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Targeted psychotherapy can enhance bipolar disorder outcomes.

Psychotherapy specifically designed for bipolar disorder can prevent or delay relapse, and there is no clear evidence that the occurrence of prior episodes negates the treatment effect, a British meta-analysis shows.

Despite some evidence of benefit with psychological therapies specific to bipolar disorder (BD), not all studies have concluded that the addition of a psychosocial intervention improves outcomes more than pharmacologic treatment alone. Post hoc analyses have shown a lack of benefit in patients with more than 12 previous episodes.

Dominic H. Lam, Ph.D., and his colleagues at the University of Hull (England), conducted a systematic review and metaanalysis to examine the overall efficacy of bipolar-disorder-specific psychological therapies and the impact of previous episodes on its efficacy in relapse prevention (Bipolar Disord. 2009;11:474-82).

A literature search found 15 trials, and 5 of those trials were excluded from the analysis for various reasons. For example, one study was excluded because the subjects had comorbid bipolar disorder and substance use.

The metaanalysis included studies that used a range of interventions, from individual cognitive-behavioral therapy, to family format, to group therapy (psychoeducation).

Dr. Lam and his colleagues found that the overall relative risk of relapse was calculated to be 0.74 with a 95% confidence interval of 0.64-0.85. Meta-regression of six studies showed no relationship between the number of episodes and number of relapses at the end point. However, there was some heterogeneity between the studies.

The finding that psychotherapy specific to bipolar disorder helps prevent or delay relapses in bipolar seemed robust, regardless of "whether the control group received usual psychiatric care, brief educational sessions, education, support, and problem solving, or nonspecific group meeting," Dr. Lam and his colleagues reported.

Regardless of the kind of therapy conducted, the metaanalysis found no evidence of efficacy alone without medication.

Given that finding, the researchers said clinicians should be cautious and "advise against terminating medication to replace it with psychological therapy as the sole treatment."

Future studies aimed at examining the efficacy of interventions in preventing relapse in bipolar should ensure that participants are recruited during euthymia "in order to create maximum opportunity to explore relapse prevention techniques," the researchers advised.

They also called for additional studies aimed at understanding patients' ascent to mania and the impact of that ascent on cognition and behavior.
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Title Annotation:ADULT PSYCHIATRY
Author:Helwick, Caroline
Publication:Clinical Psychiatry News
Date:Sep 1, 2009
Words:384
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