Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis

Oud, Matthijs; Mayo‐Wilson, Evan; Braidwood, Ruth; Schulte, Peter F.J.; Jones, Steven H.; Morriss, Richard; Kupka, Ralph; Cuijpers, Pim; Kendall, Tim

doi:10.1192/bjp.bp.114.157123

Cited by 115 publications

(99 citation statements)

References 91 publications

(216 reference statements)

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“…These programmes, the Barcelona BDs Program77 (21 sessions over 6 months) and the Life Goals Program78 (phase I is six weekly sessions), also have tools to aid implementation with workbooks and handout materials, and both are first‐line psychoeducational interventions based on level 2 evidence for the prevention of relapse. Individual psychoeducation based on these manuals would probably be effective, and when individual trials utilizing several different approaches to psychoeducation are combined in a meta‐analysis, individual psychoeducation of at least five sessions would still be a first‐line intervention for relapse prevention, based on level 2 evidence 75, 79, 80. One large study demonstrated that the six‐session Life Goals Program psychoeducational intervention was equivalent in relapse prevention to 20 sessions of individual CBT, at far lower cost,81 with probable shared mechanisms 82.…”

Section: Foundations Of Managementmentioning

confidence: 99%

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

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Foundations Of Managementmentioning

confidence: 99%

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

et al. 2018

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“…9) seemed to be outliers compared to other RCTs of individual or group psychoeducation versus either treatment as usual or attentional controls (14). The evidence was reported as weak or very weak with few pre-registered large multicentre blinded RCTs conducted independently of the developers of the intervention (1,14,15). Few studies controlled for the variation in outcome due to natural history of bipolar disorder e.g.…”

Section: Introductionmentioning

confidence: 99%

Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial

Morriss

Lobban

Riste

et al. 2016

The Lancet Psychiatry

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SummaryBackground: Group psychoeducation (PEd) is a cheap NICE recommended treatment for bipolar disorder. Its clinical effectiveness and acceptability are unclear compared to unstructured group support (PS) matched for delivery and aim of treatment, and previous bipolar history. Methods: Randomised, parallel group, observer blinded superiority controlled trial recruiting at eight sites from secondary care or self-referral with two year follow up. Participants aged 18 years or over with bipolar disorder, no episode in the preceding four weeks. Randomisation using minimisation for number of previous episodes (1-7, 8-19, 20+ bands) and site by clinical trials unit to either 21 two-hour weekly sessions of PEd or PS, allocation conveyed to trial co-ordinator and masking of assessors to outcome. Intention to treat primary outcome was time to the next bipolar episode with planned moderator analysis of number of previous bipolar episodes and qualitative interview of participant experience. Trial registration number ISRCTN62761948, ended. (IQR) 14 (15.5) versus 9 (15) sessions, p=0.026). Over 96 weeks, time to first bipolar episode did not differ between PEd and PS (number of bipolar episodes 89 (58%) versus 95 (65%), hazard ratio (HR) = 0.83 (95% CI 0.62-1.11) p=0.217. The treatment was moderated in favour of PEd for participants with fewer previous bipolar episodes (X 2 = 6.80, p = 0.034, HR 0.28 (95% CI 0.12-0.68) for 1-7 previous episodes). Four participants (1 PEd, 3 PS) died in the follow-up period of the study. Interpretation: Structured group psychoeducation was no more clinically effective than similarly intensive unstructured group support but was more acceptable and improved outcome in participants with few previous episodes.

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“…(3) Existing systematic reviews and meta-analyses were searched for further papers (Justo et al, 2007;Oud et al, 2016;Reinares et al, 2016;Yesufu-Udechuku et al, 2015). Reviews were identified from the electronic searches and through searching the Cochrane database.…”

Section: Search Strategymentioning

confidence: 99%

‘Between a rock and a hard place’: family members’ experiences of supporting a relative with bipolar disorder

Baruch

Pistrang

Barker

2018

Soc Psychiatry Psychiatr Epidemiol

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Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis

Cited by 115 publications

References 91 publications

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

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

Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial

‘Between a rock and a hard place’: family members’ experiences of supporting a relative with bipolar disorder

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