The Role of Interpersonal and Social Rhythm Therapy in Improving Occupational Functioning in Patients With Bipolar I Disorder

Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 11/2008; 165(12):1559-65. DOI: 10.1176/appi.ajp.2008.07121953
Source: PubMed


Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder. The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years.
Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment.
The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes.
In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.

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    • "IPSRT has demonstrated efficacy an adjunct to pharmacotherapy for the management of mood disorders (Miklowitz et al. 2008). Treatment with IPSRT is associated with reduced time to recovery from an episode of depression (Miklowitz et al. 2007) and improved psychosocial and occupational functioning (Frank et al. 2008) among patients "
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    • "The stabilization of daily routines (sleeping, eating, exercise, etc.) was correlated with the quality of the duration of the remission in the maintenance phase. IPSRT also improved the occupational functioning of bipolar patients (Frank et al., 2008). Self-management strategies (Murray et al., 2011; Suto et al., 2010) can also be of help. "
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    • "Psychological interventions have been trialed as an adjunct to medication therapies to improve outcomes for the disorder (Beynon et al. 2008; Miklowitz 2008; Sachs 2008; Tomba and Fava 2009). Therapies such as cognitive behavior therapy (CBT) (Ball et al. 2006; Lam et al. 2005; Scott et al. 2006), interpersonal and social rhythm therapy (Frank et al. 2008), and family therapy (Miklowitz et al. 2003) have all shown benefits. Mindfulness-based interventions are becoming increasingly popular and have been formally examined in a variety of psychiatric conditions. "
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