Interpreting the Findings of a Meta-analysis of Psychosocial Interventions in Bipolar Disorder

Tong, Co Co; Strawbridge, Rebecca; Jauhar, Sameer

doi:10.1001/jamapsychiatry.2020.4418

Cited by 1 publication

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“…The lack of difference between BD, BSp and uMDD groups in therapy response suggests that these widely available therapies could be appropriate for people with BD. More broadly, the effectiveness of psychological therapies for BD is reflected by prioritisation in clinical guidelines (NICE, 2020 ) despite concerns about the risk of bias in the evidence (Tong, Strawbridge, & Jauhar, 2021 ). IAPT pilot programmes have recently been trialled for people with SMI, but despite efforts made to address the low rates of therapy access for severely ill people (Jones et al, 2018 ), it is not yet known how widely this will be available.…”

Section: Discussionmentioning

confidence: 99%

Is there a ‘bipolar iceberg’ in UK primary care psychological therapy services?

et al. 2022

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Background Improving Access to Psychological Therapies (IAPT) is a primary care therapy service commissioned by England's National Health Service (NHS) for people with unipolar depression and anxiety-related disorders. Its scope does not extend to ‘severe mental illness’, including bipolar disorders (BD), but evidence suggests there is a high BD prevalence in ostensibly unipolar major depressive disorder (uMDD) samples. This study aimed to indicate the prevalence and characteristics of people with BD in a naturalistic cohort of IAPT patients. Methods 371 participants were assessed before initiating therapy. Participants were categorised by indicated diagnoses: BD type-I (BD-I) or type-II (BD-II) as defined using a DSM diagnostic interview, bipolar spectrum (BSp, not meeting diagnostic criteria but exceeding BD screening thresholds), lifetime uMDD or other. Information about psychiatric history and co-morbidities was examined, along with symptoms before and after therapy. Results 368 patients provided sufficient data to enable classification. 10% of participants were grouped as having BD-I, 20% BD-II, 40% BSp, 25% uMDD and 5% other. BD and uMDD participants had similar demographic characteristics, but patients meeting criteria for BD-I/BD-II had more complex psychiatric presentations. All three ‘bipolar’ groups had particularly high rates of anxiety disorders. IAPT therapy receipt was comparable between groups, as was therapy response (F9704 = 1.113, p = 0.351). Conclusions Notwithstanding the possibility that bipolar diathesis was overestimated, findings illustrate a high prevalence of BD in groups of people notionally with uMDD or anxiety. As well as improving the detection of BD, further substantive investigation is required to establish whether individuals affected by BD should be eligible for primary care psychological intervention.

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Section: Discussionmentioning

confidence: 99%