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


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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    • "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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    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.
    Full-text · Article · Apr 2014 · Psychological Medicine
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    • "Psychological interventions have been trialed as an adjunct to medication therapies to improve outcomes for the disorder (Beynon et al. 2008; Miklowitz 2008; Sachs 2008; Tomba and Fava 2009). Therapies such as cognitive behavior therapy (CBT) (Ball et al. 2006; Lam et al. 2005; Scott et al. 2006), interpersonal and social rhythm therapy (Frank et al. 2008), and family therapy (Miklowitz et al. 2003) have all shown benefits. Mindfulness-based interventions are becoming increasingly popular and have been formally examined in a variety of psychiatric conditions. "
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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
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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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    ABSTRACT: BACKGROUND: The importance of personal recovery in mental health is increasing widely recognised. However, there is no measure available to assess recovery experiences in individuals with a diagnosis of bipolar disorder. This paper reports on the development of the Bipolar Recovery Questionnaire (BRQ) to aid recovery informed developments in research and clinical practice. METHODS: A draft 45 item BRQ was developed based on prior literature review and qualitative research. In the current study a panel of clinicians, academics and consumers rated draft items on recovery relevance and comprehensibility leading to the 36 item questionnaire subjected to psychometric evaluation. 60 participants with bipolar disorder completed BRQ along with measures of mood, quality of life, functioning and personal growth. RESULTS: BRQ was internally consistent and reliable over a month long test-retest period. BRQ scores were significantly associated with lower depression and mania scores and with higher wellbeing. BRQ was also significantly associated with better functioning, better mental health quality of life and personal growth. Regression analysis indicated that depression, wellbeing and personal growth were all uniquely associated with BRQ. LIMITATIONS: Sample size did not permit exploration of the factor structure of BRQ. The sample is drawn from the North West of England thus it is not clear how these findings might generalise beyond this group. CONCLUSIONS: BRQ is designed to assess personal experiences of recovery in bipolar disorder. The present study indicates that it is reliable and valid, being associated with both symptomatic and functional outcomes consistent with established definitions of recovery.
    Full-text · Article · Nov 2012 · Journal of Affective Disorders
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