Abstract
Although pharmacotherapy is the mainstay of treatment strategies for bipolar disorder, research over the last 5 years suggests that combining psychologic interventions with drug treatment increases overall effectiveness, mostly by further protecting from relapse or recurrence. We aimed at critically examining the relevance and effectiveness of psychosocial approaches to bipolar illness by doing a systematic review of the current literature. Currently, most studies show that patients receiving psychologic treatments have significantly fewer relapses, reduced hospitalization rates, and increased treatment adherence. Psychoeducation, family-focused psychoeducation, and cognitive-behavioral therapy seem to be the most efficacious interventions in the prophylaxis from recurrences in medicated bipolar patients. Recent studies have shown that psychologic approaches do not have the same "weightrd in all bipolar patients. Pharmacologic treatment and psychologic interventions are complementary and share many goals, such as avoiding recurrences and improving clinical outcome. A wise combination of these two approaches may help bipolar patients to achieve a better symptomatic and functional recovery. Further research should focus on determining the therapeutic value of each ingredient of the tested psychologic interventions.
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References and Recommended Reading
Scott J: Psychotherapy for bipolar disorder. Br J Psychiatry 1995, 167:581–588.
Colom F, Vieta E, Martinez A, et al.: What is the role of psychotherapy in the treatment of bipolar disorder? Psychother Psychosom 1998, 67:3–9.
Swartz HA, Frank E: Psychotherapy for bipolar depression: a phase-specific treatment strategy? Bipolar Disord 2001, 3:11–22.
Basco MR, Rush AJ: Cognitive Behavioral Treatment of Manic-Depressive Disorder. New York: Guilford Press; 1996.
Bauer MS, McBride L: Structured Group Psychotherapy for Bipolar Disorder. The Life Goals Program. New York: Springer Publishing Company; 1996.
Frank E, Swartz HA, Mallinger AG, et al.: Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J Abnorm Psychol 1999, 108:579–587.
Perry A, Tarrier N, Morriss R, et al.: Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999, 318:149–153.
Scott J, Garland A, Moorhead S: A pilot study of cognitive therapy in bipolar disorders. Psychol Med 2001, 31:459–467.
Colom F, Vieta E, Martinez-Aran A, et al.: A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003, 60:402–407.
Lam DH, Watkins ER, Hayward P, et al.: A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003, 60:145–152.
Miklowitz DJ, George EL, Richards JA, et al.: A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003, 60:904–912.
Rea MM, Tompson MC, Miklowitz DJ, et al.: Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. J Consult Clin Psychol 2003, 71:482–492.
Goodwin GM: Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003, 17:149–173.
Calabrese JR, Kasper S, Johnson G, et al.: International Consensus Group on Bipolar I Depression Treatment Guidelines. J Clin Psychiatry 2004, 65:571–579.
Judd LL, Akiskal HS, Schettler PJ, et al.: The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002, 59:530–537.
Tohen M, Hennen J, Zarate Jr CM, et al.: Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry 2000, 157:220–228.
Martinez-Aran A, Vieta E, Reinares M, et al.: Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004, 161:262–270. Outstanding study assessing cognition of 40 bipolar patients (whose neuropsychological performance was evaluated during euthymia, mania or hypomania and depression) and 30 healthy subjects.
Martinez-Aran A, Vieta E, Colom F, et al.: Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004, 6:224–232. A continuation of the above mentioned paper, this time focusing on practical implications.
Balanza-Martinez V, Tabares-Seisdedos R, Selva-Vera G, et al.: Persistent cognitive dysfunctions in bipolar I disorder and schizophrenic patients: a 3-year follow-up study. Psychother Psychosom 2005, 74:113–119.
Vieta E: Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry 2005, 66(Suppl 1):24–29.
Colom F, Vieta E, Martinez-Aran A, et al.: Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000, 61:549–555.
Lingam R, Scott J: Treatment non-adherence in affective disorders. Acta Psychiatr Scand 2002, 105:164–172.
Morselli PL, Elgie R: GAMIAN-Europe/BEAM survey I--global analysis of a patient questionnaire circulated to 3450 members of 12 European advocacy groups operating in the field of mood disorders. Bipolar Disord 2003, 5:265–278.
Scott J, Tacchi MJ: A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis. Bipolar Disord 2002, 4:386–392.
