Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder.
ABSTRACT Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population.
To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.
Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years.
Research clinic in a university medical center.
One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.
Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.
Time to stabilization in the acute phase and time to recurrence in the maintenance phase.
We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).
Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.
- SourceAvailable from: Ulrich Hegerl[Show abstract] [Hide abstract]
ABSTRACT: According to the recently proposed vigilance model of affective disorders (vigilance in the sense of "brain arousal"), manic behaviour is partly interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulating environment, and the sensation avoidance and withdrawal in Major Depressive Disorder (MDD) is seen as an autoregulatory reaction to tonically increased vigilance. Indeed, using a newly developed EEG-based algorithm, hyperstable vigilance was found in MDD, and the contrary, with rapid drops to sleep stages, in mania. Furthermore, destabilising vigilance (e.g. by sleep deprivation) triggers (hypo)mania and improves depression, whereas stabilising vigilance, e.g. by prolonged sleep, improves mania. ADHD and mania have common symptoms, and the unstable vigilance might be a common pathophysiology. There is even evidence that psychostimulants might ameliorate both ADHD and mania. Hyperactivity of the noradrenergic system could explain both the high vigilance level in MDD and, as recently argued, anhedonia and behavioural inhibition. Interestingly, antidepressants and electroconvulsions decrease the firing rate of neurons in the noradrenergic locus coeruleus, whereas many antimanic drugs have opposite effects.Neuroscience & Biobehavioral Reviews 07/2014; 44:45-57. DOI:10.1016/j.neubiorev.2012.10.008
- [Show abstract] [Hide abstract]
ABSTRACT: Euthymic bipolar patients are often impacted by residual symptoms (RSs) that increase the risk of relapse or low functioning. We aimed to identify the perceptions of RSs, barriers to management, and service needs in euthymic bipolar patients. A qualitative methodology (focus group) was used. The interviews were investigated using a semistructured guide, tape-recorded, transcribed verbatim, and analyzed thematically. Twenty-three bipolar patients expressed concern about several RSs, such as emotional dysregulation, circadian rhythm disruption, cognitive impairment, low self-esteem, and physical symptoms. They reported concern about the impact of RSs on their functioning and about the need for more systematic assessment of RSs during interepisode visits. Selection bias may have occurred because the recruitment was limited to France and there may be cultural differences in the perceptions of RSs. Bipolar patients experienced bipolar disorder as a chronic disorder because they frequently continued to suffer from RSs associated with a functional impact.
- [Show abstract] [Hide abstract]
ABSTRACT: Background. The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. Method. Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. Results. Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT)=2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT=32.0) or >20 (NNT=9.0) depressive episodes. Conclusions. Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.Psychological Medicine 04/2014; 44(16):1-13. DOI:10.1017/S0033291714000804