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.

To investigate the role of psychoeducation in BD.

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.

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.

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.

• Bipolar disorder
• Mood disorders
• Psychoeducation
• Adherence
• Mania
• Depression

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders.

Design: Retrospective chart review.

Settings: Veterans Administration Medical Center (VAMC).

Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%).

Intervention: Eight-week MBCT class.

Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations.

Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535).

Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

• meditation
• mindfulness
• mindfulness-based cognitive therapy
• outcomes
• veterans

• Adult
• Cognitive Behavioral Therapy/methods
• Cognitive Behavioral Therapy/statistics & numerical data
• Female
• Humans
• Male
• Meditation
• Mental Disorders/therapy
• Middle Aged
• Mindfulness/methods
• Mindfulness/statistics & numerical data
• Patient Acceptance of Health Care/statistics & numerical data
• Retrospective Studies
• Stress Disorders, Post-Traumatic/therapy
• Treatment Outcome
• Veterans/statistics & numerical data
• Young Adult

• Adolescent
• Bipolar disorder
• Child
• Family Assessment Device
• Family functioning
• Young adult

The term resilience describes stress–response patterns of subjects across scientific disciplines. In ecology, advances have been made to clearly distinguish resilience definitions based on underlying mechanistic assumptions. Engineering resilience (rebound) is used for describing the ability of subjects to recover from adverse conditions (disturbances), and is the rate of recovery. In contrast, the ecological resilience definition considers a systemic change: when complex systems (including humans) respond to disturbances by reorganizing into a new regime (stable state) where structural and functional aspects have fundamentally changed relative to the prior regime. In this context, resilience is an emergent property of complex systems. We argue that both resilience definitions and uses are appropriate in psychology and psychiatry, but although the differences are subtle, the implications and uses are profoundly different.

We borrow from the field of ecology to discuss resilience concepts in the mental health sciences.

In psychology and psychiatry, the prevailing view of resilience is adaptation to, coping with, and recovery (engineering resilience) from adverse social and environmental conditions. Ecological resilience may be useful for describing vulnerability, onset, and the irreversibility patterns of mental disorders. We discuss this in the context of bipolar disorder.

Rebound, adaptation, and coping are processes that are subsumed within the broader systemic organization of humans, from which ecological resilience emanates. Discerning resilience concepts in psychology and psychiatry has potential for a mechanistically appropriate contextualization of mental disorders at large. This might contribute to a refinement of theory and contextualize clinical practice within the broader systemic functioning of mental illnesses.

• Bipolar disorder
• Ecological resilience
• Ecological theory
• Engineering resilience
• Interdisciplinary research
• Mental disorders
• Stress-recovery

• couples and family systems therapy
• outcome research
• test development

• Bipolar disorder
• Cognitive behavior therapy
• Dialectical behavior therapy
• Family therapy
• Interpersonal and social rhythm therapy
• Psychosocial interventions

• Bipolar disorder
• Burden
• Caregiver
• Expressed emotion
• Family
• Family intervention

• Bipolar Disorder/nursing
• Bipolar Disorder/therapy
• Caregivers/psychology
• Cost of Illness
• Family Therapy/methods
• Humans

• Mood disorders
• couples therapy
• family psychoeducation
• multifamily groups
• veterans

• UL1 TR000039 NCATS NIH HHS

• Bipolar disorder
• cognitive behavior therapy
• group
• interpersonal
• psychoeducation
• psychosocial
• women

• adherence to treatment
• bipolar disorder
• medicine use
• patient characteristics
• perception

• adults
• efficacy
• mental illness
• meta-analysis
• randomized controlled trial
• systemic therapy

• Bipolar disorder
• Prognosis
• Psychological treatment
• Psychosocial

• Adult
• Bipolar Disorder/therapy
• Female
• Humans
• Male
• Middle Aged
• Psychotherapy/methods
• Randomized Controlled Trials as Topic
• Secondary Prevention
• Treatment Outcome

• K23 MH093410 NIMH NIH HHS
• R01 MH048171 NIMH NIH HHS

• Bipolar disorder
• depression
• group psychotherapy
• interpersonal psychotherapy

• Adult
• Aged
• Diagnostic and Statistical Manual of Mental Disorders
• Group Structure
• Health Status
• Humans
• Mental Disorders/diagnosis
• Mental Disorders/psychology
• Mental Disorders/therapy
• Mental Health
• Middle Aged
• Multicenter Studies as Topic
• Psychotherapy/methods
• Psychotherapy/standards
• Randomized Controlled Trials as Topic
• Socioeconomic Factors
• Treatment Outcome

Bipolar disorder patients often display abnormalities in circadian rhythm, and they are sensitive to irregular diurnal rhythms. CRY2 participates in the core clock that generates circadian rhythms. CRY2 mRNA expression in blood mononuclear cells was recently shown to display a marked diurnal variation and to respond to total sleep deprivation in healthy human volunteers. It was also shown that bipolar patients in a depressive state had lower CRY2 mRNA levels, nonresponsive to total sleep deprivation, compared to healthy controls, and that CRY2 gene variation was associated with winter depression in both Swedish and Finnish cohorts.

Four CRY2 SNPs spanning from intron 2 to downstream 3′UTR were analyzed for association to bipolar disorder type 1 (n = 497), bipolar disorder type 2 (n = 60) and bipolar disorder with the feature rapid cycling (n = 155) versus blood donors (n = 1044) in Sweden. Also, the rapid cycling cases were compared with bipolar disorder cases without rapid cycling (n = 422). The haplotype GGAC was underrepresented among rapid cycling cases versus controls and versus bipolar disorder cases without rapid cycling (OR = 0.7, P = 0.006−0.02), whereas overrepresentation among rapid cycling cases was seen for AAAC (OR = 1.3−1.4, P = 0.03−0.04) and AGGA (OR = 1.5, P = 0.05). The risk and protective CRY2 haplotypes and their effect sizes were similar to those recently suggested to be associated with winter depression in Swedes.

We propose that the circadian gene CRY2 is associated with rapid cycling in bipolar disorder. This is the first time a clock gene is implicated in rapid cycling, and one of few findings showing a molecular discrimination between rapid cycling and other forms of bipolar disorder.

• Bipolar Disorder/therapy
• Cognitive Behavioral Therapy
• Family Therapy
• Humans
• Randomized Controlled Trials as Topic
• Recurrence