Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-17T16:51:46.048Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial

Published online by Cambridge University Press:  15 April 2020

A. González Isasi ,
E. Echeburúa ,
J.M. Limiñana  and
A. González-Pinto
A. González Isasi*
Affiliation:
Psychiatry Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
E. Echeburúa
Affiliation:
Faculty of Psychology, University of the Basque Country, CIBERSAM, San Sebastián, Spain
J.M. Limiñana
Affiliation:
Unidad de Investigación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
A. González-Pinto
Affiliation:
CIBERSAM, Department of Psychiatry, Santiago Apóstol Hospital, EHU/UPV, Vitoria, Spain
*
*Corresponding author. Hospital Universitario Insular de Gran Canaria, Servicio de Psiquiatría, Avenida Marítima s/n, 35016 Las Palmas, Las Palmas de Gran Canaria, Spain. Tel.: +34 92 84 41 50 2; fax: +34 92 84 41 55 5. E-mail address: [email protected] (A. González Isasi).
Get access

Abstract

Objective:

The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological + psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder.

Method:

Forty patients were randomly assigned to either an Experimental group–under combined treatment — or a Control group — under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points.

Results:

Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P = 0.015). The Experimental group showed lower depression and anxiety in the 6-month (P = 0.006; P = 0.019), 12-month (P = 0.001; P < 0.001) and 5-year (P < 0.001, P < 0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P = 0.009; P < 0.001) and were sustained throughout the study (6-month: P = 0.006, P < 0.001; 12-month: P < 0.001, P < 0.001; 5-year: P = 0.004, P < 0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning.

Conclusions:

A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented.

