David Baxter PhD
Late Founder
Combination treatment benefits patients with refractory bipolar disorder
By Mark Cowen, MedWire News
07 September 2010
J Affect Disord 2010; 126: 80?87
Results from a Spanish study suggest that psychotherapy combined with pharmacotherapy has greater short- and long-term benefits for patients with refractory bipolar disorder than pharmacotherapy alone.
"Current pharmacological treatments fail to control the course of bipolar disorder in half of the cases," explain Ana Gonz?lez Isasi (Las Palmas de Gran Canaria, Spain) and team.
They add: "Patients with a refractory bipolar disorder? frequently have a poor prognosis; they usually present residual symptoms, rapid cycling, and suicide attempts, in spite of an appropriate treatment with mood stabilizers. Furthermore, even without presentation of rapid cycling, these patients may suffer frequent relapses and have severe difficulties in their social-occupational functioning."
To investigate the short- and long-term benefits of combining psychotherapy (psycho-education and cognitive-behavioral therapy) with pharmacotherapy, the researchers enrolled 40 patients with refractory bipolar disorder who were receiving treatment with mood stabilizers.
Of the participants, 20 were randomly assigned to an intervention group that received combined psychotherapy and pharmacotherapy, while the remainder were assigned to a control group that continued to receive pharmacotherapy alone. Psychotherapy consisted of 20 weekly 1.5-hour sessions led by a clinical psychologist assisted by psychiatric nurses.
There were no significant differences between the two groups at baseline regarding gender distribution, age, number of prior hospitalizations, number of recent hospitalizations, use of mood stabilizers, adherence, persistent affective symptoms (Beck's Depression Index score >7, Young Mania Rating Scale score >6), and/or severe difficulties in social-occupational functioning (Inadaptation Scale score >14).
The researchers found that immediately after completion of the psychotherapy program (post-treatment evaluation), 45% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning. In contrast, 80% of controls met these criteria at this time.
At the 6-month evaluation, 40% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning compared with 80% of controls, and 30% and 83%, respectively, were affected by these problems at the 12-month evaluation.
All of these between-group differences were significant, the researchers note.
They also found that, overall, patients in the intervention group were hospitalized less often than those in the control group, although intervention patients had been hospitalized more often than controls at the time of the post-treatment evaluation.
Isasi and team conclude in the Journal of Affective Disorders: "Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Further research lines could address the evaluation of each of the components of the psychological program (psycho-education and cognitive-behavioral therapy) or other psychological approaches (behavioral experiments or exposure techniques), as well as the possible additive effect of setting up a psycho-education program for relatives who live with the patients."
Abstract
By Mark Cowen, MedWire News
07 September 2010
J Affect Disord 2010; 126: 80?87
Results from a Spanish study suggest that psychotherapy combined with pharmacotherapy has greater short- and long-term benefits for patients with refractory bipolar disorder than pharmacotherapy alone.
"Current pharmacological treatments fail to control the course of bipolar disorder in half of the cases," explain Ana Gonz?lez Isasi (Las Palmas de Gran Canaria, Spain) and team.
They add: "Patients with a refractory bipolar disorder? frequently have a poor prognosis; they usually present residual symptoms, rapid cycling, and suicide attempts, in spite of an appropriate treatment with mood stabilizers. Furthermore, even without presentation of rapid cycling, these patients may suffer frequent relapses and have severe difficulties in their social-occupational functioning."
To investigate the short- and long-term benefits of combining psychotherapy (psycho-education and cognitive-behavioral therapy) with pharmacotherapy, the researchers enrolled 40 patients with refractory bipolar disorder who were receiving treatment with mood stabilizers.
Of the participants, 20 were randomly assigned to an intervention group that received combined psychotherapy and pharmacotherapy, while the remainder were assigned to a control group that continued to receive pharmacotherapy alone. Psychotherapy consisted of 20 weekly 1.5-hour sessions led by a clinical psychologist assisted by psychiatric nurses.
There were no significant differences between the two groups at baseline regarding gender distribution, age, number of prior hospitalizations, number of recent hospitalizations, use of mood stabilizers, adherence, persistent affective symptoms (Beck's Depression Index score >7, Young Mania Rating Scale score >6), and/or severe difficulties in social-occupational functioning (Inadaptation Scale score >14).
The researchers found that immediately after completion of the psychotherapy program (post-treatment evaluation), 45% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning. In contrast, 80% of controls met these criteria at this time.
At the 6-month evaluation, 40% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning compared with 80% of controls, and 30% and 83%, respectively, were affected by these problems at the 12-month evaluation.
All of these between-group differences were significant, the researchers note.
They also found that, overall, patients in the intervention group were hospitalized less often than those in the control group, although intervention patients had been hospitalized more often than controls at the time of the post-treatment evaluation.
Isasi and team conclude in the Journal of Affective Disorders: "Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Further research lines could address the evaluation of each of the components of the psychological program (psycho-education and cognitive-behavioral therapy) or other psychological approaches (behavioral experiments or exposure techniques), as well as the possible additive effect of setting up a psycho-education program for relatives who live with the patients."
Abstract
