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Fountoulakis KN, Yatham LN, Grunze H, Vieta E, Young AH, Blier P, Tohen M, Kasper S, Moeller HJ. The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder. Int J Neuropsychopharmacol 2020; 23:230-256. [PMID: 31802122 PMCID: PMC7177170 DOI: 10.1093/ijnp/pyz064] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Resistant bipolar disorder is a major mental health problem related to significant disability and overall cost. The aim of the current study was to perform a systematic review of the literature concerning (1) the definition of treatment resistance in bipolar disorder, (2) its clinical and (3) neurobiological correlates, and (4) the evidence-based treatment options for treatment-resistant bipolar disorder and for eventually developing guidelines for the treatment of this condition. MATERIALS AND METHODS The PRISMA method was used to identify all published papers relevant to the definition of treatment resistance in bipolar disorder and the associated evidence-based treatment options. The MEDLINE was searched to April 22, 2018. RESULTS Criteria were developed for the identification of resistance in bipolar disorder concerning all phases. The search of the literature identified all published studies concerning treatment options. The data were classified according to strength, and separate guidelines regarding resistant acute mania, acute bipolar depression, and the maintenance phase were developed. DISCUSSION The definition of resistance in bipolar disorder is by itself difficult due to the complexity of the clinical picture, course, and treatment options. The current guidelines are the first, to our knowledge, developed specifically for the treatment of resistant bipolar disorder patients, and they also include an operationalized definition of treatment resistance. They were based on a thorough and deep search of the literature and utilize as much as possible an evidence-based approach.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Correspondence: Konstantinos N. Fountoulakis, MD, 6, Odysseos str (1st Parodos Ampelonon str.), 55535 Pylaia Thessaloniki, Greece ()
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall & Paracelsus Medical University, Nuremberg, Germany
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Pierre Blier
- The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna
- Center for Brain Research, Medical University Vienna, MUV, Vienna, Austria
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Chen R, Zhu X, Capitão LP, Zhang H, Luo J, Wang X, Xi Y, Song X, Feng Y, Cao L, Malhi GS. Psychoeducation for psychiatric inpatients following remission of a manic episode in bipolar I disorder: A randomized controlled trial. Bipolar Disord 2019; 21:76-85. [PMID: 29578271 DOI: 10.1111/bdi.12642] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of psychoeducation for bipolar I inpatients following remission of a manic episode in a Chinese population. METHOD The study recruited currently medicated bipolar I patients, aged 18-60 years, who were in remission from a manic episode, as determined using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Patients were randomized (1:1) to either eight sessions of group-based psychoeducation (active treatment group) or regular free discussions (control group). The primary outcomes were the rates of any type of recurrence and rehospitalization following treatment. The secondary outcomes were changes in mood symptoms, medication adherence, global functioning, as well as treatment response (as measured using the Clinical Global Impression scale). Subjects were assessed at baseline and then at 2 weeks, and 1, 2, 3, 5, 7, 9, and 12 months following treatment. RESULTS At 1 year, patients receiving the psychoeducation treatment demonstrated significantly less recurrence. Those in the treatment group also showed a significant reduction in mania recurrence but not depressive recurrence, and psychoeducation increased time to remission. Notably, lower rates of rehospitalization were found in the active treatment group. Those receiving the psychoeducation treatment also revealed higher change from baseline on measures of depression (17-item Hamilton Rating Scale for Depression), mania (Young Mania Rating Scale), global functioning (Clinical Global Impression-severity scale and World Health Organization Disability Assessment Schedule) (P<.05). However, there were no significant group differences for the medication adherence scores. CONCLUSION This preliminary evidence suggests that short, group-based psychoeducation benefits currently medicated inpatients following the remission of mania in bipolar I disorder. This intervention warrants further investigation, especially in other Chinese populations. If future studies confirm its benefits, group-based psychoeducation could be incorporated into routine psychiatric inpatient care for bipolar patients in China.
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Affiliation(s)
- Runsen Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Xuequan Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Huijun Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jiong Luo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yingjun Xi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiuping Song
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yancun Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Liuzhong Cao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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Echezarraga A, Calvete E, González-Pinto AM, Las Hayas C. Resilience dimensions and mental health outcomes in bipolar disorder in a follow-up study. Stress Health 2018. [PMID: 28639427 DOI: 10.1002/smi.2767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The individual process of resilience has been related to positive outcomes in mental disorders. We aimed (a) to identify the resilience domains from the Resilience Questionnaire for Bipolar Disorder that are associated cross sectionally and longitudinally with mental health outcomes in bipolar disorder (BD) and (b) to explore cross-lagged associations among resilience factors. A clinical adult sample of 125 patients diagnosed with BD (62.10% female, mean age = 46.13, SD = 10.89) gave their informed consent and completed a battery of disease-specific tools on resilience, personal recovery, symptomatology, psychosocial functioning, and quality of life, at baseline and at follow-up (n = 63, 58.10% female, mean age = 45.13, SD = 11.06, participation rate = 50.40%). Resilience domains of self-management of BD, turning point, self-care, and self-confidence were significantly associated with mental health indicators at baseline. In addition, self-confidence at baseline directly predicted an increase in personal recovery at follow-up, and self-confidence improvement mediated the relationship between interpersonal support and self-care at baseline and personal recovery at follow-up. These findings highlight that resilience domains are significantly associated with positive mental health outcomes in BD and that some predict personal recovery at follow-up. Moreover, some resilience factors improve other resilience factors over time.
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Affiliation(s)
- A Echezarraga
- Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | - E Calvete
- Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | - A M González-Pinto
- Psychiatry Department, University Hospital Santiago Apostol, Vitoria-Gasteiz, Spain.,CIBERSAM
| | - C Las Hayas
- Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
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Rajagopalan A, Shah P, Zhang MW, Ho RC. Digital Platforms in the Assessment and Monitoring of Patients with Bipolar Disorder. Brain Sci 2017; 7:E150. [PMID: 29137156 PMCID: PMC5704157 DOI: 10.3390/brainsci7110150] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 01/12/2023] Open
Abstract
This paper aims to review the application of digital platforms in the assessment and monitoring of patients with Bipolar Disorder (BPD). We will detail the current clinical criteria for the diagnosis of BPD and the tools available for patient assessment in the clinic setting. We will go on to highlight the difficulties in the assessment and monitoring of BPD patients in the clinical context. Finally, we will elaborate upon the impact that diital platforms have made, and have the potential to make, on healthcare, mental health, and specifically the management of BPD, before going on to evaluate the benefits and drawbacks of the use of such technology.
