affiliation(s)
- Ippei Morokuma
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan
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Determinants of adherence to treatment in bipolar disorder: a comprehensive review. J Affect Disord 2013; 149:247-52. [PMID: 23489403 DOI: 10.1016/j.jad.2013.01.036] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/29/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Comprehensively review studies evaluating factors associated with adherence to treatment in bipolar disorder (BD), as well as the results of interventions developed to enhance adherence in this population. METHODS The following search engines were consulted: PubMed, Scielo, LILACS and PsycINFO. The keywords used were "Bipolar Disorder", "Factor", "Adherence", "Nonadherence", "Compliance" and "Intervention". In addition, references list of selected studies were consulted searching for relevant articles. RESULTS Adherence has been defined in various ways, with some considering adherence vs. nonadherence, and other including a "partial" adherence measure. In addition, methods to assess adherence differ for each study. Several factors were related to poor adherence, including patient-related factors (e.g. younger age, male gender, low level of education, alcohol and drugs comorbidity), disorder-related factors (e.g. younger age of onset, severity of BD, insight and lack of awareness of illness) and treatment-related factors (e.g. side effects of medications, effectiveness). To improve adherence, the main recommendations are to provide customized interventions focusing on the underlying causes of nonadherence, strong therapeutic alliance and different modalities based on psychoeducation. CONCLUSION Our results indicate that nonadherence is a multicausal phenomenon and strategies to prevent and approaches them must include enhanced therapeutic alliance, flexible topics, early intervention, group setting, and psychoeducation. LIMITATIONS Different definitions and measures of adherence in the literature currently moderate the generalization of the findings in this review. Further studies are necessary regarding factors of adherence in BD and interventions to improve it, especially on social factors like stigma and family.
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Javadpour A, Hedayati A, Dehbozorgi GR, Azizi A. The impact of a simple individual psycho-education program on quality of life, rate of relapse and medication adherence in bipolar disorder patients. Asian J Psychiatr 2013; 6:208-13. [PMID: 23642977 DOI: 10.1016/j.ajp.2012.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 10/15/2012] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bipolar disorder is one of ten most debilitating diseases in the world, leading to a lessened quality of life amongst its sufferers. This randomised control trial demonstrates the effectiveness of psycho-education intervention along with a patient support system in the management of this disorder. METHODOLOGY In this trial, 108 patients, divided equally into two groups, were randomly assigned to receive either pharmacotherapy alone (control group) or psycho-education along with pharmacotherapy treatment (intervention group) for a two year period. Each individual patient in the "intervention" group received eight, fifty-minute sessions of psychological education, followed by monthly telephone follow-up care and psychological support in the subsequent 18 months. Each group was evaluated, once every 6 months for a period of 18 months, in the areas of "quality of life", "symptoms of relapse", "pharmacotherapy compliance" and "number of hospital admission for recurrence of bipolar disorder". RESULT The result of this study indicates that patients in the "intervention" group had a statistically significant enhancement in medication compliance (P = 0.008). Regarding every aspect of life quality, this group was at a better position than the "control" group (P = 0.000). As to relapse and hospital admission, the "intervention" group reported much lower cases compared with the "control" group at a significance level of P = 0.000. CONCLUSION AND DISCUSSION This research has demonstrated that in the psycho-education intervention group, there was a more significant improvement in all areas of quality of life, number of relapses, and hospitalization due to recurrence of bipolar disorder and medication compliance than it was evident in the control groups.
