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Vol. 82, No. 5, 2013
Issue release date: August 2013
Psychother Psychosom 2013;82:292-298
(DOI:10.1159/000348447)

Polarity Index of Psychological Interventions in Maintenance Treatment of Bipolar Disorder

Popovic D. · Reinares M. · Scott J. · Nivoli A. · Murru A. · Pacchiarotti I. · Vieta E. · Colom F.
aBipolar Disorders Unit, Department of Psychiatry, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain; bDepartment of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy; cAcademic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

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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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References

  1. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC: Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007;64:543-552.
  2. De Dios C, Agud JL, Ezquiaga E, García-López A, Soler B, Vieta E: Syndromal and subsyndromal illness status and five-year morbidity using criteria of the International Society for Bipolar Disorders compared to alternative criteria. Psychopathology 2012;45:102-108.
  3. Bonnín CM, Sánchez-Moreno J, Martínez-Arán A, Solé B, Reinares M, Rosa AR, Goikolea JM, Benabarre A, Ayuso-Mateos JL, Ferrer M, Vieta E, Torrent C: Subthreshold symptoms in bipolar disorder: impact on neurocognition, quality of life and disability. J Affect Disord 2012;136:650-659.
  4. Sanchez-Moreno J, Martinez-Aran A, Tabarés-Seisdedos R, Torrent C, Vieta E, Ayuso-Mateos JL: Functioning and disability in bipolar disorder: an extensive review. Psychother Psychosom 2009;78:285-297.
  5. Rosa AR, Reinares M, Amann B, Popovic D, Franco C, Comes M, Torrent C, Bonnín CM, Solé B, Valentí M, Salamero M, Kapczinski F, Vieta E: Six-month functional outcome of a bipolar disorder cohort in the context of a specialized-care program. Bipolar Disord 2011;13:679-686.
  6. Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S, O'Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Young AH, Alda M, Milev R,Vieta E, Calabrese JR, Berk M, Ha K, Kapczinski F: 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 2009. Bipolar Disord 2009;11:225-255.
  7. Vieta E, Günther O, Locklear J, Ekman M, Miltenburger C, Chatterton ML, Åström M, Paulsson B: Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol 2011;14:1029-1049.
  8. Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ: The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence. Am J Psychiatry 2003;160:2099-2107.
  9. Tohen M, Calabrese JR, Sachs GS, Banov MD, Detke HC, Risser R, Baker RW, Chou JC, Bowden CL: Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry 2006;163:247-256.
  10. Judd LL, Schettler PJ, Akiskal HS, Coryell W, Leon AC, Maser JD, Solomon DA: Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psychiatry 2008;65:386-394.
  11. Miklowitz D: Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry 2008;165:1408-1419.
  12. Schöttle D, Huber CG, Bock T, Meyer TD: Psychotherapy for bipolar disorder: a review of the most recent studies. Curr Opin Psychiatry 2011;24:549-555.
  13. American Psychiatric Association: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, ed 3. Washington, American Psychiatric Association, 2010.
  14. National Collaborating Centre for Mental Health: Depression: the treatment and management of depression in adults. NICE Clinical Guideline 90. London, National Institute for Health and Clinical Excellence, 2009, p 64.
  15. Zimmerman M: Symptom severity and guideline-based treatment recommendations for depressed patients: implications of DSM-5′s potential recommendation of the PHQ-9 as the measure of choice for depression severity. Psychother Psychosom 2012;81:329-332.
  16. Colom F, Vieta E, Daban C, Pacchiarotti I, Sanchez-Moreno J: Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006;93;13-17.
  17. Baldessarini RJ, Undurraga J, Vázquez GH, Tondo L, Salvatore P, Ha K, Khalsa HM, Lepri B, Ha TH, Chang JS, Tohen M, Vieta E: Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr Scand 2012;125:293-302.
  18. Martinez-Aran A, Vieta E, Chengappa KN, Gershon S, Mullen J, Paulsson B: Reporting outcomes in clinical trials for bipolar disorder: a commentary and suggestions for change. Bipolar Disord 2008;10:566-579.
  19. Ketter TA, Citrome L, Wang PW, Culver JL, Srivastava S: Treatments for bipolar disorder: can number needed to treat/harm help inform clinical decisions? Acta Psychiatr Scand 2011;123:175-189.
  20. Popovic D, Reinares M, Amann B, Salamero M, Vieta E: Number needed to treat analyses of drugs used for maintenance treatment of bipolar disorder. Psychopharmacology (Berl) 2011;213:657-667.
  21. Citrome L: Compelling or irrelevant? Using number needed to treat can help decide. Acta Psychiatr Scand 2008;117:412-419.
  22. Popovic D, Reinares M, Goikolea JM, Bonnin CM, Gonzalez-Pinto A, Vieta E: Polarity index of pharmacological agents used for maintenance treatment of bipolar disorder. Eur Neuropsychopharmacol 2012;22:339-346.
  23. Richy F, Ethgen O, Bruyere O, Deceulaer F, Reginster JY: From sample size to effect-size: small study effect investigation (SSEi). J Epidemiol 2004;1:1.
  24. Kraemer HC, Kupfer DJ: Size of treatment effects and their importance to clinical research and practice. Biol Psychiatry 2006;59:990-996.
  25. Cook RJ, Sackett DL: The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452-454.
  26. Vieta E, Suppes T, Ekholm B, Udd M, Gustafsson U: Long-term efficacy of quetiapine in combination with lithium or divalproex on mixed symptoms in bipolar I disorder. J Affect Disord 2012;142:36-44.
  27. Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P: A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003;60:145-152.
  28. Lam DH, Hayward P, Watkins ER, Wright K, Sham P: Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005;162:324-329.
  29. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL: A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003;60:904-912.
  30. Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J: A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003;60:402-407.
  31. Colom F, Vieta E, Sánchez-Moreno J, Palomino-Otiniano R, Reinares M, Goikolea JM, Benabarre A, Martínez-Arán A: Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009;194:260-265, erratum 571.
  32. Reinares M, Colom F, Sánchez-Moreno J, Torrent C, Martínez-Arán A, Comes M, Goikolea JM, Benabarre A, Salamero M, Vieta E: Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar Disord 2008;10:511-519.
  33. Lobban F, Taylor L, Chandler C, Tyler E, Kinderman P, Kolamunnage-Dona R, Gamble C, Peters S, Pontin E, Sellwood W, Morriss RK: Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial. Br J Psychiatry 2010;196:59-63.
  34. Perry A, Tarrier N, Morriss R, McCarthy E, Limb K: Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999;318:149-153.
  35. Meyer TD, Hautzinger M: Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychol Med 2011;21:1-11.
  36. Scott J, Paykel E, Morriss R, Bentall R, Kinderman P, Johnson T, Abbott R, Hayhurst H: Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. Br J Psychiatry 2006;188:313-320.
  37. Tomba E, Bech P: Clinimetrics and clinical psychometrics: macro- and micro-analysis. Psychother Psychosom 2012;81:333-343.
  38. Fava GA, Rafanelli C, Tomba E, Guidi J, Grandi S: The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychother Psychosom 2011;80:136-143.


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