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Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives

Published online by Cambridge University Press:  16 April 2020

Britta Bernhard ,
Annette Schaub ,
Petra Kümmler ,
Sandra Dittmann ,
Emanuel Severus ,
Florian Seemüller ,
Christoph Born ,
Anna Forsthoff ,
Rasmus W. Licht  and
Heinz Grunze
Britta Bernhard*
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Annette Schaub
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Petra Kümmler
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Sandra Dittmann
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Emanuel Severus
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Florian Seemüller
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Christoph Born
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Anna Forsthoff
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
Rasmus W. Licht
Affiliation:
Mood Disorders Research Unit, Psychiatric Hospital of the University of Aarhus, Risskov, Denmark
Heinz Grunze
Affiliation:
Bipolar Disorder Program, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80806Munich, Germany
*
*Corresponding author. E-mail address:[email protected] (B. Bernhard).
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Abstract

Background.

In recent years, several controlled studies could show that psychoeducational interventions have been effective for relapse prevention in bipolar disorders. We therefore established a cognitive-psychoeducational group intervention with 14 sessions providing information about the illness, early warning signs, cognitive and behavioural strategies for stress management and social rhythm. Additionally we offered a group intervention for the patients' relatives. The objective of this study was to describe the outcome associated with our psychoeducational intervention in bipolar patients and their relatives.

Methods.

Sixty-two bipolar patients attended 14 sessions (à 90 min) of cognitive-psychoeducational group therapy. Patients' knowledge of bipolar disorder and their satisfaction with the treatment were assessed using self-developed questionnaires before and after the group intervention. Additionally, 49 relatives of bipolar patients received two psychoeducational workshops of 4 hours each. We assessed demographic variables, burden, high expressed emotion and depressive symptoms of the relatives before and after the two workshops and at 1-year follow-up.

Results.

Patients significantly improved their knowledge of bipolar disorder. They also have benefited from the discussions and the exchange of useful coping strategies. Burden and high expressed emotions showed no significant reductions at post-assessment, however they were significantly reduced at 1-year follow-up. Relatives also felt significantly better informed about the illness.

Conclusions.

These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.

Keywords

Bipolar disorderPsychoeducationInterventionRelatives
Type
Original article
Information
European Psychiatry , Volume 21 , Issue 2 , March 2006 , pp. 81 - 86
Copyright
Copyright © Elsevier SAS 2006