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Affiliation(s)
- Arvind Rajagopalan
- Imperial College School of Medicine, South Kensington Campus, London SW7 2AZ, UK.
| | - Pooja Shah
- Imperial College School of Medicine, South Kensington Campus, London SW7 2AZ, UK.
| | - Melvyn W Zhang
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore 119228, Singapore, Singapore.
| | - Roger C Ho
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore 119228, Singapore, Singapore.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
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6
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A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders. J Affect Disord 2017; 222:28-31. [PMID: 28668712 DOI: 10.1016/j.jad.2017.06.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorders are ranked amongst the top ten causes of global disability and cause high health care costs. Previous studies have showed that mood stabilizing drug therapy combined with psychological treatments lead to significantly fewer relapses and a reduction in hospitalization rates. However, there is a wide spectrum of psychosocial intervention methods for individuals and groups which have been insufficiently examined on a scientific basis. METHODS Studies published between 2003 and 2015 on different types of adjuvant psychosocial group interventions in the MESH database were reviewed and evaluated for their efficacy on patients with bipolar disorder related to the relapse ratio by a meta-analysis. RESULTS The meta-analysis included 24 intervention groups and showed that 75% of treated groups under medication and psychosocial therapy had a lower risk of a relapse than the control groups which only received medication therapy. LIMITATIONS The meta-analysis includes a number of trials with participants in different phases of disease course and study designs, the number of studies in each analyzed intervention group was not balanced and many studies focused on recovery and recurrence of episodes, precluding identification of the impact on subsyndromal symptoms CONCLUSIONS: Adjuvant psychosocial interventions seem to be indispensable for patients, their relations as well as for saving costs in the health care system. Nevertheless, an evaluation of effectiveness and impact factors of different psychosocial intervention methods needs further research.
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7
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Abstract
Background
In the last decade, an increasing number of publications have examined the precursors of bipolar disorders (BD) and attempted to clarify the early origins and illness trajectory. This is a complex task as the evolution of BD often shows greater heterogeneity than psychosis, and the first onset episode of BD may be dominated by depressive or manic features or both. To date, most of the published reviews have not clarified whether they are focused on prodromes, risk syndromes or addressing both phenomena.
To assist in the interpretation of the findings from previous reviews and independent studies, this paper examines two concepts deemed critical to understanding the pre-onset phase of any mental disorder: prodromes and risk syndromes. The utility of these concepts to studies of the evolution of bipolar disorder (BD) is explored. Findings The term “prodrome” is commonly used to describe the symptoms and signs that precede episode onset. If strictly defined, the term should only be applied retrospectively as it refers to cohorts of cases that all progress to meet diagnostic criteria for a specific disorder and gives insights into equifinality. Whilst prodromes may reliably predict individual relapses, the findings cannot necessarily be extrapolated to identify prospectively who will develop a first episode of a specific disorder from within a given population. In contrast, ‘risk syndrome’ is a term that encompasses sub-threshold symptom clusters, but has often been extended to include other putative risk factors such as family history, or other variables expressed continuously in the population, such as personality traits. Only a minority of individuals ‘at risk’ make the transition to a specific mental disorder. By prospectively observing those cases where the risk syndrome does not progress to severe disorder or progress to a non-BD condition, we gain insights into the discriminant validity of different pre-BD characteristics, pluripotentiality of outcomes, and protective factors and resilience. Conclusion We emphasize the clinical and research utility of prodromes and risk syndromes, examine examples of the conflation of the concepts, and highlight the rationale for regarding them as discrete entities.
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Affiliation(s)
- Pierre Alexis Geoffroy
- U1144, Inserm, 75006, Paris, France.,Pôle de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, 75475, Paris, France
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Wolfson Unit, Newcastle University, Newcastle upon Tyne, UK.
