Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program.

Department of Psychology, Boston University, Boston, Massachusetts, United States
Archives of General Psychiatry (Impact Factor: 14.48). 04/2007; 64(4):419-26. DOI: 10.1001/archpsyc.64.4.419
Source: PubMed

ABSTRACT Psychosocial interventions have been shown to enhance pharmacotherapy outcomes in bipolar disorder.
To examine the benefits of 4 disorder-specific psychotherapies in conjunction with pharmacotherapy on time to recovery and the likelihood of remaining well after an episode of bipolar depression.
Randomized controlled trial.
Fifteen clinics affiliated with the Systematic Treatment Enhancement Program for Bipolar Disorder. Patients A total of 293 referred outpatients with bipolar I or II disorder and depression treated with protocol pharmacotherapy were randomly assigned to intensive psychotherapy (n = 163) or collaborative care (n = 130), a brief psychoeducational intervention.
Intensive psychotherapy was given weekly and biweekly for up to 30 sessions in 9 months according to protocols for family-focused therapy, interpersonal and social rhythm therapy, and cognitive behavior therapy. Collaborative care consisted of 3 sessions in 6 weeks.
Outcome assessments were performed by psychiatrists at each pharmacotherapy visit. Primary outcomes included time to recovery and the proportion of patients classified as well during each of 12 study months.
All analyses were by intention to treat. Rates of attrition did not differ across the intensive psychotherapy (35.6%) and collaborative care (30.8%) conditions. Patients receiving intensive psychotherapy had significantly higher year-end recovery rates (64.4% vs 51.5%) and shorter times to recovery than patients in collaborative care (hazard ratio, 1.47; 95% confidence interval, 1.08-2.00; P = .01). Patients in intensive psychotherapy were 1.58 times (95% confidence interval, 1.17-2.13) more likely to be clinically well during any study month than those in collaborative care (P = .003). No statistically significant differences were observed in the outcomes of the 3 intensive psychotherapies.
Intensive psychosocial treatment as an adjunct to pharmacotherapy was more beneficial than brief treatment in enhancing stabilization from bipolar depression. Future studies should compare the cost-effectiveness of models of psychotherapy for bipolar disorder. Identifier: NCT00012558.

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    • "All analyses were by intent to treat. Patients were included until their final assessment point with a maximum of 365 days in the study (Miklowitz et al., 2007) (M ¼ 291.47 days, SD ¼ 96.93). The proportionality of risk assumption was not upheld for survival analyses involving baseline mania symptoms, so the timedependent covariate (interaction term between time and baseline mania symptoms) was included in all analyses (Tabachnik and Fidell, 2007). "
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    ABSTRACT: Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that "extreme" (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation. Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat. Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05). Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility.
    Journal of Psychiatric Research 10/2013; 47(10):1329-1336. DOI:10.1016/j.jpsychires.2013.05.016 · 3.96 Impact Factor
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    • "Therefore, chronotherapeutics (controlled exposure to environmental stimuli that act on biological rhythms), such as SD, light, and dark therapy may be useful interventions for BD and some small studies have shown this to be the case.113,158,159 Studies have also demonstrated the efficacy of interpersonal social rhythm therapy, which aims to stabilize social rhythms in preventing BD relapse.160,161 "
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    Nature and Science of Sleep 05/2013; 5:61-75. DOI:10.2147/NSS.S34842
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    • "It has been reported to be an effective adjunctive psychosocial treatment for various mental health problems [3]. Randomized controlled trials have demonstrated increased efficacy of pharmacological intervention when combined with family psychoeducation in the treatment of mental health problems [4]. Although psychoeducation was initially developed to assist patients with schizophrenia, special modules have been developed for different psychological disorders such as bipolar disorder, eating disorders and personality disorders [2]. "
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    ABSTRACT: Background We explored how family psychoeducation could be made culturally sensitive for postpartum mothers with psychotic illness in a Ugandan setting. Methods A qualitative multi-method approach using an already existing family psychoeducation Tool Kit was adapted to incorporate lay perceptions related to psychotic illness in the postpartum period in this Ugandan setting. The participants consisted of postpartum women with psychotic illness, caregivers/family members, psychiatric nurses and psychologists. A modified version of a family psychoeducation programme for postpartum women with psychosis was formulated and pilot-tested. Results Modifications in the standard family psychoeducation programme were both in the process and content of family psychoeducation. Under process, effective communication, cultural background, appropriate dress, involving only one family member, low literacy, and flexibility in timekeeping were raised. The theme of content yielded the incorporation of lay perceptions of mental illness, family planning, income generating, and an emphasis of premorbid and morbid personalities of the patients. Conclusion The basic principles and assumptions underlying psychoeducation remained the same. Changes made in the process and content of family psychoeducation reflected the social, cultural and gender reality of the population.
    BMC Psychiatry 05/2013; 13(1):131. DOI:10.1186/1471-244X-13-131 · 2.21 Impact Factor
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