Psychosocial interventions for the prevention of relapse in bipolar disorder: Systematic review of controlled trials

Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
The British Journal of Psychiatry (Impact Factor: 7.99). 02/2008; 192(1):5-11. DOI: 10.1192/bjp.bp.107.037887
Source: PubMed


Pharmacological interventions alone do not provide sufficient benefit for some individuals with bipolar disorder.
To determine the effectiveness of psychosocial interventions for the prevention of relapse in bipolar disorder.
A systematic review and meta-analysis of randomised or quasi-randomised controlled trials were conducted.
Cognitive-behavioural therapy or group psychoeducation may be effective for relapse prevention in stable individuals. Family therapy was no more or less effective than individual psychosocial therapy or crisis management. There is no evidence that care management or integrated group therapy is effective in the prevention of relapse.
Cognitive-behavioural therapy, group psychoeducation and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments.

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Available from: Karla Soares-Weiser
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    • "Previous research examining the effectiveness of psychological treatments, such as CBT, in treating bipolar disorder has also demonstrated mixed results. For instance, while some researchers have shown benefits using a range of adjunctive psychological treatments in the management of bipolar disorder (Beynon et al. 2008; Miklowitz 2008; Sachs 2008; Tomba and Fava 2009), others have noted no or minimal improvements (Miklowitz et al. 2007; Scott et al. 2006). Thus, it is important to place results of MBCT in this context. "
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    ABSTRACT: Mindfulness-based approaches are popular in the treatment of a variety of psychiatric disorders. This article examines how mindfulness-based inventions may assist in the management of bipolar disorder and in addressing common comorbidities, such as anxiety disorders. We also examine how mindfulness mediation may ameliorate cognitive deficits associated with bipolar disorder and reduce the impact of stress in managing day-to-day life events. Initial results of mindfulness-based cognitive therapy studies for those with bipolar disorder are promising; however, further research is needed to examine the efficacy of these approaches in the long term management of this disorder.
    Full-text · Article · Apr 2014 · Mindfulness
    • "Bipolar disorder is characterized by emotional dysregulation and patients therefore demonstrate impairments in emotional control and executive functioning, even during euthymic states (Green et al., 2007; Phillips et al., 2008). Pharmacological management is considered the treatment of choice for bipolar disorder and there is some evidence that cognitive-behavioural therapy (CBT), group psycho-education and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments for the prevention of relapse in stable patients (Beyon et al., 2008;. Scott et al., 2007; Vieta and Colom, 2004). "
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    ABSTRACT: Preliminary research findings have shown that mindfulness-based cognitive therapy improves anxiety and depressive symptoms in bipolar disorder. In this study, we further investigated the effects of MBCT in bipolar disorder, in a controlled fMRI study. Twenty three patients with bipolar disorder underwent neuropsychological testing and functional MRI. Sixteen of these patients were tested before and after an eight-week MBCT intervention, and seven were wait listed for training and tested at the same intervals. The results were compared with 10 healthy controls. Prior to MBCT, bipolar patients reported significantly higher levels of anxiety and symptoms of stress, scored significantly lower on a test of working memory, and showed significant BOLD signal decrease in the medial PFC during a mindfulness task, compared to healthy controls. Following MBCT, there were significant improvements in the bipolar treatment group, in measures of mindfulness, anxiety and emotion regulation, and in tests of working memory, spatial memory and verbal fluency compared to the bipolar wait list group. BOLD signal increases were noted in the medial PFC and posterior parietal lobe, in a repeat mindfulness task. A region of interest analysis revealed strong correlation between signal changes in medial PFC and increases in mindfulness. The small control group is a limitation in the study. These data suggest that MBCT improves mindfulness and emotion regulation and reduces anxiety in bipolar disorder, corresponding to increased activations in the medial PFC, a region associated with cognitive flexibility and previously proposed as a key area of pathophysiology in the disorder.
    No preview · Article · Jun 2013 · Journal of Affective Disorders
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    • "Psychoeducation is known to reduce relapse rates and readmissions in several psychiatric disorders such as schizophrenia, depression and bipolar disorder [1-4]. Thus, significant mental health expenditure and substantial human suffering can be avoided by the participation of patients and their family members in this low-cost intervention. "
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    ABSTRACT: Background Psychoeducation has been shown to reduce relapse rates in several psychiatric disorders. Studies investigating for which psychiatric diagnoses psychoeducation is offered and assessing its perceived relevance compared to other interventions are lacking. Methods A two-part questionnaire addressing these questions was sent to the heads of all psychiatric hospitals in Germany, Austria and Switzerland. Results were compared with those from a similar survey 5 years earlier. Results 289 of 500 (58%) institutions responded. Significantly (p = 0,02) more institutions (93%) offer any type of psychoeducation as compared to 5 years before (86%). Psychoeducation is mainly offered for schizophrenia (86%) and depression (67%) and less frequently for anxiety disorders (18%) and substance abuse (17%). For the following specific diagnoses it is offered by less than 10% of the institutions: Personality disorder, bipolar disorder, posttraumatic stress disorder, dementia, obsessive compulsive disorder, sleeping disorders, eating disorders, schizophrenia plus substance abuse, pain, attention deficit hyperactivity disorder and early psychosis. 25% offer diagnosis-unspecific psychoeducation. ‘Pharmacotherapy’ (99%), ‘basic occupational therapy’ (95%) and ‘psychoeducation for patients’ (93%) were the therapies being most often, ‘light therapy’ (24%) and ‘sleep deprivation’ (16%) the therapies being least often perceived as relevant by the respondents when asked about the value of different interventions offered in their hospitals. Art therapy (61%) and psychoanalytically oriented psychotherapy (59%), two therapies with a smaller evidence base than light therapy or sleep deprivation, were perceived as relevant by more than the half of the respondents. Conclusion Psychoeducation for patients is considered relevant and offered frequently in German-speaking countries, however, mostly only for schizophrenia and depression. The ranking of the perceived relevance of different treatment options suggests that the evidence base is not considered crucial for determining their relevance.
    Full-text · Article · Jun 2013 · BMC Psychiatry
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