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8
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Lobban F, Dodd AL, Sawczuk AP, Asar O, Dagnan D, Diggle PJ, Griffiths M, Honary M, Knowles D, Long R, Morriss R, Parker R, Jones S. Assessing Feasibility and Acceptability of Web-Based Enhanced Relapse Prevention for Bipolar Disorder (ERPonline): A Randomized Controlled Trial. J Med Internet Res 2017; 19:e85. [PMID: 28341619 PMCID: PMC5384993 DOI: 10.2196/jmir.7008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/18/2017] [Accepted: 02/11/2017] [Indexed: 01/15/2023] Open
Abstract
Background Interventions that teach people with bipolar disorder (BD) to recognize and respond to early warning signs (EWS) of relapse are recommended but implementation in clinical practice is poor. Objectives The objective of this study was to test the feasibility and acceptability of a randomized controlled trial (RCT) to evaluate a Web-based enhanced relapse prevention intervention (ERPonline) and to report preliminary evidence of effectiveness. Methods A single-blind, parallel, primarily online RCT (n=96) over 48 weeks comparing ERPonline plus usual treatment with “waitlist (WL) control” plus usual treatment for people with BD recruited through National Health Services (NHSs), voluntary organizations, and media. Randomization was independent, minimized on number of previous episodes (<8, 8-20, 21+). Primary outcomes were recruitment and retention rates, levels of intervention use, adverse events, and participant feedback. Process and clinical outcomes were assessed by telephone and Web and compared using linear models with intention-to-treat analysis. Results A total of 280 people registered interest online, from which 96 met inclusion criteria, consented, and were randomized (49 to WL, 47 to ERPonline) over 17 months, with 80% retention in telephone and online follow-up at all time points, except at week 48 (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship that the users have with Web-based interventions. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of BD at 24 weeks (10.70, 95% CI 0.90 to 20.5) and 48 weeks (13.1, 95% CI 2.44 to 23.93); increased monitoring of EWS of depression at 48 weeks (−1.39, 95% CI −2.61 to −0.163) and of hypomania at 24 weeks (−1.72, 95% CI −2.98 to −0.47) and 48 weeks (−1.61, 95% CI −2.92 to −0.30), compared with WL. There was no evidence of impact of ERPonline on clinical outcomes or medication adherence, but relapse rates across both arms were low (15%) and the sample remained high functioning throughout. One person died by suicide before randomization and 5 people in ERPonline and 6 in WL reported ideas of suicide or self-harm. None were deemed study related by an independent Trial Steering Committee (TSC). Conclusions ERPonline offers a cheap accessible option for people seeking ongoing support following successful treatment. However, given high functioning and low relapse rates in this study, testing clinical effectiveness for this population would require very large sample sizes. Building in human support to use ERPonline should be considered. Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 56908625; http://www.isrctn.com/ISRCTN56908625 (Archived by WebCite at http://www.webcitation.org/6of1ON2S0)
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Alyson L Dodd
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.,Department of Psychology, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Adam P Sawczuk
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ozgur Asar
- Department of Bio-statistics and Medical Informatics, Acibadem University, Istanbul, Turkey.,CHICAS, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dave Dagnan
- Cumbria Partnership NHS Foundation Trust, Penrith, Cumbria, United Kingdom
| | - Peter J Diggle
- CHICAS, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Martin Griffiths
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Mahsa Honary
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dawn Knowles
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Rita Long
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Richard Morriss
- Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Rob Parker
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Steven Jones
- Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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9
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Camacho EM, Ntais D, Jones S, Riste L, Morriss R, Lobban F, Davies LM. Cost-effectiveness of structured group psychoeducation versus unstructured group support for bipolar disorder: Results from a multi-centre pragmatic randomised controlled trial. J Affect Disord 2017; 211:27-36. [PMID: 28086146 DOI: 10.1016/j.jad.2017.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) costs the English economy an estimated £5.2billion/year, largely through incomplete recovery. This analysis estimated the cost-effectiveness of group psychoeducation (PEd), versus group peer support (PS), for treating BD. METHODS A 96-week pragmatic randomised controlled trial (RCT), conducted in NHS primary care. The primary analysis compared PEd with PS, using multiple imputed datasets for missing values. An economic model was used to compare PEd with treatment as usual (TAU). The perspective was Health and Personal Social Services. RESULTS Participants receiving PEd (n=153) used more (costly) health-related resources than PS (n=151) (net cost per person £1098 (95% CI, £252-£1943)), with a quality-adjusted life year (QALY) gain of 0.023 (95% CI, 0.001-0.056). The cost per QALY gained was £47,739. PEd may be cost-effective (versus PS) if decision makers are willing to pay at least £37,500 per QALY gained. PEd costs £10,765 more than PS to avoid one relapse. The economic model indicates that PEd may be cost-effective versus TAU if it reduces the probability of relapse (by 15%) or reduces the probability of and increases time to relapse (by 10%). LIMITATIONS Participants were generally inconsistent in attending treatment sessions and low numbers had complete cost/QALY data. Factors contributing to pervasive uncertainty of the results are discussed. CONCLUSIONS This is the first economic evaluation of PEd versus PS in a pragmatic trial. PEd is associated with a modest improvement in health status and higher costs than PS. There is a high level of uncertainty in the data and results.
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Affiliation(s)
- E M Camacho
- Manchester Centre for Health Economics, The University of Manchester, UK.
| | - D Ntais
- Manchester Centre for Health Economics, The University of Manchester, UK
| | - S Jones
- Spectrum Centre for Mental Health Research, Lancaster University, UK
| | - L Riste
- School of Psychological Sciences, The University of Manchester, UK
| | - R Morriss
- Institute of Mental Health, University of Nottingham, UK; Nottinghamshire Healthcare NHS Trust, UK
| | - F Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, UK
| | - L M Davies
- Manchester Centre for Health Economics, The University of Manchester, UK
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10
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Fagbamigbe AF, Makanjuola VA. Modeling association between times to recurrence of the different polarities in bipolar disorder among service seekers in urban Nigeria: a survival analysis approach. Neuropsychiatr Dis Treat 2017; 13:1967-1974. [PMID: 28769564 PMCID: PMC5533472 DOI: 10.2147/ndt.s133167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Bipolar disorder (BD) remains both a clinical and public health challenge worldwide, especially in developing countries such as Nigeria. Many studies have focused on prevalence and recurrences among BD service seekers but little has been documented on the nature, strength, direction, existence, and estimation of association between times to recurrence of the two possible polarities or mood episodes in BD. In this study, we explored the association between durations before recurrence of depression and manic episodes among people seeking treatment for BD. METHODS This analytical study used retrospective data of 467 persons who sought treatment for BD at the psychiatric clinic of University College Hospital, Ibadan, Nigeria between 2005 and 2014. Descriptive statistics were used to explore the data. We right-censored the data and obtained Kaplan-Meier estimates of the time to recurrence of the outcomes and transformed the estimates to standardized binormal data using quantile-quantile transformation. The likelihood was maximized to obtain the maximum likelihood estimate of the association parameter at 5% significance level. RESULTS The mean (± standard deviation) age of the respondents was 32.9±12.9 years, this was lower among service seekers who were initially diagnosed with mania than among those initially diagnosed with depression (31.3±11.6, 33.2±11.9, respectively). The median survival time to recurrence of mania and depression among the patients was 1,120 and 745 days, respectively, whereas association between times to recurrence of mania and depression was maximized at 0.67 (95% confidence interval: 0.62-0.71). CONCLUSION There exists a strong and positive association between times to recurrence of depression and mania in BD. The longer the time to recurrence of mania, the longer the time to recurrence of depression and vice versa.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
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11
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Bilderbeck AC, Atkinson LZ, McMahon HC, Voysey M, Simon J, Price J, Rendell J, Hinds C, Geddes JR, Holmes E, Miklowitz DJ, Goodwin GM. Psychoeducation and online mood tracking for patients with bipolar disorder: A randomised controlled trial. J Affect Disord 2016; 205:245-251. [PMID: 27454410 DOI: 10.1016/j.jad.2016.06.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychoeducation is an effective adjunct to medications in bipolar disorder (BD). Brief psychoeducational approaches have been shown to improve early identification of relapse. However, the optimal method of delivery of psychoeducation remains uncertain. Here, our objective was to compare a short therapist-facilitated vs. self-directed psychoeducational intervention for BD. METHODS BD outpatients who were receiving medication-based treatment were randomly assigned to 5 psychoeducation sessions administered by a therapist (Facilitated Integrated Mood Management; FIMM; n=60), or self-administered psychoeducation (Manualized Integrated Mood Management; MIMM; n=61). Follow-up was based on patients' weekly responses to an electronic mood monitoring programme over 12 months. RESULTS Over follow-up, there were no group differences in weekly self-rated depression symptoms or relapse/readmission rates. However, knowledge of BD (assessed with the Oxford Bipolar Knowledge questionnaire (OBQ)) was greater in the FIMM than the MIMM group at 3 months. Greater illness knowledge at 3 months was related to a higher proportion of weeks well over 12 months. LIMITATIONS Features of the trial may have reduced the sensitivity to our psychoeducation approach, including that BD participants had been previously engaged in self-monitoring. CONCLUSIONS Improved OBQ score, while accelerated by a short course of therapist-administered psychoeducation (FIMM), was seen after both treatments. It was associated with better outcome assessed as weeks well. When developing and testing a new psychosocial intervention, studies should consider proximal outcomes (e.g., acquired knowledge) and their short-term impact on illness course in bipolar disorder.