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References

Auracher, C.Belastungen, Attributionen und Reaktionen bei Angehörigen von Depressionspatienten-Entwicklung und Ergebnisse eines Angehörigenfragebogens. München: Ludwig-Maximilians-Universität Unveröffentlichte Diplomarbeit; 2001.Google Scholar
Bauer, M.S.McBride, L.Chase, C.Sachs, G.Shea, N.Manual-based group psychotherapy for bipolar disorder: a feasibility study. J. Clin. Psychiatry 1998;59(9):449–455.CrossRefGoogle Scholar
Bauer, M.S.McBride, L.Shea, N.Gavin, C.Holden, F.Kendall, S.Impact of an easy-access VA clinic-based program for patients with bipolar disorder. Psychiatr. Serv. 1997;48(4):491–496.Google ScholarPubMed
Beck, A.T.Steer, R.A.Garbin, M.G.Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin. Psychol. Rev. 1988;8:77–100.CrossRefGoogle Scholar
Benazon, N.R.Coyne, J.C.Living with a depressed spouse. Journal of Family Psychology 2000;14:71–79.CrossRefGoogle ScholarPubMed
Butzlaff, R.L.Hooley, J.M.Expressed emotion and psychiatric relapse: a meta-analysis. Arch. Gen. Psychiatry 1998;55(6):547–552.CrossRefGoogle ScholarPubMed
Clarkin, J.F.Carpenter, D.Hull, J.Wilner, P.Glick, I.Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses. Psychiatr. Serv. 1998;49(4):531–533.CrossRefGoogle ScholarPubMed
Clarkin, J.F.Glick, I.D.Haas, G.L.Spencer, J.H.Lewis, A.B.Peyser, J.et al.A randomized clinical trial of inpatient family intervention. V. Results for affective disorders. J. Affect. Disord. 1990;18(1):17–28.CrossRefGoogle ScholarPubMed
Colom, F.Vieta, E.Non-adherence in psychiatric disorders: misbehaviour or clinical feature?. Acta Psychiatr. Scand. 2002;105(3):161–163.Google ScholarPubMed
Colom, F.Vieta, E.Martinez-Aran, A.Reinares, M.Benabarre, A.Gasto, C.Clinical factors associated with treatment non-compliance in euthymic bipolar patients. J. Clin. Psychiatry 2000;61(8):549–555.CrossRefGoogle Scholar
Colom, F.Vieta, E.Martinez-Aran, A.Reinares, M.Goikolea, J.M.Benabarre, A.et al.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(4):402–407.CrossRefGoogle ScholarPubMed
Colom, F.Vieta, E.Sanchez-Moreno, J.Martinez-Aran, A.Torrent, C.Reinares, M.et al.Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord. 2004;6(4):294–298.CrossRefGoogle ScholarPubMed
Coyne, J.C.Kessler, R.C.Tal, M.Turnbull, J.Wortman, C.B.Greden, J.F.Living with a depressed person. J. Consult. Clin. Psychol. 1987;55(3):347–352.CrossRefGoogle ScholarPubMed
Feinstein, E.Fragebogenverfahren zur Erhebung des Expressed-Emotion-Maßes: Kurzverfahren zur Rückfallprognose bei psychiatrischen Patienten. In: Buchkremer, G.Rath, N., editors. Therapeutische Arbeit mit Angehörigen schizophrener Patienten. Messinstrumente, Methoden, Konzepte Bern: Hans Huber; 1989. p. 39–45.Google Scholar
First, M.B.Gibbon, M.Spitzer, R.L.Williams, J.B.W.Benjamin, L.Structured clinical interview for DSM-IV Axis II Personality Disorder (SCID-II). Washington: American Psychiatric Press; 1997.Google Scholar
First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.W.Structured Clinical Interview for DSM-IV Axis I Disorder- Clinician Version (SCID-CV). Washington: American Psychiatric Press; 1997.Google Scholar
Frank, E.Hlastala, S.Ritenour, A.Houck, P.Tu, X.M.Monk, T.H.et al.Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol. Biol. Psychiatry 1997;41(12):1165–1173.CrossRefGoogle ScholarPubMed
Frank, E.Swartz, H.A.Kupfer, D.J.Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biol. Psychiatry 2000;48(6):593–604.CrossRefGoogle ScholarPubMed
Frank, E.Swartz, H.A.Mallinger, A.G.Thase, M.E.Weaver, E.V.Kupfer, D.J.Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J. Abnorm. Psychol. 1999;108(4):579–587.CrossRefGoogle ScholarPubMed
Gonzalez-Pinto, A.Gonzalez, C.Enjuto, S.Fernandez, D.C.Lopez, P.Palomo, J.et al.Psychoeducation and cognitive-behavioral therapy in bipolar disorder: an update. Acta Psychiatr Scand 2004;109(2):83–90.CrossRefGoogle ScholarPubMed
Hamilton, M.Development of a rating scale for primary depressive illness. Br. J. Soc. Clin. Psychol. 1967;6(4):278–296.CrossRefGoogle ScholarPubMed
Honig, A.Hofman, A.Hilwig, M.Noorthoorn, E.Ponds, R.Psychoeducation and expressed emotion in bipolar disorder: preliminary findings. Psychiatry Res. 1995;56(3):299–301.CrossRefGoogle ScholarPubMed
Honig, A.Hofman, A.Rozendaal, N.Dingemans, P.Psycho-education in bipolar disorder: effect on expressed emotion. Psychiatry Res. 1997;72(1):17–22.CrossRefGoogle ScholarPubMed
Jamison, K.R.Gerner, R.H.Goodwin, F.K.Patient and physician attitudes toward lithium: relationship to compliance. Arch Gen Psychiatry 1979;36(8 Spec No):866–869.CrossRefGoogle ScholarPubMed
Kim, E.Y.Miklowitz, D.J.Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. J. Affect. Disord. 2004;82(3):343–352.Google ScholarPubMed
