A Randomized Study of Family-Focused Psychoeducation and Pharmacotherapy in the Outpatient Management of Bipolar Disorder

Miklowitz, David J.; George, Elizabeth; Richards, Jeffrey A.; Simoneau, Teresa L.; Suddath, Robert

doi:10.1001/archpsyc.60.9.904

Cited by 565 publications

(402 citation statements)

References 90 publications

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“…A 2-year followup showed continuation of treatment effect with FFT patients experiencing fewer relapses (35 vs 54%, hazard ratio = 0.38), longer survival intervals (74 vs 53 weeks, P = 0.003), greater medication adherence and greater reduction in mood symptoms. 91 Medication adherence mediated positive effects on mania symptoms but not depressive symptoms.…”

Section: Family-focused Treatmentmentioning

confidence: 98%

Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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Section: Family-focused Treatmentmentioning

confidence: 98%

Treatment-resistant bipolar disorder

2006

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“…25 Family-focused therapy involves the patient and caregivers (parents or spouse) in up to 21 sessions of psychoeducation, communication skills training, and problem-solving skills training. 89 Two randomised controlled trials including symptomatic patients with bipolar I and II found that, in the 1-2 years after a manic, mixed, or depressive episode, patients with bipolar disorder who received familyfocused therapy and pharma cotherapy had 30-35% lower rates of relapse and rehospitalisation and less severe symptoms than did patients in case manage ment 28 or equally intensive individual treatment. 63 Two randomised controlled trials in paediatric populations-one in adolescents (aged 12-18 years) with bipolar disorder 64 and one in children and adolescents (aged 9-17 years) with depression or hypomania with a first degree relative with bipolar disorder 65 -found that children and adolescents who received familyfocused therapy and pharmacotherapy recovered more rapidly from depressive episodes (HR 0·37-0·54) than did children and adolescents in brief psychoeducation and pharmacotherapy.…”

Section: Family-focused Therapymentioning

confidence: 99%

“…Responses to stressful events 23,24 Negative events are associated with depressive episodes; goal attainment events are associated with manic episodes; psychosocial treatments can modulate responses to stress High expressed emotion and negative family interactions 23,25,26 Crucial attitudes in caregivers and negative verbal interactions between caregivers and patients associated with greater likelihood of recurrence; family-focused therapy enhances family communication and is associated with reduction in mood symptoms Drug adherence [27][28][29] Psychoeducational treatments improve adherence to mood stabilisers, leading to lower likelihood of manic recurrence…”

Section: Psychosocial Variablesmentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

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“…A TCC com ênfase na educação sobre a doença e o tratamento, com reestruturação cognitiva e intervenções para solucionar os problemas, a rotina e melhorar distúrbios do sono, diminuiu os episódios depressivos, de mania e hipomania, mantendo o paciente eutímico por mais tempo. A terapia focada na família também melhora o curso da doença, diminuindo as crises depressivas e maníacas, além de oferecer maior proteção contra as recorrências de depressão (Otto et al, 2003).…”

Section: Adesão E Transtorno Bipolarunclassified

Adesão ao tratamento no transtorno bipolar

Santin¹,

Ceresér²,

Rosa

2005

Rev. psiquiatr. clín.

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ResumoO transtorno bipolar (TB) é uma doença crônica, recorrente, presente em 1,5% da população, estando associada a altas taxas de mortalidade e prejuízos socioeconômicos. O lítio, a carbamazepina e o ácido valpróico são os estabilizadores de humor mais usados. Em tratamentos prolongados, como é o caso do TB, a má-adesão dos pacientes é uma das maiores dificuldades. Verificase que fatores ligados ao paciente, aos medicamentos e aos médicos possam ser responsáveis pela baixa adesão. A psicoeducação, a terapia cognitivocomportamental e a terapia focada na família são estratégias propostas para o aumento da adesão.Palavras-chave: Transtorno bipolar, adesão, tratamento. AbstractBipolar disorder (BD) is a chronic and recurrent illness that occurs in 1,5% of the population. This illness is associated with high rates of mortality and social/economic burden. Lithium, carbamazepine and valproic acid are the most used mood stabilizers. In long term treatments, as in BD, one of the main difficulties is the patient's adherence. It appears that factors associated to the patient, drug and the physician are responsible for the low adherence. The use of psycho-education, cognitive-behavioral therapy and focused family therapy have been put forward as a means to increase adherence.

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A Randomized Study of Family-Focused Psychoeducation and Pharmacotherapy in the Outpatient Management of Bipolar Disorder

Abstract: Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients.

Cited by 565 publications

References 90 publications

Treatment-resistant bipolar disorder

Treatment-resistant bipolar disorder

The Treatment of Bipolar Disorder

Adesão ao tratamento no transtorno bipolar

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