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Affiliation(s)
- Amy C Bilderbeck
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lauren Z Atkinson
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hannah C McMahon
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jonathan Price
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jennifer Rendell
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Chris Hinds
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - John R Geddes
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emily Holmes
- University Department of Psychiatry, University of Oxford, Oxford, UK; MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - David J Miklowitz
- University Department of Psychiatry, University of Oxford, Oxford, UK; Semel Institute, UCLA, Los Angeles, CA, USA
| | - Guy M Goodwin
- University Department of Psychiatry, University of Oxford, Oxford, UK.
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12
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Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial. Lancet Psychiatry 2016; 3:1029-1038. [PMID: 27688021 DOI: 10.1016/s2215-0366(16)30302-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/09/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Group psychoeducation is a low-cost National Institute for Health and Care Excellence-recommended treatment for bipolar disorder. However, the clinical effectiveness and acceptability of this intervention are unclear compared with unstructured peer support matched for delivery and aim of treatment, and for previous bipolar history. We aimed to assess the clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder. METHODS We did this pragmatic, multicentre, parallel-group, observer-blind, randomised controlled superiority trial at eight community sites in two regions in England. Participants aged 18 years or older with bipolar disorder and no episode in the preceding 4 weeks were recruited via self-referral or secondary care referral. Participants were individually randomly assigned (1:1), via a computer-generated stochastic allocation sequence, to attend 21 2-h weekly sessions of either structured group psychoeducation or optimised unstructured peer support. Randomisation was minimised by number of previous episodes (one to seven, eight to 19, or ≥20) and stratified by clinical site. Outcome assessors were masked to group allocation. The primary outcome was time from randomisation to next bipolar episode, with planned moderator analysis of number of previous bipolar episodes and qualitative interview of participant experience. We did analysis by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN62761948. FINDINGS Between Sept 28, 2009, and Jan 9, 2012, we randomly assigned 304 participants to receive psychoeducation (n=153) or peer support (n=151); all (100%) participants had complete primary outcome data. Attendance at psychoeducation groups was higher than at peer-support groups (median 14 sessions [IQR three to 18] vs nine sessions [two to 17]; p=0·026). At 96 weeks, 89 (58%) participants in the psychoeducation group had experienced a next bipolar episode compared with 98 (65%) participants in the peer-support group; time to next bipolar episode did not differ between groups (hazard ratio [HR] 0·83, 95% CI 0·62-1·11; p=0·217). Planned moderator analysis showed that psychoeducation was most beneficial in participants with few (one to seven) previous bipolar episodes (χ2; HR 0·28, 95% CI 0·12-0·68; p=0·034). Four (1%) participants (one in the psychoeducation group and three in the peer-support group) died during follow-up; these deaths were deemed unrelated to the study interventions or procedures. INTERPRETATION Structured group psychoeducation was no more clinically effective than similarly intensive unstructured peer support, but was more acceptable and improved outcome in participants with fewer previous bipolar episodes. Optimum provision of structured psychological interventions, such as group psychoeducation, early in the course of bipolar disorder might have important benefits on the course of illness, and merits further research. FUNDING National Institute for Health Research.
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13
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 457] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Barbato A, Vallarino M, Rapisarda F, Lora A, Parabiaghi A, D'Avanzo B, Lesage A. Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. Int J Soc Psychiatry 2016; 62:334-44. [PMID: 26896028 DOI: 10.1177/0020764016631368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. AIMS This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. METHOD Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. RESULTS A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. CONCLUSION Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy
| | - Martine Vallarino
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- Mental Health Department, Lecco Hospital, Lecco, Italy
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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Morrison AP, Law H, Barrowclough C, Bentall RP, Haddock G, Jones SH, Kilbride M, Pitt E, Shryane N, Tarrier N, Welford M, Dunn G. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Steven H Jones
- The Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK
| | - Martina Kilbride
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Pitt
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Shryane
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Mary Welford
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
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Oud M, Mayo-Wilson E, Braidwood R, Schulte P, Jones SH, Morriss R, Kupka R, Cuijpers P, Kendall T. Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry 2016; 208:213-22. [PMID: 26932483 DOI: 10.1192/bjp.bp.114.157123] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychological interventions may be beneficial in bipolar disorder. AIMS To evaluate the efficacy of psychological interventions for adults with bipolar disorder. METHOD A systematic review of randomised controlled trials was conducted. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE method. RESULTS We included 55 trials with 6010 participants. Moderate-quality evidence associated individual psychological interventions with reduced relapses at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48-0.92) and follow-up (RR = 0.74, 95% CI 0.63-0.87), and collaborative care with a reduction in hospital admissions (RR = 0.68, 95% CI 0.49-0.94). Low-quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psychoeducation with reduced symptoms of depression and mania. CONCLUSIONS There is evidence that psychological interventions are effective for people with bipolar disorder. Much of the evidence was of low or very low quality thereby limiting our conclusions. Further research should identify the most effective (and cost-effective) interventions for each phase of this disorder.
