Psychological therapies in bipolar disorder: the effect of illness history on relapse prevention – a systematic review

Lam, Dominic; Burbeck, Rachel; Wright, Kim; Pilling, Steve

doi:10.1111/j.1399-5618.2009.00724.x

Cited by 82 publications

(59 citation statements)

References 24 publications

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“…Other studies have found similar results in managing mania symptoms using CBT in comparison with TAU in BD [21]. Patients’ cognitive styles may also be involved in the poor adherence to the psychotherapeutic strategies designed for bipolar patients [35,36]. The prophylaxis of mania episodes seems to be necessarily associated with adherence to medication and a stabilized routine [17].…”

Section: Discussionmentioning

confidence: 90%

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder

Gomes

Abreu

Brietzke

et al. 2011

Psychother Psychosom

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Background: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. Methods: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. Results: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ² = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = –2.554; p = 0.011). Conclusions: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.

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Section: Discussionmentioning

confidence: 90%

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder

Gomes

Abreu

Brietzke

et al. 2011

Psychother Psychosom

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“…The large sample size and matching of participants by number of previous episodes allowed us to explore if there is an interaction between psychological treatment and number of previous bipolar episodes as some studies have previously shown (22,33), but others have not (34). Number of previous bipolar episodes may be prone to recall bias and are not precise; however, a person with a few episodes can be distinguished readily from someone with 20 or more previous bipolar episodes.…”

Section: Discussionmentioning

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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“…87 A second meta-analysis of ten trials showed an overall RR of 0·74 (0·64-0·85) for mood relapse. 88 …”

Section: Adjunctive Psychotherapy In Long-term Maintenancementioning

confidence: 97%

Treatment of Bipolar Disorder

Geddes

Miklowitz

2014

FOC

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation. (Reprinted with permission from the Lancet 2013; 381: 1672-82)

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Psychological therapies in bipolar disorder: the effect of illness history on relapse prevention – a systematic review

Abstract: Psychological therapy specifically designed for bipolar disorder is effective in preventing or delaying relapses in bipolar disorders, and there is no clear evidence that the number of previous episodes moderated the effect.

Cited by 82 publications

References 24 publications

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder

A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for 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

Treatment of Bipolar Disorder

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