A Comparison of the Life Goals Program and Treatment as Usual for Individuals With Bipolar Disorder

Abstract

Objective This randomized controlled study of 164 outpatients with bipolar disorder in a community mental health center who received standardized psychoeducation (Life Goals Program [LGP]) or treatment as usual sought to determine whether there were differences between the groups in medication adherence attitudes and behaviors. Methods Patients were randomly assigned to treatment as usual (N=80) or treatment as usual plus LGP (N=84) and were assessed at baseline and at the three-, six-, and 12-month follow-up. Primary outcomes were change in score from baseline on the Drug Attitude Inventory (DAI) and on self-reported treatment adherence behaviors (SRTAB). Results At baseline, there were no significant differences between the two groups. Slightly less than half (N=41, 49%) of the LGP group participated in most or all (four to six) LGP sessions, 14% (N=12) participated in one to three sessions, and 37% (N=31) did not participate in any sessions. At the 12-month follow-up there was improvement among all patients, with no significant differences between the two groups, in DAI scores, SRTAB, symptoms, psychopathology, and functional status. Greater depressive severity at baseline was associated with more negative attitudes toward treatment over time, although this finding was not significant (p=.056). Secondary analysis of persons in the LGP group found that compared with those who did not go to any LGP sessions, those with partial or full participation in LGP sessions had improved attitudes toward medication at the three- and six-month follow-up, but no difference was found between the three LGP subgroups by the 12-month follow-up. Conclusions There were no differences between two groups in treatment attitudes at the 12-month follow-up. Low attendance rates mitigated effects on primary outcomes. Effects of LGP may become lost over time without ongoing intervention, and individuals with depression may have reduced response to LGP.

Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials

“…Finally, we cannot comment directly on the efficacy of psychoeducation delivered during active episodes of illness; however, the results from four RCTs identified in our search ( Supplementary Table 1 ) do not suggest that psychoeducation is effective in this situation.…”

Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis

“…Most studies recruited patients diagnosed with the broad inclusion criteria of bipolar disorder according to DSM criteria, which include type 1, 2 or cyclothymic disorder (33 trials, n = 2620). 30,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]52,54,55,60,61,[63][64][65][66][68][69][70][71][72][73][74] Nearly half of the studies required patients to be euthymic at intake (20 trials, n = 1262). 30,33,35,37,38,[40][41][42][44][45][46][48][49][50]55,59,63,…”

Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis

“…Across all trials the median of the mean ages of participants was 40 years (range 26-55); the median percentage who were female was 58% (range 9-77) and the median percentage of participants with type 1 bipolar disorder was 81% (range 42-100, apart from one study with 0%). Four studies included participants experiencing a depressive episode at baseline, [43][44][45][46] six studies included participants experiencing depressive and manic episodes, 37,38,[47][48][49][50] and thirty-two studies included only euthymic participants. Twelve studies included a mix of euthymic and symptomatic cases at baseline, 35,40,41,[51][52][53][54][55][56][57][58][59] of which only two studies provided disaggregated data.…”