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Affiliation(s)
- Matthijs Oud
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Evan Mayo-Wilson
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ruth Braidwood
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Peter Schulte
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Steven H Jones
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Richard Morriss
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Ralph Kupka
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Pim Cuijpers
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
| | - Tim Kendall
- Matthijs Oud, MSc, Department of Care Innovation, Trimbos Institute, Utrecht, The Netherlands; Evan Mayo-Wilson, MPA, DPhil, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Ruth Braidwood, MSc, Department of Clinical, Educational and Health Psychology, University College London, UK; Peter Schulte, MD, PhD, Treatment Centre for Bipolar Disorders, Mental Health Service Noord-Holland-Noord, Alkmaar, The Netherlands; Steven H. Jones, PhD, Department of Clinical Psychology, Spectrum Centre for Mental Health Research, Lancaster University, UK; Richard Morriss, MD, FRCPsych, Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, UK; Ralph Kupka, MD, PhD, Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands; Pim Cuijpers, PhD, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, London, UK
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Harnessing the potential of community-based participatory research approaches in bipolar disorder. Int J Bipolar Disord 2016; 4:4. [PMID: 26856996 PMCID: PMC4746206 DOI: 10.1186/s40345-016-0045-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/20/2016] [Indexed: 01/13/2023] Open
Abstract
Background Despite the rapid growth in the sophistication of research on bipolar disorder (BD), the field faces challenges in improving quality of life (QoL) and symptom outcomes, adapting treatments for marginalized communities, and disseminating research insights into real-world practice. Community-based participatory research (CBPR)—research that is conducted as a partnership between researchers and community members—has helped address similar gaps in other health conditions. This paper aims to improve awareness of the potential benefits of CBPR in BD research. Methods This paper is a product of the International Society for Bipolar Disorders (ISBD) Taskforce on Community Engagement which includes academic researchers, healthcare providers, people with lived experience of BD, and stakeholders from BD community agencies. Illustrative examples of CBPR in action are provided from two established centres that specialize in community engagement in BD research: the Collaborative RESearch Team to study psychosocial issues in BD (CREST.BD) in Canada, and the Spectrum Centre for Mental Health Research in the United Kingdom. Results and discussion We describe the philosophy of CBPR and then introduce four core research areas the BD community has prioritized for research: new treatment approaches, more comprehensive outcome assessments, tackling stigma, and enhanced understanding of positive outcomes. We then describe ways in which CBPR is ideal for advancing each of these research areas and provide specific examples of ways that CBPR has already been successfully applied in these areas. We end by noting potential challenges and mitigation strategies in the application of CBPR in BD research. Conclusions We believe that CBPR approaches have significant potential value for the BD research community. The observations and concerns of people with BD, their family members, and supports clearly represent a rich source of information. CBPR approaches provide a collaborative, equitable, empowering orientation to research that builds on the diversity of strengths amongst community stakeholders. Despite the potential merits of this approach, CBPR is as yet not widely used in the BD research field, representing a missed opportunity.
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Cree L, Brooks HL, Berzins K, Fraser C, Lovell K, Bee P. Carers' experiences of involvement in care planning: a qualitative exploration of the facilitators and barriers to engagement with mental health services. BMC Psychiatry 2015; 15:208. [PMID: 26319602 PMCID: PMC4553006 DOI: 10.1186/s12888-015-0590-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Formal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers' dissatisfaction with care-planning procedures have been relatively neglected in the research literature, despite the substantial and significant contribution that they make to mental health services. The aim of the study was to explore carers' experiences of the care planning process for people with severe mental illness. METHODS Qualitative interviews and focus groups were undertaken with carers. Data were combined and analysed using framework analysis. RESULTS Whilst identifying a shared desire for involvement and confirming a potential role for carers within services, our data highlighted that many carers perceive a lack of involvement in care planning and a lack of recognition and appreciation of their role from health professionals. Barriers to involvement included structural barriers, such as the timing and location of meetings, cultural barriers relating to power imbalances within the system and specific barriers relating to confidentiality. CONCLUSIONS This qualitative study led by a researcher who was a carer herself has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.
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Affiliation(s)
- Lindsey Cree
- EQUIP, School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Helen L Brooks
- EQUIP, School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Kathryn Berzins
- School of Healthcare, University of Leeds, ᅟ, Leeds, LS2 9JT, UK.
| | - Claire Fraser
- EQUIP, School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Karina Lovell
- EQUIP, School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Manchester Mental Health and Social Care Trust, University of Leeds, ᅟ, Manchester, ᅟ, UK.
