Relapse Prevention in Patients With Bipolar Disorder: Cognitive Therapy Outcome After 2 Years

Department of Psychology, Institute of Psychiatry, King's College, London, UK.
American Journal of Psychiatry (Impact Factor: 12.3). 03/2005; 162(2):324-9. DOI: 10.1176/appi.ajp.162.2.324
Source: PubMed

ABSTRACT In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months.
Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals.
Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition.
Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy.

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Available from: Edward R Watkins, Sep 28, 2015
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    • "It is possible that individuals with 10–20 previous depression episodes have reached a level of chronicity where the collaborative care intervention is too brief to provide benefit, but the 'extra dose' (i.e. more sessions) and additional treatment ingredients unique to intensive psychotherapies [e.g. enhancing family communication, activity planning, challenging negative thoughts, addressing interpersonal difficulties (Miklowitz et al. 2000; Frank et al. 2000, 2005; Lam et al. 2005)] are enough of a boost to achieve recovery. The relative advantage of intensive psychotherapy, however , was diminished among the most chronic patients with more than 20 episodes. "
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    • "Research into the longer term outcomes of pharmacological and psychological interventions for bipolar disorder has concentrated on symptom reduction and relapse prevention (Colom et al., 2009; Geddes, 2004; Lam et al., 2005; Lobban et al., 2010). "
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