Efficacy of Functional Remediation in Bipolar Disorder: A Multicenter Randomized Controlled Study

Abstract

OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…One intervention, functional remediation (FR), involves a 21‐session group intervention over 6 months. In a large RCT, FR was shown to have a substantial impact on functioning, in comparison to treatment as usual 117. Coupled with the results of other small studies involving other interventions, these findings suggest that there is considerable hope in addressing cognitive and functional deficits in BD 118.…”

A systematic review of cognitive rehabilitation for bipolar disorder

“…Deckersbach et al 17 reported five dropouts from 18 participants and Preiss et al 18 reported 21 dropouts out of 45 participants at study outset. Torrent et al 20 reported that 28.6% patients discontinued in the functional remediation group, 24.4% discontinued rehabilitation in BD are more likely to be published.…”

“…19 Unfortunately, the authors did not report the number of sessions per week or the CR procedures employed. The article published by Torrent et al 20 was an exception, describing the main topics of each session. We suggest that future studies should clearly describe their samples and intervention procedures with a view to enabling replication.…”

“…17 and Preiss et al 18 focused on psychosocial and daily life functioning. In contrast, both Lahera et al 19 and Torrent et al 20 focused specifically on cognitive functioning, but whereas the former emphasized social cognition and emotion recognition, the latter emphasized There were notable increases in social cognition, in the psychoeducation group, and 17.5% discontinued in the treatment-as-usual group. Only one study was categorized as a group intervention, while the others were classified as "mixed modality" (both individual and group sessions).…”

Should bipolar disorder treatment be modified depending on staging?

“…For instance, a study showed that while almost all patients with first-episode mania had recovery from the syndrome within 2 years, only one-third of them achieved functional recovery [19]. A functional remediation therapy was recently developed in order to address this functional impairment [20]. A multicenter randomized controlled trial with 239 outpatients with bipolar disorder showed that functional remediation presented significant efficacy in improving functional impairment as compared with treatment as usual for euthymic patients over 21 weeks of treatment [20].…”