| | - Penny Bee
- EQUIP, School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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Relapse rate and outcome correlates in Egyptian patients with bipolar disorder treated with behavioural family psychoeducation. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000466278.16335.8f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bond K, Anderson IM. Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar Disord 2015; 17:349-62. [PMID: 25594775 DOI: 10.1111/bdi.12287] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/03/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Previous reviews have concluded that interventions including psychoeducation are effective in preventing relapse in bipolar disorder, but the efficacy of psychoeducation itself has not been systematically reviewed. Our aim was to evaluate the efficacy of psychoeducation for bipolar disorder in preventing relapse and other outcomes, and to identify factors that relate to clinical outcomes. METHODS We employed the systematic review of randomized controlled trials of psychoeducation in participants with bipolar disorder not in an acute illness episode, compared with treatment-as-usual, and placebo or active interventions. Pooled odds ratios (ORs) for non-relapse into any episode, mania/hypomania, and depression were calculated using an intent-to-treat (ITT) analysis, assigning dropouts to relapse, with a sensitivity analysis in which dropouts were assigned to non-relapse (optimistic ITT). RESULTS Sixteen studies were included, eight of which provided data on relapse. Although heterogeneity in the data warrants caution, psychoeducation appeared to be effective in preventing any relapse [n = 7; OR: 1.98-2.75; number needed to treat (NNT): 5-7, depending on the method of analysis] and manic/hypomanic relapse (n = 8; OR: 1.68-2.52; NNT: 6-8), but not depressive relapse. Group, but not individually, delivered interventions were effective against both poles of relapse; the duration of follow-up and hours of therapy explained some of the heterogeneity. Psychoeducation improved medication adherence and short-term knowledge about medication. No consistent effects on mood symptoms, quality of life, or functioning were found. CONCLUSIONS Group psychoeducation appears to be effective in preventing relapse in bipolar disorder, with less evidence for individually delivered interventions. Better understanding of mediating mechanisms is needed to optimize efficacy and personalize treatment.
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Affiliation(s)
- Kirsten Bond
- Specialist Service for Affective Disorders, Manchester Mental Health and Social Care Trust, Manchester, UK
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Lobban F, Dodd AL, Dagnan D, Diggle PJ, Griffiths M, Hollingsworth B, Knowles D, Long R, Mallinson S, Morriss RM, Parker R, Sawczuk AP, Jones S. Feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline): trial protocol. Contemp Clin Trials 2015; 41:100-9. [PMID: 25602581 DOI: 10.1016/j.cct.2015.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relapse prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web-based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders. METHODS/DESIGN This protocol describes the development and feasibility testing of the ERPonline web-based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding of the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates. DISCUSSION The findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web-based interventions designed to support people with mental health problems.
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Affiliation(s)
- F Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK.
| | - A L Dodd
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - D Dagnan
- Cumbria Partnership NHS Foundation Trust, UK
| | - P J Diggle
- Faculty of Medicine, Lancaster University, UK; Institution for Infection and Global Health, University of Liverpool, UK
| | - M Griffiths
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - B Hollingsworth
- Division of Health Research, Lancaster University, Lancaster, UK
| | - D Knowles
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - R Long
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | | | - R M Morriss
- School of Medicine, University of Nottingham, UK
| | - R Parker
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - A P Sawczuk
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - S Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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Miziou S, Tsitsipa E, Moysidou S, Karavelas V, Dimelis D, Polyzoidou V, Fountoulakis KN. Psychosocial treatment and interventions for bipolar disorder: a systematic review. Ann Gen Psychiatry 2015; 14:19. [PMID: 26155299 PMCID: PMC4493813 DOI: 10.1186/s12991-015-0057-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Stella Miziou
- Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | | | - Vangelis Karavelas
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | - Dimos Dimelis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
| | | | - Konstantinos N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos Street (1st Parodos, Ampelonon Str.), Pournari Pylaia, 55535 Thessaloníki, Greece
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24
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Jones SH, Smith G, Mulligan LD, Lobban F, Law H, Dunn G, Welford M, Kelly J, Mulligan J, Morrison AP. Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder: randomised controlled pilot trial. Br J Psychiatry 2015; 206:58-66. [PMID: 25213157 DOI: 10.1192/bjp.bp.113.141259] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically designed to enhance personal recovery for individuals with recent-onset bipolar disorder. AIMS A pilot study to assess the feasibility and effectiveness of a new intervention, recovery-focused cognitive-behavioural therapy (CBT), designed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes. METHOD A single, blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused CBT plus TAU (n = 67). RESULTS Recruitment and follow-up rates within 10% of pre-planned targets to 12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU, recovery-focused CBT significantly improved personal recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean score 310.87, 95% CI 75.00-546.74 (s.e. = 120.34), P = 0.010, d = 0.62) and increased time to any mood relapse during up to 15 months follow-up (χ2 = 7.64, P<0.006, estimated hazard ratio (HR) = 0.38, 95% CI 0.18-0.78). Groups did not differ with respect to medication adherence. CONCLUSIONS Recovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness. Clinical- and cost-effectiveness now need to be reliably estimated in a definitive trial.
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Affiliation(s)
- Steven H Jones
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Gina Smith
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Lee D Mulligan
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Fiona Lobban
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Heather Law
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Graham Dunn
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Mary Welford
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - James Kelly
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - John Mulligan
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
| | - Anthony P Morrison
- Steven H. Jones, MSc (Clin Psychol), PhD, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster; Gina Smith, PGDipPsych, DClinPsych, 5 Boroughs Partnership NHS Foundation Trust, Warrington; Lee D. Mulligan, MSc, Manchester Mental Health and Social Care Trust, Manchester; Fiona Lobban, DClinPsy, PhD, Lancaster University, Lancaster; Heather Law, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester; Graham Dunn, MA, MSc, PhD, Institute of Population Health, University of Manchester; Mary Welford, DClinPsy, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust; James Kelly, MSc, ClinPsyD, Lancashire Care NHS Foundation Trust, Lancaster; John Mulligan, MSc, ClinPsyD, The Beaco Service HMP Garth, Mersey Care NHS Trust, Liverpool; Anthony P. Morrison, ClinPsyD, Department of Clinical Psychology, University of Manchester, Manchester, UK
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Abstract
Several psychological interventions-including group psychoeducation, family-focused psychoeducation, and interpersonal social-rhythm therapy-have demonstrated prophylactic efficacy as an adjunct to medication in bipolar disorders (BDs). The field of psychological interventions for BD has experienced impressive progress over the last 15 years. Certain unexplored areas, however, require further research in order to establish the full potential of psychological interventions for BD. Such research should focus, among other things, on cognitive impairment associated with BD, BD in the elderly, comorbid anxiety disorders and other comorbidities, the treatment of BD in pregnant women, and the improvement of patients' overall physical health.
