Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled Trial

Department of Psychology, Boston University, Boston, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 10/2007; 164(9):1340-7. DOI: 10.1176/appi.ajp.2007.07020311
Source: PubMed


Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode.
Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. All patients received pharmacotherapy. Eighty-four patients were randomly assigned to intensive psychosocial intervention (30 sessions over 9 months of interpersonal and social rhythm therapy, cognitive behavior therapy [CBT], or family-focused therapy), and 68 patients were randomly assigned to collaborative care (a 3-session psychoeducational treatment). Independent evaluators rated the four subscales of the Longitudinal Interval Follow-Up Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT) (relationships, satisfaction with activities, work/role functioning, and recreational activities) through structured interviews given at baseline and every 3 months over a 9-month period.
Patients in intensive psychotherapy had better total functioning, relationship functioning, and life satisfaction scores over 9 months than patients in collaborative care, even after pretreatment functioning and concurrent depression scores were covaried. No effects of psychosocial intervention were observed on work/role functioning or recreation scores during this 9-month period.
Intensive psychosocial treatment enhances relationship functioning and life satisfaction among patients with bipolar disorder. Alternate interventions focused on the specific cognitive deficits of individuals with bipolar disorder may be necessary to enhance vocational functioning after a depressive episode.

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    • "While mood episode severity fluctuated, relationships with parents, friends, and siblings had very little fluctuation, even during the onset of mood episodes. Of note, the design and strength of the measure of interpersonal functioning (PFS) is to capture large, clinically meaningful changes in interpersonal functioning over time (e.g., DelBello et al., 2007; Goldstein et al., 2009; Keller et al., 1987; Leon et al., 1999; Leon et al., 2000; Miklowitz et al., 2007; Philips et al., 2006). Thus, it is not intended to measure subtle changes in interpersonal functioning, which might be one reason for the observed stability. "
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    • "It is also possible that the duration of the intervention was insufficient for this particular group of patients who were still in episode because it has been noted that further research is needed to establish whether those individuals with more complex presentations require a longer course of therapy (Scott 2006). The attrition rate for those in the intervention group (34%) was similar to that in other therapy studies (35.6%) (Miklowitz et al. 2007), which suggests that the therapy was generally acceptable to patients. However, it does highlight the need for further understanding of factors which influenced patients not to engage in therapy. "
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    • "A recent study from Norway comparing Global Assessment of Function for the diagnoses schizophrenia and bipolar disorder in a mixed study population of in-patients and out-patients conclude that schizophrenia and bipolar disorder cannot be viewed as categorically different [44]. In the design of this trial we have carefully considered this aspect and have chosen to mix patients with two the diagnosis, since there some support of an equal level of functioning on the GAF score (it ranges from 51.79 to 53.00) [24,38,45] for this trial population and since patients included in the trial are admitted to the same treatment unit reflected same level of functioning. However, to secure that the compared groups are similar the allocation sequence is stratified by diagnosis and community mental health centre. "
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    ABSTRACT: Schizophrenia and bipolar disorder are severe mental illnesses that can have a significant disabling impact on the lives of people. Psychosocial interventions that stress hope and recovery as a part of a multi-dimensional approach are possibly indicated to support people with severe mental illness in facilitating recovery. Illness Management and Recovery (IMR) is a curriculum-based psychosocial intervention designed as structured program with a recovery-oriented approach. The aim of IMR is to rehabilitate people with severe mental illnesses by helping them acquire knowledge and skills in managing their illness and achieve personal recovery goals. Previous randomised clinical trials indicate that IMR can be implemented with a good effect and a high fidelity though further trials are crucial to demonstrate the potential effectiveness of IMR. The trial design is a randomised, assessor-blinded, multi-centre, clinical trial of the IMR program compared with treatment as usual for 200 participants diagnosed with schizophrenia or bipolar disorder under the care of two community mental health centres in the Capital Region of Denmark. The primary outcome is level of functioning at the end of treatment. The secondary outcomes are disease symptoms; use of alcohol/drugs; individual meaning of recovery; hope; hospital admissions and out-patient psychiatric treatment at the end of treatment and the abovementioned and level of functioning at follow-up 21 months after baseline. If the results of this trial show IMR to be effective these positive results will strengthen the evidence of IMR as an effective comprehensive psychosocial intervention with a recovery-oriented approach for people with severe mental illness. This will have significant implications for the treatment and recovery of people with severe mental illness.
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