Frank E, Swartz HA, Kupfer DJ: Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biol Psychiatry 2000, 48:593–604.
Morselli PL, Elgie R, Cesana BM: GAMIAN-Europe/BEAM survey II: cross-national analysis of unemployment, family history, treatment satisfaction and impact of the bipolar disorder on life style. Bipolar Disord 2004, 6:487–497. Data coming from a huge survey developed by a federation of advocacy groups.
Cochran SD: Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. J Consult Clin Psychol 1984, 52:873–878.
Harvey NS, Peet M: Lithium maintenance: 2. Effects of personality and attitude on health information acquisition and compliance. Br J Psychiatry 1991, 158:200–204.
Peet M, Harvey NS: Lithium maintenance: 1. A standard education programme for patients. Br J Psychiatry 1991, 158:197–200.
van Gent EM: [Follow-up study of 3 years group therapy with lithium treatment]. Encephale 2000, 26:76–79.
Colom F, Vieta E, Reinares M, et al.: Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry 2003, 64:1101–1105.
Colom F, Vieta E, Sanchez-Moreno J, et al.: Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004, 6:294–298. Subanalysis of a study published in the Archives of General Psychiatry. Shows the efficacy of psychoeducation in preventing relapse in bipolar patients, even if they are comorbid to a personality disorder.
Dunayevich E, Sax KW, Keck Jr PE, et al.: Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 2000, 61:134–139.
Vieta E, Colom F, Corbella B, et al.: Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2001, 3:253–258.
Bieling PJ, MacQueen GM, Marriot MJ, et al.: Longitudinal outcome in patients with bipolar disorder assessed by lifecharting is influenced by DSM-IV personality disorder symptoms. Bipolar Disord 2003, 5:14–21.
Leverich GS, Altshuler LL, Frye MA, et al.: Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry 2003, 64:506–515.
Black DW, Winokur G, Hulbert J, Nasrallah A: Predictors of immediate response in the treatment of mania: the importance of comorbidity. Biol Psychiatry 1988, 24:191–198.
Scott J, Paykel E, Morriss R, et al.: Cognitive behaviour therapy for severe and recurrent bipolar disorders: a randomised controlled trial. Br J Psychiatry, In press. An outstanding study showing the lack of efficacy of CBT in bipolar patients with more than twelve episodes.
Lam DH, Hayward P, Watkins ER, et al.: Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005, 162:324–329. This study is the continuation of another one published in the Archives of General Psychiatry. Shows that CBT has no preventive effect after 18 months.
Goldstein MJ, Miklowitz DJ: Bipolar Disorder: A Family Focused Treatment Approach. New York: Guilford Press; 1997.
Miklowitz DJ, Simoneau TL, George EL, et al.: Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 2000, 48:582–592.
Miklowitz DJ, Richards JA, George EL, et al.: Integrated family and individual therapy for bipolar disorder: results of a treatment development study. J Clin Psychiatry 2003, 64:182–191.
Reinares M, Colom F, Martinez-Aran A, et al.: Therapeutic interventions focused on the family of bipolar patients. Psychother Psychosom 2002, 71:2–10.
Reinares M, Vieta E, Colom F, et al.: Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychother Psychosom 2004, 73:312–319.
Frank E, Kupfer DJ, Thase ME, et al.: Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005, 62:996–1004. This study shows the efficacy of IPSRT in some difficult-to-treat specific bipolar populations.
Frank E: Interpersonal and social rhythm therapy prevents depressive symptomatology in bipolar I patients. Bipolar Disord 1999, 1(Suppl):13.
Colom F, Lam D: Psychoeducation: improving outcome in bipolar disorder. Eur Psychiatry 2005, 20:359–364.
Scott J, Gutierrez MJ: The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention. Bipolar Disord 2004, 6:498–503.
Scott J, Colom F: Psychosocial treatments for bipolar disorders. Psychiatr Clin North Am 2005, 28:371–384.
Jackson A, Cavanagh J, Scott J: A systematic review of manic and depressive prodromes. J Affect Disord 2003, 74:209–217.
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Vieta, E., Pacchiarotti, I., Scott, J. et al. Evidence-based research on the efficacy of psychologic interventions in bipolar disorders: A critical review. Curr Psychiatry Rep 7, 449–455 (2005). https://doi.org/10.1007/s11920-005-0066-8
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DOI: https://doi.org/10.1007/s11920-005-0066-8