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Popovic D, Reinares M, Scott J, Nivoli A, Murru A, Pacchiarotti I, Vieta E, Colom F. Polarity index of psychological interventions in maintenance treatment of bipolar disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:292-8. [PMID: 23942231 DOI: 10.1159/000348447] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 12/29/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although several adjunctive psychological interventions are effective in the maintenance of bipolar disorders (BD), no attempt has been made to classify them according to their ability to prevent manic versus depressive episodes. Our study aims to rank the adjunctive psychotherapies for the prophylaxis of BD by means of their polarity index (PI). METHODS Randomized controlled trials comparing the efficacy of a psychological intervention with a comparator in BD maintenance treatment in patients aged over 18 were systematically reviewed. Exclusion criteria were a small sample size, a study sample not exclusively composed of bipolar patients and the absence of a control group. PI is a novel metric indicating the relative antimanic versus antidepressive preventive efficacy of treatments. PI was retrieved by calculating the ratio of the number needed to treat (NNT) for prevention of depression and the NNT for prevention of mania. PI >1.0 indicates a relatively higher antimanic prophylactic efficacy and PI <1.0 a greater antidepressive efficacy. RESULTS A total of 9 studies were included. PI was 0.33, 0.63 and 0.89 for cognitive-behavioral therapy, 0.42 for family-focused therapy, 0.73 and 0.78 for psychoeducation, 1 for enhanced relapse prevention, 1.78 for caregiver group psychoeducation and 3.36 for brief technique-driven interventions. With regard to the PI for 1 cognitive-behavioral study, enhanced relapse prevention and brief technique-driven interventions may not be reliable since those trials were negative. CONCLUSIONS The PI provides a measure of how much depression-preventive or (hypo) mania-preventive an intervention is and may guide the choice of adjunctive psychotherapy in the context of individualized long-term treatment of BD.
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Affiliation(s)
- Dina Popovic
- Bipolar Disorders Unit, Department of Psychiatry, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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27
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Reinares M, Sánchez-Moreno J, Fountoulakis KN. Psychosocial interventions in bipolar disorder: what, for whom, and when. J Affect Disord 2014; 156:46-55. [PMID: 24439829 DOI: 10.1016/j.jad.2013.12.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- María Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain.
| | - José Sánchez-Moreno
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain
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28
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Jones S, Mulligan LD, Higginson S, Dunn G, Morrison AP. The bipolar recovery questionnaire: psychometric properties of a quantitative measure of recovery experiences in bipolar disorder. J Affect Disord 2013. [PMID: 23182591 DOI: 10.1016/j.jad.2012.10.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, School of Health and Medicine, Lancaster University, UK.
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29
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Stafford N, Colom F. Purpose and effectiveness of psychoeducation in patients with bipolar disorder in a bipolar clinic setting. Acta Psychiatr Scand 2013:11-8. [PMID: 23581788 DOI: 10.1111/acps.12118] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This article reviews psychological therapies in the treatment of bipolar disorder, in particular psychoeducation, and how the inclusion of four fundamental principles - patient/therapist communication, flow of information, patient involvement and a trusting relationship - can improve patient outcomes. METHOD The content of this article is based on the proceedings of a 1-day standalone symposium in November 2011 exploring how to establish a bipolar clinic within the context of existing services in the UK's National Health Service. RESULTS Certain psychological interventions have emerged as beneficial add-on treatments to pharmacotherapy in bipolar disorder and are associated with greater stabilisation of symptoms, fewer relapses and longer time to relapse. Psychoeducation is a simple approach to support prevention of future episodes by delivering behavioural training to improve illness insight, early symptom identification and development of coping strategies. Empowering patients to actively participate in their treatment provides independence, counteracts the current disconnect of therapist and patient, and increases awareness and understanding of the challenges of living with and treating bipolar disorder. CONCLUSION Psychoeducation enables patients to understand bipolar disorder, get actively involved in therapy planning, and be aware of methods for episode prevention, therefore effectively contributing to improved treatment outcomes and patient quality of life.
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Affiliation(s)
- N. Stafford
- Leicestershire Partnership NHS Trust; Adult Mental Health Services; Leicestershire; UK
| | - F. Colom
- Bipolar Disorders Unit; IDIBAPS-CIBERSAM-Hospital Clinic Barcelona; Barcelona; Spain
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30
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 540] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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31
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[Psychiatric care for subjects with bipolar disorder: results of the new German S3 guidelines]. DER NERVENARZT 2012; 83:595-603. [PMID: 22532326 DOI: 10.1007/s00115-011-3417-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bipolar affective disorders are frequent and have severe consequences. The German S3 guidelines outline the principles of evidence-based treatment of this condition. Based on a partnership with service users and their families accessibility to illness-specific therapy including psychotherapy/psychoeducation, self-help groups for family members and for users are important. Other significant service aspects include assertive outreach and specific rehabilitation (including work). Psychiatric services in Germany remain scattered; therefore there is a need for more coordination.
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32
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Brieger P, Bernhard B. Psychoedukation in der Gruppe ergänzt medikamentöse Therapie. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s15202-012-0175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lobban F, Solis-Trapala I, Tyler E, Chandler C, Morriss RK. The Role of Beliefs About Mood Swings in Determining Outcome in Bipolar Disorder. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9452-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Abstract
This review of psychosocial interventions in bipolar disorders demonstrates that some therapies, when combined with medication, are more efficacious at preventing or delaying depressive relapse, and can be more effective than medication alone in reducing time to recovery from an acute bipolar depressive episode. However, apparent benefits diminish over time, suggesting that maintenance or « booster » therapy sessions may be needed. Given the scarcity of trained therapists, further studies are needed to determine which bipolar depressed patients should be targeted and to establish more clearly the potential cost and benefits of such interventions.
