Objective To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. Design Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. Setting Mental health services in four NHS trusts (one teaching, three non-teaching). Subjects 69 patients with bipolar disorder who had had a relapse in the previous 12 months. Interventions Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. Main outcome measures Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. Results 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df = 1, P = 0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P = 0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P = 0.003) and employment (mean difference 0.7 (0.1 to 1.3), P = 0.030) by 18 months. Conclusion Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.

Objectives: To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia. Design: Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone. Setting: Adjunct treatments were carried out in outpatient clinics or in the patient's home. Subjects: 87 patients with persistent positive symptoms who complied with medication; 72 completed treatment. Outcome measures: Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital. Results: Significant improvements were found in the severity (F = 5.42, df = 2,86; P = 0.006) and number (F = 4.99, df = 2,86; P = 0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms ( 2 = 5.18, df = 1; P = 0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital. Conclusions: Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.

At 12-month follow-up the significant advantage of cognitive-behavioural therapy compared to routine care alone remained.