Psychosocial treatment and interventions for bipolar disorder: a systematic review

Abstract

BackgroundBipolar disorder (BD) is a chronic disorder with a high relapse rate, significant general disability and burden and with a psychosocial impairment that often persists despite pharmacotherapy. This indicates the need for effective and affordable adjunctive psychosocial interventions, tailored to the individual patient. Several psychotherapeutic techniques have tried to fill this gap, but which intervention is suitable for each patient remains unknown and it depends on the phase of the illness.MethodsThe papers were located with searches in PubMed/MEDLINE through May 1st 2015 with a combination of key words. The review followed the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement.ResultsThe search returned 7,332 papers; after the deletion of duplicates, 6,124 remained and eventually 78 were included for the analysis. The literature supports the usefulness only of psychoeducation for the relapse prevention of mood episodes and only in a selected subgroup of patients at an early stage of the disease who have very good, if not complete remission, of the acute episode. Cognitive-behavioural therapy and interpersonal and social rhythms therapy could have some beneficial effect during the acute phase, but more data are needed. Mindfulness interventions could only decrease anxiety, while interventions to improve neurocognition seem to be rather ineffective. Family intervention seems to have benefits mainly for caregivers, but it is uncertain whether they have an effect on patient outcomes.ConclusionThe current review suggests that the literature supports the usefulness only of specific psychosocial interventions targeting specific aspects of BD in selected subgroups of patients.

Awareness of and attitudes toward CBT, DBT, and ACT in an acute psychiatric sample

“…Before engaging in our partial hospital treatment, we also assessed the level of familiarity with and overall impression of three specific EBPTs on which our partial hospital program's services are based (CBT: Beck, Rush, Shaw, & Emery, ; dialectical behavior therapy, DBT: Linehan, Armstrong, Suarez, Allmon, & Heard, ; acceptance and commitment therapy, ACT: Hayes, Strosahl, & Wilson, ). These EBPTs were chosen due to their status as first‐line psychosocial treatments for mood, anxiety, and borderline personality disorders (Cristea et al, ; Kliem, Kröger, & Kosfelder, ; Li et al, ; Miziou et al, ; Twohig & Levin, ); which collectively are among the most common diagnoses in the partial hospital program from which participants were recruited for the current study.…”

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

“…Bipolar disorder (BD) is the fourth leading cause of disability worldwide for 10‐ to 24‐year‐olds due to marked economic, social, familial and individual burden (Gore et al, ). First‐line treatment for BD is pharmacotherapy with mood stabilizers such as lithium (Bauer & Mitchner, ) and other medications including antipsychotics, antidepressants and anti‐epileptics (Miziou et al, ). As an index of the lack of optimal utility of these agents, extensive polypharmacy is normative (Sachs, Peters, Sylvia, & Grunze, ).…”

“…As an index of the lack of optimal utility of these agents, extensive polypharmacy is normative (Sachs, Peters, Sylvia, & Grunze, ). Outcomes remain less than ideal (Sachs et al, ), with medications not fully addressing patients' needs, particularly regarding functional recovery (Miziou et al, ). Medications are also less useful for depression than mania, with depression associated with the greatest burden (Judd et al, ).…”

“…There is little work on psychological interventions for young people (15‐24 years) in the early stages of BD (Macneil et al, ; Vallarino et al, ). This is surprising given that psychological interventions—such as pharmacotherapies—are potentially more effective early in the disorder (Berk et al, ; McMurrich et al, ; Miziou et al, ).…”

Contextual Cognitive-Behavioral Therapies Across the Psychosis Continuum

“…Data suggests that psychosocial interventions appear beneficial for patients with a diagnosis within the psychosis continuum in a wide range of areas, namely regarding positive symptoms, functioning, relapse rates, affective symptoms, anxiety symptoms, social and vocational func-tioning (e.g., Huxley, Rendall, & Sederer, 2000;Miziou et al, 2015;Richardson, 2010;Wykes, Steel, Everitt, & Tarrier, 2008). Therefore, international clinical guidelines recommend the offer of several psychosocial interventions such as Cognitive-Behavioral Therapy (CBT) both for people with persisting psychotic symptoms and people in remission, family interventions (Kreyenbuhl, Buchanan, Dickerson, & Dixon, 2009;NICE, 2014), and additionally arts therapies (NICE, 2014), assertive community treatment, supported employment, skills training, token econ-omy interventions (Kreyenbuhl et al, 2009).…”