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35
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TODD NICHOLASJ, JONES STEVENH, LOBBAN FIONAA. “Recovery” in bipolar disorder: How can service users be supported through a self-management intervention? A qualitative focus group study. J Ment Health 2011; 21:114-26. [DOI: 10.3109/09638237.2011.621471] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Peters S, Pontin E, Lobban F, Morriss R. Involving relatives in relapse prevention for bipolar disorder: a multi-perspective qualitative study of value and barriers. BMC Psychiatry 2011; 11:172. [PMID: 22044486 PMCID: PMC3247067 DOI: 10.1186/1471-244x-11-172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/01/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Managing early warning signs is an effective approach to preventing relapse in bipolar disorder. Involving relatives in relapse prevention has been shown to maximize the effectiveness of this approach. However, family-focused intervention research has typically used expert therapists, who are rarely available within routine clinical services. It remains unknown what issues exist when involving relatives in relapse prevention planning delivered by community mental health case managers. This study explored the value and barriers of involving relatives in relapse prevention from the perspectives of service users, relatives and care-coordinators. METHODS Qualitative interview study nested within a randomized controlled trial of relapse prevention for individuals with bipolar disorder. The purposive sample of 52 participants comprised service users (n = 21), care coordinators (n = 21) and relatives (n = 10). Data were analyzed using a grounded theory approach. RESULTS All parties identified benefits of involving relatives in relapse prevention: improved understanding of bipolar disorder; relatives gaining a role in illness management; and improved relationships between each party. Nevertheless, relatives were often discouraged from becoming involved. Some staff perceived involving relatives increased the complexity of their own role and workload, and some service users valued the exclusivity of their relationship with their care-coordinator and prioritized taking individual responsibility for their illness over the benefits of involving their relatives. Barriers were heightened when family relationships were poor. CONCLUSIONS Whilst involving relatives in relapse prevention has perceived value, it can increase the complexity of managing bipolar disorder for each party. In order to fully realize the benefits of involving relatives in relapse prevention, additional training and support for community care coordinators is needed. TRIAL REGISTRATION ISRCTN41352631
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Affiliation(s)
- Sarah Peters
- School of Psychological Sciences, University of Manchester, UK
| | - Eleanor Pontin
- School of Population, Community and Behavioural Sciences, University of Liverpool, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, University of Lancaster, UK
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37
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Lobban F, Solis-Trapala I, Symes W, Morriss R. Early warning signs checklists for relapse in bipolar depression and mania: utility, reliability and validity. J Affect Disord 2011; 133:413-22. [PMID: 21640385 DOI: 10.1016/j.jad.2011.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/26/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recognising early warning signs (EWS) of mood changes is a key part of many effective interventions for people with Bipolar Disorder (BD). This study describes the development of valid and reliable checklists required to assess these signs of depression and mania. METHODS Checklists of EWS based on previous research and participant feedback were designed for depression and mania and compared with spontaneous reporting of EWS. Psychometric properties and utility were examined in 96 participants with BD. RESULTS The majority of participants did not spontaneously monitor EWS regularly prior to use of the checklists. The checklists identified most spontaneously generated EWS and led to a ten fold increase in the identification of EWS for depression and an eight fold increase for mania. The scales were generally reliable over time and responses were not associated with current mood. Frequency of monitoring for EWS correlated positively with social and occupational functioning for depression (beta=3.80, p=0.015) and mania (beta=3.92, p=0.008). LIMITATIONS The study is limited by a small sample size and the fact that raters were not blind to measures of mood and function. CONCLUSIONS EWS checklists are useful and reliable clinical and research tools helping to generate enough EWS for an effective EWS intervention.
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre, School of Health and Medicine, Lancaster University, United Kingdom.
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38
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Morriss RK, Lobban F, Jones S, Riste L, Peters S, Roberts C, Davies L, Mayes D. Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder. BMC Psychiatry 2011; 11:114. [PMID: 21777426 PMCID: PMC3146925 DOI: 10.1186/1471-244x-11-114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/21/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-didactically delivered curriculum based group psychoeducation has been shown to be more effective than both group support in a specialist mood disorder centre in Spain (with effects lasting up to five years), and treatment as usual in Australia. It is unclear whether the specific content and form of group psychoeducation is effective or the chance to meet and work collaboratively with other peers. The main objective of this trial is to determine whether curriculum based group psychoeducation is more clinically and cost effective than unstructured peer group support. METHODS/DESIGN Single blind two centre cluster randomised controlled trial of 21 sessions group psychoeducation versus 21 sessions group peer support in adults with bipolar 1 or 2 disorder, not in current episode but relapsed in the previous two years. Individual randomisation is to either group at each site. The groups are carefully matched for the number and type of therapists, length and frequency of the interventions and overall aim of the groups but differ in content and style of delivery. The primary outcome is time to next bipolar episode with measures of the therapeutic process, barriers and drivers to the effective delivery of the interventions and economic analysis. Follow up is for 96 weeks after randomisation. DISCUSSION The trial has features of both an efficacy and an effectiveness trial design. For generalisability in England it is set in routine public mental health practice with a high degree of expert patient involvement.
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Affiliation(s)
- Richard K Morriss
- Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham & Nottinghamshire Healthcare NHS Trust.
| | - Fiona Lobban
- Senior Lecturer in Clinical Psychology, Spectrum Centre for Mental Health Research, School of Health and Medicine, Lancaster University
| | - Steven Jones
- Professor of Clinical Psychology, Spectrum Centre for Mental Health Research, School of Health and Medicine, Lancaster University
| | - Lisa Riste
- PARADES Programme Manager, Department of Psychology, University of Manchester
| | - Sarah Peters
- Senior Lecturer in Psychology, University of Manchester
| | | | - Linda Davies
- Professor of Health Economics, University of Manchester
| | - Debbie Mayes
- Service User Researcher, Spectrum Centre for Mental Health Research, Lancaster University
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39
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Colom F. Keeping therapies simple: psychoeducation in the prevention of relapse in affective disorders. Br J Psychiatry 2011; 198:338-40. [PMID: 21525516 DOI: 10.1192/bjp.bp.110.090209] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Psychological interventions for mood disorders can be divided into 'skilled' and 'simple'. Psychoeducation belongs to the latter group: a simple and illness-focused therapy with prophylactic efficacy in all major mood disorders. Successful implementation of psychoeducation requires a proper setting, including open-door policy, team effort and empowerment of the therapeutic alliance.
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