Kleindienst, N.Greil, W.Are illness concepts a powerful predictor of adherence to prophylactic treatment in bipolar disorder?. J. Clin. Psychiatry 2004;65(7):966–974.CrossRefGoogle ScholarPubMed
Lam, D.H.Bright, J.Jones, S.Hayward, P.Schuck, N.Chisholm, D.et al.Cognitive therapy for bipolar illness—a pilot study of relapse prevention. Cognit. Ther. Res. 2000;24:503–520.CrossRefGoogle Scholar
Lam, D.H.Watkins, E.R.Hayward, P.Bright, J.Wright, K.Kerr, N.et al.A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch. Gen. Psychiatry 2003;60(2):145–152.CrossRefGoogle Scholar
Lingam, R.Scott, J.Treatment non-adherence in affective disorders. Acta Psychiatr. Scand. 2002;105(3):164–172.CrossRefGoogle ScholarPubMed
Miklowitz, D.J.Frank, E.George, E.L.New psychosocial treatments for the outpatient management of bipolar disorder. Psychopharmacol. Bull. 1996;32(4):613–621.Google ScholarPubMed
Miklowitz, D.J.George, E.L.Richards, J.A.Simoneau, T.L.Suddath, R.L.A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch. Gen. Psychiatry 2003;60(9):904–912.CrossRefGoogle ScholarPubMed
Miklowitz, D.J.Goldstein, M.J.Behavioral family treatment for patients with bipolar affective disorder. Behav. Modif. 1990;14(4):457–489.CrossRefGoogle ScholarPubMed
Miklowitz, D.J.Goldstein, M.J.Nuechterlein, K.H.Snyder, K.S.Mintz, J.Family factors and the course of bipolar affective disorder. Arch. Gen. Psychiatry 1988;45(3):225–231.CrossRefGoogle ScholarPubMed
Miklowitz, D.J.Richards, J.A.George, E.L.Frank, E.Suddath, R.L.Powell, K.B.et al.Integrated family and individual therapy for bipolar disorder: results of a treatment development study. J. Clin. Psychiatry 2003;64(2):182–191.CrossRefGoogle ScholarPubMed
Miklowitz, D.J.Simoneau, T.L.George, E.L.Richards, J.A.Kalbag, A.Sachs-Ericsson, N.et al.Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol. Psychiatry 2000;48(6):582–592.CrossRefGoogle ScholarPubMed
Mino, Y.Shimodera, S.Inoue, S.Fujita, H.Tanaka, S.Kanazawa, S.Expressed emotion of families and the course of mood disorders: a cohort study in Japan. J. Affect. Disord. 2001;63(1–3):43–49.CrossRefGoogle Scholar
O’Connell, R.A.Mayo, J.A.Flatow, L.Cuthbertson, B.O’Brien, B.E.Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry 1991;159:123–129.CrossRefGoogle ScholarPubMed
Parikh, S.V.Kusumakar, V.Haslam, D.R.Matte, R.Sharma, V.Yatham, L.N.Psychosocial interventions as an adjunct to pharmacotherapy in bipolar disorder. Can. J. Psychiatry 1997;42(Suppl 2):74S–78S.Google ScholarPubMed
Patelis-Siotis, I.Young, L.T.Robb, J.C.Marriott, M.Bieling, P.J.Cox, L.C.et al.Group cognitive behavioral therapy for bipolar disorder: a feasibility and effectiveness study. J. Affect. Disord. 2001;65(2):145–153.CrossRefGoogle ScholarPubMed
Peet, M.Harvey, N.S.Lithium maintenance: 1. A standard education programme for patients. Br. J. Psychiatry 1991;158:197–200.CrossRefGoogle ScholarPubMed
Perlick, D.A.Rosenheck, R.R.Clarkin, J.F.Raue, P.Sirey, J.Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J. Nerv. Ment. Dis. 2001;189(1):31–37.CrossRefGoogle ScholarPubMed
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(7177):149–153.CrossRefGoogle ScholarPubMed
Priebe, S.Wildgrube, C.Müller-Oerlinghausen, B.Lithium prophylaxis and expressed emotion. Br J Psychiatry 1989;154:396–399.CrossRefGoogle ScholarPubMed
Reinares, M.Colom, F.Martinez-Aran, A.Benabarre, A.Vieta, E.Therapeutic interventions focused on the family of bipolar patients. Psychother. Psychosom. 2002;71(1):2–10.CrossRefGoogle ScholarPubMed
Reinares, M.Vieta, E.Colom, F.Martinez-Aran, A.Torrent, C.Comes, M.et al.Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychother. Psychosom. 2004;73(5):312–319.CrossRefGoogle ScholarPubMed
Schaub, A.Illness self-management programs in schizophrenia and severe affective disorder. In: Schaub, A. editor. New family interventions and associated research in psychiatric disorders Wien: Springer; 2002. 229–247.CrossRefGoogle Scholar
Schaub, A.Bernhard, B.Gauck, L.Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Göttingen: Hogrefe: Ein Therapiemanual; 2004.Google Scholar
Scott, J.Garland, A.Moorhead, S.A pilot study of cognitive therapy in bipolar disorders. Psychol. Med. 2001;31(3):459–467.CrossRefGoogle ScholarPubMed
van Gent, E.M.Zwart, F.M.Psychoeducation of partners of bipolar-manic patients. J. Affect. Disord. 1991;21(1):15–18.CrossRefGoogle ScholarPubMed
Vieta, E.Colom, F.Psychological interventions in bipolar disorder: from wishful thinking to an evidence-based approach. Acta Psychiatr. Scand. Suppl. 2004;422:34–38.CrossRefGoogle Scholar
Yan, L.J.Hammen, C.Cohen, A.N.Daley, S.E.Henry, R.M.Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients. J. Affect. Disord. 2004;83(2–3):199–206.CrossRefGoogle ScholarPubMed
Young, R.C.Biggs, J.T.Ziegler, V.E.Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br. J. Psychiatry 1978;133:429–435.CrossRefGoogle ScholarPubMed
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