Re: How well do psychosocial interventions work in bipolar disorder?

Mathematical Model of Interaction of Therapist and Patients with Bipolar Disorder: A Systematic Literature Review

Mood swings in patients with bipolar disorder (BD) are difficult to control and can lead to self-harm and suicide. The interaction between the therapist and BD will determine the success of therapy. The interaction model between the therapist and BD begins by reviewing the models that were previously developed using the Systematic Literature Review and Bibliometric methods. The limit of articles used was sourced from the Science Direct, Google Scholar, and Dimensions databases from 2009 to 2022. The results obtained were 67 articles out of a total of 382 articles, which were then re-selected. The results of the selection of the last articles reviewed were 52 articles. Using VOSviewer version 1.6.16, a visualization of the relationship between the quotes “model”, “therapy”, “emotions”, and “bipolar disorder” can be seen. This study also discusses the types of therapy that can be used by BD, as well as treatment innovations and the mathematical model of the therapy itself. The results of this study are expected to help further researchers to develop an interaction model between therapists and BD to improve the quality of life of BD.

Psychosocial treatment and interventions for bipolar disorder: a systematic review

BACKGROUND

Bipolar disorder (BD) is a chronic disorder with a high relapse rate, significant general disability and burden and with a psychosocial impairment that often persists despite pharmacotherapy. This indicates the need for effective and affordable adjunctive psychosocial interventions, tailored to the individual patient. Several psychotherapeutic techniques have tried to fill this gap, but which intervention is suitable for each patient remains unknown and it depends on the phase of the illness.

METHODS

The papers were located with searches in PubMed/MEDLINE through May 1st 2015 with a combination of key words. The review followed the recommendations of the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses statement.

RESULTS

The search returned 7,332 papers; after the deletion of duplicates, 6,124 remained and eventually 78 were included for the analysis. The literature supports the usefulness only of psychoeducation for the relapse prevention of mood episodes and only in a selected subgroup of patients at an early stage of the disease who have very good, if not complete remission, of the acute episode. Cognitive-behavioural therapy and interpersonal and social rhythms therapy could have some beneficial effect during the acute phase, but more data are needed. Mindfulness interventions could only decrease anxiety, while interventions to improve neurocognition seem to be rather ineffective. Family intervention seems to have benefits mainly for caregivers, but it is uncertain whether they have an effect on patient outcomes.

CONCLUSION

The current review suggests that the literature supports the usefulness only of specific psychosocial interventions targeting specific aspects of BD in selected subgroups of patients.

Psychosocial interventions in bipolar disorder: what, for whom, and when

BACKGROUND

Bipolar disorder (BD) is a chronic condition with a high relapse rate, morbidity and psychosocial impairment that often persist despite pharmacotherapy, highlighting the need for adjunctive psychosocial treatments. It is still unclear which populations are most likely to benefit from which approach and the best timing to implement them.

METHODS

A review was conducted with the aim to determine what the efficacious psychological treatments are, for whom and when. Randomized-controlled trials and key studies in adults with BD published until June 2013 were included

RESULTS

The adjunctive psychological treatments most commonly tested in BD were cognitive-behavioral therapy, psychoeducation, interpersonal and social rhythm therapy, and family intervention. The efficacy of specific adjunctive psychosocial interventions has been proven not only in short- but also long-term follow-up for some treatments. Outcomes vary between studies, with most trials focused on clinical variables like recurrence prevention or symptom reduction and less attention, although gradually expanding, paid to other aspects such as psychosocial functioning. The samples were usually in remission or with mild symptoms when recruited but there were a few studies with acute patients, which resulted in discrepant findings. The efficacy of psychological interventions seems to differ depending on the characteristics of the subjects and the course of the illness. Different approaches, such as functional remediation and mindfulness-based cognitive therapy, have begun to be tested in BD.

LIMITATIONS

Heterogeneity of comparison groups.

CONCLUSIONS

Adjunctive psychological treatments can improve BD outcomes. Although several moderators and mediators have been identified, more research is needed to design shorter but effective interventions tailored to the characteristics of the target population. Ideally, the treatment should be introduced as soon as possible, although it does not mean that more complex patients would not benefit from psychotherapy.