Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis

Abstract

Bipolar affective disorder is a chronic, severe mental disorder characterised by acute episodes of depressed, manic and mixed mood states.1,2 Globally bipolar disorder affects 0.7% of the adult population, 3 and is associated with significant disability and cost owing to the severity and chronicity of the condition. 4,5 In 2010 the disorder accounted for 1.3% of years of life lost to disability globally, and was the fifth leading cause of disability among mental and substance use disorders. 4 Although pharmacotherapy is the recommended first-line therapy for manic, depressive and residual states, 6 medication adherence is typically poor, 7 relapse rates are high, 8 and full remission is rare. 1 Psychosocial therapies are recommended as an adjunctive treatment to medications in many guidelines, 9-11 to reduce relapse to acute depression or mania, potentially through improved medication adherence, identification of early warning signs, self-management and family communication.12 These psychosocial therapies have been evaluated through randomised controlled trials (RCTs) and meta-analyses with mixed results. Previous systematic reviews and meta-analyses were based on small numbers of studies, 13,14 were limited to particular interventions (e.g. CBT only), 15 did not cover key peripheral indicators of recovery and did not adjust for study characteristics such as the control groups. 16 The most comprehensive review and meta-analysis recently published produced significant positive effects for some psychosocial interventions; however, multiple analyses were undertaken, several of which included only one study and did not address study quality. 17,18 Importantly, the study did not use meta-regression to examine factors that might have influenced intervention efficacy. The purpose of our systematic review and network meta-analysis (NMA) was to address these previous limitations by employing the NMA approach to examine the efficacy of psychosocial interventions used for the adjunctive treatment of bipolar disorder in adults on relapse rates, depressive and manic symptoms, global functioning and medication adherence.Meta-regression techniques were used to identify factors related to the efficacy of this group of therapies. Unlike standard metaanalysis that can compare only two treatments at a time, NMA (also called mixed treatment comparisons) can assess the relative effectiveness of several interventions simultaneously even when the treatments have not been directly compared. It combines the evidence from studies directly comparing interventions (RCTs) with indirect information (comparisons made between RCTs through a common comparator such as treatment as usual). 19-21Using NMA addresses the issue of multiple testing found in previous meta-analyses as well as providing additional information in the form of indirect comparisons. The hypothesis was that network meta-analysis would improve the rigour of the results. MethodElectronic peer-reviewed databases including Medline, PsycINFO and the Cochrane Library of Systematic ...

Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial

“…Average reported post-treatment attrition rates for individual-based psychosocial treatments are approximately 25% (median 27%, range 9%–41%; (Ball et al, 2006; Fava, Rafanelli, Tomba, Guidi, & Grandi, 2011; Frank et al, 2005; Jones et al, 2015; Meyer & Hautzinger, 2012; Miklowitz et al, 2007; Parikh et al, 2012; Reilly-Harrington et al, 2007; Scott et al, 2006; Swartz, Frank, & Cheng, 2012; Zaretsky, Lancee, Miller, Harris, & Parikh, 2008; for recent reviews, see Chatterton et al, 2017; Salcedo et al, 2016; Stratford et al, 2015; Swartz & Swanson, 2014). For example, Parikh et al (2012), Zaretsky et al (2008), and Reilly-Harrington et al (2007) report acute post-treatment attrition rates of 29%, 28% and 40% respectively for adjunctive individual CBT treatment conditions in their studies.…”

A randomized controlled trial of MoodSwings 2.0: An internet‐based self‐management program for bipolar disorder

“…Bipolar depression, often the cause of significant burden in bipolar disorder (BD) and the most common of mood states, may be influenced by psychological and social factors . It is difficult to treat using medications alone, and adjunctive psychotherapy is frequently necessary . However, access to psychotherapy is often limited by geographic, service capacity and financial barriers, especially for individuals living in regional and remote areas .…”

Is a SIMPLe smartphone application capable of improving biological rhythms in bipolar disorder?

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