Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled Trial
ABSTRACT 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.
- SourceAvailable from: Heather Hower
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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. "
ABSTRACT: This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar (BP) disorder. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-up Evaluation Psychosocial Functioning Schedule and Psychiatric Rating Scales, on average, every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships and whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth.Journal of Nervous & Mental Disease 02/2015; 203(3). DOI:10.1097/NMD.0000000000000261 · 1.81 Impact Factor
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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. "
ABSTRACT: The aim of the study is (1) to assess the feasibility of delivering nurse-led specialist supportive care as an adjunct to usual care in the clinical setting; (2) to examine the relationship between the delivery of specialist supportive care and improved self-efficacy and functioning and reduced depressive symptoms. A randomized controlled trial of the clinical effectiveness of specialist supportive care as an adjunct to usual care was conducted in community mental health services at one site. Participants were randomized to either usual care or usual care and the adjunctive intervention. Self-report measures of depression, general functioning and self-efficacy were completed by participants in both groups at baseline and 9 months. The intervention was delivered parallel to usual treatment arrangements. While recruitment numbers were sufficient, a low rate of engagement meant we were unable to show significant differences in depressive symptoms or self-efficacy between the usual care group and the specialist supportive care plus usual care group. This study demonstrated that it was difficult to engage patients with bipolar disorder in specialist supportive care when they were currently in a mood episode and under the care of community mental health services.Journal of Psychiatric and Mental Health Nursing 09/2011; 19(5):446-54. DOI:10.1111/j.1365-2850.2011.01822.x · 0.98 Impact Factor
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- "Intensive psychosocial intervention, including cognitive-behavioral therapy, family-focused therapy, or interpersonal and social rhythm therapy, in combination with mood-stabilizing pharmacologic treatments appears to enhance social and other measures of functioning in BPD patients (Miklowitz et al., 2007a). Such psychosocial interventions have been particularly beneficial in enhancing stabilization from BP depression (Miklowitz et al., 2007b). "
ABSTRACT: Since bipolar disorder (BPD) patients are often functionally impaired, and factors associated with recovery from disability are largely unknown, we investigated demographic, clinical, and neurocognitive correlates of current social functional recovery in 65 stable participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) type I (n=42) or II (n=23) BPD. Regaining highest previous levels of social functioning was rated with the Interpersonal Relationships Questionnaire. We also considered neuropsychological test findings as well as demographic and clinical information including mania and depression symptom-ratings. We examined factors associated with social recovery status using univariate analyses and then multiple logistic regression modeling. Of all subjects, 30 (46%) achieved current social functional recovery and 35 (54%) did not. Younger age (P=0.005) and lesser current depressive symptoms (P=0.02) were associated with social functional recovery, even after controlling for time since the last major mood episode, diagnostic type (II vs. I), co-morbid psychiatric illness, and executive functioning status. The findings are consistent with deleterious effects of even residual depressive symptoms in BPD patients.Psychiatry Research 03/2010; 177(1-2):131-4. DOI:10.1016/j.psychres.2010.02.020 · 2.68 Impact Factor