Gaps and Limitations of Psychological Interventions for Bipolar DisordersScott J.a · Colom F.b
aUniversity Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK; bBipolar Disorder Program, Neuroscience Institute, Hospital Clinic Barcelona, Barcelona, Spain
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Objective: To highlight gaps or limitations in applying evidence-based psychological therapies as an adjunct to medication in the management of bipolar disorders. Method: General and specific gaps in knowledge or perceived limitations were determined by the authors and published examples were identified illustrating these potential barriers to the use or application of adjunctive therapies. Results: Research on the benefits of psychological therapies in bipolar disorders has progressed dramatically in the last decade. There are some uncertainties that need to be further investigated. These can be broadly classified as: for whom should therapy be provided, what therapy and when should therapy be commenced. The latter can be seen from the perspective of both current mental state as well as length of history and number of recurrences. Other issues frequently highlighted by researchers in the field relate to mediators and moderators of therapy effects. Conclusion: Gaps in our knowledge about therapy for bipolar disorder mirror those that exist whenever new treatments, including medications, are introduced into routine clinical practice. Many of these key questions relate to differences between efficacy and effectiveness of adjunctive therapies, the long-term durability of any benefits and mechanisms by which therapies achieve their effects. These can be explored using currently existing scientific paradigms.
© 2008 S. Karger AG, Basel
- Scott J, Sensky T: Methodological issues in randomized controlled trials in psychotherapy. Psychol Med 2003;33:191–196.
Scott J, Colom F, Vieta E: A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. Int J Neuropsychopharmacol 2006;20:1–7.
Goodwin F, Jamison K: Manic Depressive Illness. Oxford, Oxford University Press, 1990.
- Black DW, Winokur G, Hulbert J, Nasrallah A: Predictors of immediate response in the treatment of mania: the importance of comorbidity. Biol Psychiatry 1988;24:191–198.
- Cassano GB, Pini S, Saettoni M, Rucci P, Dell’Osso L: Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders. J Clin Psychiatry 1998;59:60–68.
- Strakowski SM, Keck PE Jr, McElroy SL, West SA, Sax KW, Hawkins JM, Kmetz GF, Upadhyaya VH, Tugrul KC, Bourne ML: Twelve-month outcome after a first hospitalisation for affective psychosis. Arch Gen Psychiatry 1998;55:49–55.
- Leverich GS, Altshuler LL, Frye MA, Suppes T, Keck PE Jr, McElroy SL, Denicoff KD, Obrocea G, Nolen WA, Kupka R, Walden J, Grunze H, Perez S, Luckenbaugh DA, Post RM: Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry 2003;64:506–515.
- Colom F, Vieta E, Martínez-Arán A, Reinares M, Benabarre A, Gastó C: Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000;61:549–555.
- Thompson WK, Kupfer DJ, Fagiolini A, Scott JA, Frank E: Prevalence and clinical correlates of medical comorbidities in patients with bipolar I disorder: analysis of acute-phase data from a randomized controlled trial. J Clin Psychiatry 2006;67:783–788.
- Scott J, Colom F: Psychological treatments for bipolar disorders. Psychiatr Clin North Am 2005;28:371–384.
- Colom F, Vieta E, Sanchez-Moreno J, Martinez-Aran A, Torrent C, Reinares M, Goikolea JM, Benabarre A, Comes M: Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004;6:294–298.
- Weiss RD, Griffin ML, Greenfield SF, Najavits LM, Wyner D, Soto JA, Hennen JA: Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. J Clin Psychiatry 2000;61:361–367.
- 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.
Scott J: Cognitive therapy in severe bipolar disorders: good news and bad. Abstracts Stanley Foundation Meet, Barcelona, October 2006.
- Lam DH, Watkins ER, Hayward P, Bright JA, 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.
- Scott J: Cognitive therapy of affective disorders: a review. J Affect Disord 1996;37:1–11.
Crits-Christoph P, Baranackie K, Kurcias JS, et al: Meta-analysis of therapist effects in psychotherapy outcome studies. Psychother Res 1991;1:81–91.
- Gortner ET, Gollan JK, Dobson KS, Jacobson NS: Cognitive behavioural treatment for depression: relapse prevention. J Consult Clin Psychol 1998;66:377–384.