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Affiliation(s)
- Ali Javadpour
- Research Centre for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 553] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Provencher MD, Hawke LD, Bélair M, Guimond AJ. La psychoéducation pour les troubles bipolaires : recension des écrits et recommandations pour le système de santé québécois. SANTE MENTALE AU QUEBEC 2012; 37:157-87. [DOI: 10.7202/1012650ar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le trouble bipolaire est une maladie chronique caractérisée par une récurrence des rechutes thymiques, et par des symptômes résiduels interférant avec le fonctionnement de l’individu. La pharmacothérapie demeure la pierre angulaire du traitement. Malheureusement, la médication a des effets limités sur certains aspects de la maladie, sans compter qu’une grande proportion de patients présente des problèmes d’observance à leur traitement pharmacologique. Cette recension des écrits aborde le rôle de la psychoéducation comme traitement complémentaire dans la prise en charge des patients bipolaires. Les différentes modalités de psychoéducation structurée, dont deux programmes psychoéducatifs manualisés appuyés par des données probantes, sont présentées. Dans une perspective de transfert des connaissances, des recommandations pour l’implantation de la psychoéducation dans le système de santé québécois sont proposées.
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Affiliation(s)
- Martin D. Provencher
- Psychologue
- Professeur agrégé, École de psychologie de l’Université Laval, Institut universitaire en santé mentale de Québec
| | - Lisa D. Hawke
- Candidate au doctorat, École de psychologie de l’Université Laval
| | - Meggy Bélair
- Candidate au doctorat, École de psychologie de l’Université Laval
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Fountoulakis KN, Kasper S, Andreassen O, Blier P, Okasha A, Severus E, Versiani M, Tandon R, Möller HJ, Vieta E. Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 2012; 262 Suppl 1:1-48. [PMID: 22622948 DOI: 10.1007/s00406-012-0323-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MEDLINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation antipsychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/carbamazepine, adding an antipsychotic is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients could benefit with add-on treatment with olanzapine, valproate, an antidepressant, or lamotrigine, depending on the index acute phase. A variety of treatment options for BP are available today, but still unmet needs are huge. Combination therapy may improve the treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6 Odysseos str./1st Parodos Ampelonon str., Pylaia, Thessaloniki, Greece.
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Swartz HA, Levenson JC, Frank E. Psychotherapy for Bipolar II Disorder: The Role of Interpersonal and Social Rhythm Therapy. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2012; 43:145-153. [PMID: 26612968 PMCID: PMC4657867 DOI: 10.1037/a0027671] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although bipolar II disorder is a highly prevalent, chronic illness that is associated with burdensome psychosocial impairment, relatively little is known about the best ways to treat the disorder. Moreover, psychosocial interventions for the management of bipolar II disorder have been largely unexplored, leaving psychologists with few evidence-based recommendations for best treatment practices. In this article, we provide information about interpersonal and social rhythm therapy (IPSRT), an empirically supported treatment for bipolar I disorder that has preliminary evidence supporting its efficacy in bipolar II disorder. After reviewing the phenomenology of bipolar II disorder and differentiating it from bipolar I disorder, we summarize the extant empirical support for using psychotherapy in the management of bipolar II disorder. We explore what is known about the role of psychotherapy in the management of bipolar II disorder as well as lacunae in the evidence base. Next, we introduce IPSRT and discuss how it has been adapted for use as a treatment for individuals suffering from bipolar II disorder. Specific strategies of the treatment are detailed, and preliminary evidence for the efficacy of IPSRT in bipolar II disorder is described. Finally, we present a case vignette demonstrating the use of IPSRT for an individual with bipolar II disorder.
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Crowe M, Porter R, Inder M, Lacey C, Carlyle D, Wilson L. Effectiveness of interventions to improve medication adherence in bipolar disorder. Aust N Z J Psychiatry 2012; 46:317-26. [PMID: 22508592 DOI: 10.1177/0004867411428101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify interventions that improve medication adherence in bipolar disorder. METHOD A review of the literature from 2004 to 2011 was conducted using Medline and manual searching. RESULTS Eleven studies were identified as meeting inclusion criteria. Five studies demonstrated improved medication adherence. No characteristics of the interventions, clinical characteristics of the groups or methodological factors distinguished those psychosocial interventions that demonstrated improvement from those that did not. CONCLUSIONS While only a few interventions improved adherence, most improved clinical outcomes. Issues were also identified about the way in which adherence is defined. It is proposed that incorporating patient preferences into measures of adherence within the context of a disorder-specific psychosocial intervention may provide an approach that demonstrates both improved adherence and improved clinical outcomes. However this requires further research.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, New Zealand.
