Improving functional outcomes in early‐stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial

Abstract

Aim Young people with bipolar disorder (BD) commonly experience reduced quality of life, persistent symptoms and impaired functional recovery despite often superior school performance. Compromised long‐term functioning can ensue. There is evidence that psychological therapies alongside pharmacology may be more efficacious earlier in the course of the disorder. Intervention in the early stages may thus reduce the burden and risk associated with BD and mitigate the impact of the disorder on normal developmental trajectories. To date, however, the availability of evidence‐based psychological therapies for young people with early BD is limited. Furthermore, there are no large‐scale randomized controlled trials (RCTs) of such interventions. Methods The study is a prospective, single‐blind, RCT examining the effectiveness of an adjunctive individualized and manualized psychological intervention, compared with treatment as usual within youth‐specific early intervention services. The REsearch into COgnitive and behavioural VERsatility (RECOVER) intervention is delivered over a 6‐month period. About 122 young people in the early stages of BD‐I (at least one manic episode in the previous 2 years, with no more than five lifetime treated/untreated manic or hypomanic episodes) will be recruited. The assessments will occur at baseline, 3, 6 (primary endpoint, end of treatment), 9, 12, 15 and 18 months. Results Recruitment will commence in January 2019 and is anticipated to occur over a 3.5‐year period. Conclusions To date, there are no evidence‐based psychological therapies tailored to young people with early BD. We will test whether early psychological intervention in the course of BD can reduce the symptomatic, psychological, vocational and social impacts that are seen in entrenched disorder.

Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features

“…There is a lack of psychotherapeutic, comorbid substance abuse and vocational rehabilitation interventions for young people in the early stages of BD (Cotton et al, 2019; Jauhar et al, 2019; Vallarino et al, 2015). The earlier delivery of interventions increases the likelihood that years lived with disability and poor functioning are diminished (Iyer et al, 2018; Lee et al, 2017).…”

“…The earlier delivery of interventions increases the likelihood that years lived with disability and poor functioning are diminished (Iyer et al, 2018; Lee et al, 2017). Key issues that need addressing in the early phase of illness include appropriate diagnosis, functioning, engagement, treatment adherence, and the impact of comorbidities such as substance use (Colom, 2010; Cotton et al, 2019; de Azevedo et al, 2015; Gold et al, 2018; Macneil et al, 2009).…”

Conceptualizing the later stage of bipolar disorder: Descriptive analyses from the ORBIT trial

“…Participants were from the ORBIT RCT (experiencing “later stage” BD, defined as having experienced 10 or more lifetime mood episodes). Importantly, various episodic “cut points” have been used to identify later stage individuals in previous studies, for example, 5 and 10 episodes 1,14,15 . The ORBIT trial from which these data were drawn employed a conservative cut point of 10 episodes to best ensure participants were within later stage.…”

Increased Asymmetric Perfusion of the Cerebral Cortices and Thalamus Indicates Individuals at Risk for Bipolar Disorder: A Family Cohort Single Photon Emission Computed Tomography Neuroimaging Study

“…Bipolar disorder is the 12th leading cause of disability worldwide ( 21 ). Untreated bipolar disorder leads to impaired ability to work, difficulty maintaining relationships, and academic failure ( 7 , 22 ). Being untreated or incorrectly treated (due to misdiagnosis with unipolar depression) amplifies the already heavy burdens associated with bipolar disorder.…”