- Davidson K, Scott J, Schmidt U, Tata P, Thornton S, Tyrer P: Therapist competence and clinical outcome in the POPMACT trial. Psychol Med 2004;34:855–863.
- Scott J: Psychotherapy for bipolar disorder: an unmet need? Br J Psychiatry 1995;167:581–588.
Scott J: Psychological treatment outcome studies in bipolar disorders. Estratto Minerva Psichiatr 2003;44:119–128.
Colom F, Vieta E: Manual for Psychoeducation for Bipolar Disorders. Cambridge, Cambridge University Press, 2006, p 248.
- DeRubeis RJ, Gelfand LA, Tang TZ, Simons AD: Medications versus cognitive behaviour therapy for severely depressed outpatients: mega-analysis of four randomised comparisons. Am J Psychiatry 1999;156:1007–1013.
- Weisman AG, Okazaki S, Gregory J, Goldstien MJ, Tompson MC, Rea M, Miklowitz DJ: Evaluating therapist competency and adherence to behavioral family management with bipolar patients. Family Process 1998;37:107–121.
- 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.
Goldstein MJ, Miklowitz DJ: Bipolar Disorder: A Family-Focused Treatment Approach. New York, Guildford Press, 1997.
- Scott J, Garland A, Moorhead S: A pilot study of cognitive therapy in bipolar disorder. Psychol Med 2001;31:459–467.
- Van Gent E, Zwart F: Psychoeducation of partners of bipolar manic patients. J Affect Disord 1991;21:15–18.
- Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, Goikolea JM, Benabarre A, Sanchez-Moreno J: Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychother Psychosom 2004;73:312–319.
- Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T: Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005;62:996–1004.
- 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.
- Martinez-Aran A, Vieta E, Colom, F, Torrent C, Reinares M, Goikolea JM, Benabarre A, Comes M, Sanchez-Moreno J: Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment? Psychother Psychosom 2005;74:295–302.
- Balanza-Martinez V, Tabares-Seisdedos R, Selva-Vera G, Martinez-Aran A, Torrent C, Salazar-Fraile J, Leal-Cercos C, Vieta E, Gomez-Beneyto M: Persistent cognitive dysfunctions in bipolar I disorder and schizophrenic patients: a 3-year follow-up study. Psychother Psychosom 2005;74:113–119.
- Miklowitz DJ, George EL, Axelson DA, Kim EY, Birmaher B, Schneck C, Beresford C, Craighead WE, Brent DA: Family-focused treatment for adolescents with bipolar disorder. J Affect Disord 2004;82(suppl 1):S113–S128.
- Scott J, Gutierrez MJ: The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention. Bipolar Disord 2004;6:498–503.
- 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;162:324–349.
- Perry A, Tarrier N, Morris 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.
- Simon GE, Ludman EJ, Bauer MS, Unutzer J, Operskalski B: Long-term effectiveness and cost of a systematic care program for bipolar disorder. Arch Gen Psychiatry 2006;63:500–508.
- Jackson A, Cavanagh J, Scott J: A systematic review of prodromal symptoms of mania and depression. J Affect Disord 2003;74:209–217.
- Sharma V, Mazmanian DS, Persad E, Kueneman KM: Treatment of bipolar depression: a survey of Canadian psychiatrists. Can J Psychiatry 1997;42:298–302.
- Ghaemi SN, Hsu DJ, Soldani F, Goodwin FK: Antidepressants in bipolar disorder: the case for caution. Bipolar Disord 2003;5:421–433.
- Vieta E: Case for caution, case for action. Bipolar Disord 2003;5:434–435.
- Kraemer H, Frank E, Kupfer D: Moderators of treatment outcomes: clinical, research, and policy importance. JAMA 2006;296:1286–1289.
- Ghaemi SN, Baldessarini RJ: The manic- depressive spectrum and mood stabilization: Kraepelin’s ghost. Psychother Psychosom 2007;76:65–69.
- Benazzi F: Is there continuity between bipolar and depressive disorders? Psychother Psychosom 2007;76:70–76.
- De Fruyt J, Demyttenaere K: Bipolar (spectrum) disorder and mood stabilization. Psychother Psychosom 2007;76:77–88.
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