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Menezes SL, Souza MCBDME. Implicações de um grupo de Psicoeducação no cotidiano de portadores de Transtorno Afetivo Bipolar. Rev Esc Enferm USP 2012; 46:124-31. [DOI: 10.1590/s0080-62342012000100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 08/20/2011] [Indexed: 11/21/2022] Open
Abstract
Há evidências crescentes de que o curso Transtorno Afetivo Bipolar (TAB) pode ser modificado por abordagens psicoterápicas, tais como a Psicoeducação. Assim, o objetivo deste trabalho foi identificar as implicações do grupo de Psicoeducação no cotidiano dos portadores. Para tanto, optou-se pelo estudo qualitativo, do tipo Estudo de Caso. Foram incluídos doze portadores de TAB que tiveram pelo menos seis participações no Grupo de Psicoeducação desenvolvido na Faculdade de Medicina de São José do Rio Preto (FAMERP). Foram realizadas entrevistas semi-estruturadas, gravadas, transcritas e trabalhadas por meio da Análise Temática. Este estudo demonstrou que tal experiência grupal favoreceu a aquisição de conhecimento; a conscientização da doença e adesão ao tratamento; a realização de mudanças positivas na vida; a possibilidade de ajudar outros portadores a se beneficiarem do aprendizado construído no grupo; a descoberta de outras realidades e estratégias de enfrentamento, obtidas por meio da troca de experiências entre os participantes.
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Morriss RK, Lobban F, Jones S, Riste L, Peters S, Roberts C, Davies L, Mayes D. Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder. BMC Psychiatry 2011; 11:114. [PMID: 21777426 PMCID: PMC3146925 DOI: 10.1186/1471-244x-11-114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/21/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-didactically delivered curriculum based group psychoeducation has been shown to be more effective than both group support in a specialist mood disorder centre in Spain (with effects lasting up to five years), and treatment as usual in Australia. It is unclear whether the specific content and form of group psychoeducation is effective or the chance to meet and work collaboratively with other peers. The main objective of this trial is to determine whether curriculum based group psychoeducation is more clinically and cost effective than unstructured peer group support. METHODS/DESIGN Single blind two centre cluster randomised controlled trial of 21 sessions group psychoeducation versus 21 sessions group peer support in adults with bipolar 1 or 2 disorder, not in current episode but relapsed in the previous two years. Individual randomisation is to either group at each site. The groups are carefully matched for the number and type of therapists, length and frequency of the interventions and overall aim of the groups but differ in content and style of delivery. The primary outcome is time to next bipolar episode with measures of the therapeutic process, barriers and drivers to the effective delivery of the interventions and economic analysis. Follow up is for 96 weeks after randomisation. DISCUSSION The trial has features of both an efficacy and an effectiveness trial design. For generalisability in England it is set in routine public mental health practice with a high degree of expert patient involvement.
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Affiliation(s)
- Richard K Morriss
- Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham & Nottinghamshire Healthcare NHS Trust.
| | - Fiona Lobban
- Senior Lecturer in Clinical Psychology, Spectrum Centre for Mental Health Research, School of Health and Medicine, Lancaster University
| | - Steven Jones
- Professor of Clinical Psychology, Spectrum Centre for Mental Health Research, School of Health and Medicine, Lancaster University
| | - Lisa Riste
- PARADES Programme Manager, Department of Psychology, University of Manchester
| | - Sarah Peters
- Senior Lecturer in Psychology, University of Manchester
| | | | - Linda Davies
- Professor of Health Economics, University of Manchester
| | - Debbie Mayes
- Service User Researcher, Spectrum Centre for Mental Health Research, Lancaster University
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Maurel M, Azorin JM, Adida M, Fakra E, Richieri R, Bottai T, Pringuey D, Kaladjian A. Troubles affectifs bipolaires : modèles et bilan des approches psychothérapeutiques. Encephale 2010; 36 Suppl 6:S202-5. [DOI: 10.1016/s0013-7006(10)70058-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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