Collaborative care for patients with bipolar disorder: randomised controlled trial

Voort, Trijntje Y. G. van der; Meijel, Berno van; Goossens, Peter; Hoogendoorn, Adriaan W.; Draisma, Stasja; Beekman, Aartjan T.F.; Kupka, Ralph

doi:10.1192/bjp.bp.114.152520

Cited by 35 publications

(18 citation statements)

References 38 publications

(67 reference statements)

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“…Another included a combination of CBT plus psychoeducation and reported that it was more effective in comparison to TAU in 40 refractory BD patients concerning hospitalization and residual symptoms at 12 months follow-up [ 27 ]. A collaborative care study on 138 patients and follow-up of 12 months also gave positive results [ 48 ]. One multicentred Italian study assessed the efficacy of the Falloon model of psychoeducational family intervention (PFI), originally developed for schizophrenia management and adapted to BD-I disorder.…”

Section: Resultsmentioning

confidence: 99%

“…A second trial randomized 138 BD patients to receive collaborative care (contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes) vs. TAU. The results suggested that collaborative care had a significant and clinically relevant effect on the number of months with depressive symptoms, as well as on severity of depressive symptoms, but there was no effect on symptoms of mania or on treatment adherence [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

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Psychosocial treatment and interventions for bipolar disorder: a systematic review

et al. 2015

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BackgroundBipolar 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.MethodsThe 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.ResultsThe 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.ConclusionThe 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Psychosocial treatment and interventions for bipolar disorder: a systematic review

et al. 2015

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“…Most of them have showed a positive effect on satisfaction with care and involvement in decision-making [ 13 – 15 ]. Only one randomized controlled study has evaluated the effectiveness of a collaborative care program (comprised several interventional modules including contracting, psychoeducation, problem-solving treatment or monitoring of outcomes) on symptoms and medication adherence in BD patients experiencing depressive symptoms, in comparison with CAU [ 48 ]. The intervention group showed significant reduction of depressive symptom severity at 12 months ( p = 0.004), with no effect on treatment adherence.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD)

et al. 2018

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BackgroundShared decision-making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. SDM has raised great interest in mental healthcare over the last decade, as it is considered a fundamental part of patient-centered care. However, there is no research evaluating the efficacy of SDM compared to usual care (CAU), as it relates to quality of care and more specifically treatment adherence, in bipolar disorder (BD).Methods/DesignThis is a 12-month multi-centre, cluster-randomized controlled trial comparing the efficacy of SDM to CAU. Adult BD patients (n = 300) will be eligible after stabilization for at least 4 weeks following an acute mood episode. The intervention will consist of applying the standardized SDM process as developed by the Ottawa Hospital Research Institute in order to choose the maintenance treatment of BD. A multidisciplinary team developed a decision aid “choose my long-term treatment with my doctor” for BD patients to clarify possible therapeutic options. Primary outcome will assess the patient’s level of adherence (based on hetero-evaluation) of ongoing treatment at 12 months. Secondary outcomes will assess the difference between the 2 groups of patients in terms of adherence to maintenance drug therapy based on other measures (self-assessment scale and plasma levels of mood stabilizers). Additionally, other dimensions will be assessed: decisional conflict, satisfaction with care and involvement in decision making, beliefs about treatment, therapeutic relationship, knowledge about information for medical decision and clinical outcomes (depression, mania, functioning and quality of life).The primary endpoint will be analysed without adjustment by comparison of adherence scores between the two groups using Student t-tests or Mann–Whitney tests according to the variable distribution. A set of secondary analyses will be adjusted for covariates of clinical interest using generalized linear mixed regression models.DiscussionThis will be the first study evaluating the effect of an SDM intervention on patient adherence in BD. This is also an innovative protocol because it proposes the development of an evidence-based tool that should help patients and clinicians to initiate discussions regarding the use of BD treatment.Trial registrationThe study has been registered with ClinicalTrials.gov as NCT03245593.

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“…The results from a RCT ( n = 138) indicated that collaborative care significantly decreased the severity of depressive symptoms from a mean QIDS (Quick Inventory for Depressive Symptomatology) score of 10.5 to 8.4 at the end of the one-year trial period. 21 Additionally, collaborative care decreased the time patients spent with depressive symptoms. The patients in the intervention group spent an average 3.2 months with depressive symptoms during the six months prior to randomization.…”

Section: Literature Reviewmentioning

confidence: 99%

Bipolar depression

Avery

Drayton

2016

Int J Psychiatry Med

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Bipolar affective disorder is a debilitating illness that manifests as cyclical episodes of mood elevation and depression, but the treatment of the depressive episodes (i.e., bipolar depression) differs considerably from the treatment of major depressive disorder. In bipolar affective disorder, it is well known that patients spend a significantly greater amount of time in depressive episodes than manic or hypomanic episodes, yet there are currently just three Food and Drug Administration-approved agents for the treatment of bipolar depression: (1) olanzapine/fluoxetine combination (2) quetiapine, both immediate- and extended-release, and (3) lurasidone. The literature review presented here focuses on the clinical trials that led to the Food and Drug Administration-approval of these second generation antipsychotics in the treatment of bipolar depression. The discussion highlights key considerations regarding overall treatment strategies to aid clinicians in the selection of pharmacologic agents. Recommended monitoring parameters, potential adverse effects, and pertinent counseling points for second generation antipsychotics used in bipolar depression are included.

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Collaborative care for patients with bipolar disorder: randomised controlled trial

Cited by 35 publications

References 38 publications

Psychosocial treatment and interventions for bipolar disorder: a systematic review

Psychosocial treatment and interventions for bipolar disorder: a systematic review

Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD)

Bipolar depression

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