Keywords

Refractory bipolar disorderCombined therapyPharmacological treatmentPsychoeducationCognitive-behavioral modelLong-term follow-up
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 3 , March 2014 , pp. 134 - 141
Copyright
Copyright © European Psychiatric Association 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amador, XF, Friedman, JH, Kasapis, C, Yale, SA, Flaum, M, Gorman, JMSuicidal behavior in schizophrenia and its relationship to awareness of illness. Am J Psychiatry 1996;153:1185–1188.Google ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical manual of mental disorders. Fourth EditionWashington D.C.: American Psychiatric Association; 1994.Google Scholar
Ball, JR, Mitchell, PB, Corry, JC, Skillecorn, A, Smith, M, Malhi, GSA randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. J Clin Psychiatry 2006;67:277–286.CrossRefGoogle ScholarPubMed
Beck, AT, Rush, AJ, Shaw, BF, Emery, GCognitive therapy of depression. New York: Guilford Press; 1979.Google Scholar
Becoña, E, Lorenzo, MCTratamientos psicológicos eficaces para el trastorno bipolar. Psicothema 2001;13:511–522.Google Scholar
Beltman, MW, Voshaar, RC, Speckens, AECognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry 2010;197:11–19.CrossRefGoogle ScholarPubMed
Bertelsen, M, Jeppesen, P, Petersen, L, Ohlenschlaeger, J, le Quach, P, Christensen, TOet al.Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness. The OPUS Trial. Arch Gen Psychiatry 2008;65:762–771.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, EA perspective on the use of psychoeducation, cognitive-behavioral therapy and interpersonal therapy for bipolar patients. Bipolar Disord 2004;6:480–486.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Martínez-Arán, A, García-García, M, Reinares, M, Torrent, Cet al.Versión española de una escala de evaluación de la manía: validez y fiabilidad de la Escala de Young. Med Clin 2002;119:366–371.CrossRefGoogle Scholar
Colom, F, Vieta, E, Sánchez-Moreno, J, Palomino-Otiniano, R, Reinares, M, Goikolea, JMet al.Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomized clinical trial. Br J Psychiatry 2009;194:260–265.CrossRefGoogle Scholar
De Dios, C, Ezquiaga, E, García, A, Soler, B, Vieta, ETime spent with symptoms in a cohort of bipolar disorder outpatients in Spain: a prospective 18-month follow-up study. J Affect Disord 2010;125:74–81.CrossRefGoogle Scholar
Echeburúa, E, Corral, P, Fernández-Montalvo, JEscala de Inadaptación: propiedades psicométricas en contextos clínicos. Análisis y Modificación de Conducta 2000;26:325–340.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBWStructured clinical interview for DSM-IV-TR Axis I disorders, research revision. Patient Edition (SCID-I/P). Biometrics Research. New York: New York State Psychiatric Institute; 2002.Google Scholar
Gazalle, FK, Hallal, PC, Andreazza, AC, Frey, BN, Kauer-Sant’Anna, M, Weyne, Fet al.Manic symptoms and quality of life in bipolar disorder. Psychiatry Res 2007;153:33–38.CrossRefGoogle ScholarPubMed
González-Isasi, A, Echeburúa, E, González-Pinto, ADiseño y evaluación de un programa de intervención psicológica para pacientes con trastorno bipolar refractarios a tratamiento: un estudio piloto. Análisis y Modificación de Conducta 2003;29:649–671.Google Scholar
González-Isasi, A, Echeburúa, E, Mosquera, F, Ibáñez, B, Aizpuru, F, González-Pinto, ALong-term efficacy of a psychological intervention program for patients with refractory bipolar disorder: a pilot study. Psychiatry Res 2010;176:161–165.CrossRefGoogle ScholarPubMed
González-Isasi, A, Echeburúa, E, Limiñana, JM, González-Pinto, AHow effective is a psychological intervention program for patients with refractory disorder? A randomized controlled trial. J Affect Disord 2010;126:80–87.CrossRefGoogle Scholar
González-Isasi, A, Echeburúa, E, Limiñana, JM, González-Pinto, APredictors of good outcome in patients with refractory bipolar disorder following a drug or a drug and cognitive-behavioral treatment. Compr Psychiatry 2012;53:224–229.CrossRefGoogle ScholarPubMed
González-Pinto, A, Lalaguna, B, Mosquera, F, Pérez de Heredia, JL, Gutiérrez, M, Ezcurra, Jet al.Use of olanzapine in dysphoric mania. J Affect Disord 2001;66:247–253.CrossRefGoogle ScholarPubMed
González-Pinto, A, Tohen, M, Lalaguna, B, Pérez-Heredia, JL, Fernández-Corres, B, Gutiérrez, Met al.Treatment of bipolar I rapid cycling patients during dysphoric mania with olanzapine. J Clin Psychopharmacol 2002;22:450–454.CrossRefGoogle ScholarPubMed
González-Pinto, A, González, C, Enjuto, S, Fernández de Corres, B, López, P, Palomo, Jet al.Psychoeducation and cognitive-behavioral therapy in bipolar disorder: an update. Acta Psychiatr Scand 2004;109:83–90.CrossRefGoogle ScholarPubMed
González-Pinto, A, Mosquera, F, Alonso, M, López, P, Ramírez, F, Vieta, Eet al.Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord 2006;8:618–624.CrossRefGoogle ScholarPubMed
González-Pinto, A, Dardennes, R, de Zélicourt, M, López, P, Oliveros, RG, Vieta, Eet al.In-patient care costs of patients with bipolar I disorder: a comparison between two European centers. J Affect Disord 2009;121:152–155.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DAet al.The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530–537.CrossRefGoogle ScholarPubMed
Judd, LL, Schettler, PJ, Akiskal, HS, Coryell, W, Leon, AC, Maser, JDet al.Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psychiatry 2008;65:386–394.CrossRefGoogle ScholarPubMed
Lam, DWhat can we conclude from studies on psychotherapy in bipolar disorder? Invited commentary on… Cognitive-behavioral therapy for severe and recurrent bipolar disorders. Br J Psychiatry 2006;188:321–322.CrossRefGoogle Scholar
Lam, DH, Jones, S, Hayward, P, Bright, JCognitive therapy for bipolar disorder: a therapist's guide to concepts. Methods and Practice. New York: John Wiley & Sons; 1999.Google Scholar
Lam, DH, Watkins, ER, Hayward, P, Bright, J, Wright, K, Kerr, Net al.A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003;60:145–152.CrossRefGoogle ScholarPubMed
Lam, DH, Hayward, P, Watkins, ER, Wright, K, Sham, PRelapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005;162:324–329.CrossRefGoogle ScholarPubMed
Linszen, D, Dingemans, P, Lenior, MEarly intervention and a five-year follow-up in young adults with a short duration of untreated psychosis: ethical implications. Schizophr Res 2001;51:55–61.CrossRefGoogle Scholar
López, P, Mosquera, F, de León, J, Gutiérrez, M, Ezcurra, J, Ramírez, Fet al.Suicide attempts in bipolar patients. J Clin Psychiatry 2001;62:963–966.CrossRefGoogle ScholarPubMed
Mansell, W, Colom, F, Scott, JThe nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation. Clin Psychol Rev 2005;25:1076–1100.CrossRefGoogle ScholarPubMed
Meyer, TD, Hautzinger, MCognitive behaviour therapy for bipolar disorders; relapse rates for treatment period and 2-year follow-up. Psychol Med 2012;42:1429–1439.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Wisniewski, SR, Kogan, JNet al.Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007;64:419–426.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Kogan, JN, Sachs, GSet al.Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month controlled trial. Am J Psychiatry 2007;164:1340–1347.CrossRefGoogle ScholarPubMed
Piccinni, A, Catena, M, Del Debbio, A, Marazziti, D, Monje, C, Schiavi, Eet al.Health-related quality of life and functioning in remitted bipolar I outpatients. Compr Psychiatry 2007;48:323–328.CrossRefGoogle ScholarPubMed
Scott, J, Paykel, E, Morriss, R, Bentall, R, Kinderman, P, Johnson, Tet al.Cognitive-behavioral therapy for severe and recurrent bipolar disorders: randomized controlled trial. Br J Psychiatry 2006;188:313–320.CrossRefGoogle Scholar
Scott, J, Colom, F, Popova, E, Benabarre, A, Cruz, N, Valenti, Met al.Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. J Clin Psychiatry 2009;70:378–386.CrossRefGoogle ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, REThe state trait anxiety inventory. Palo Alto (California): Consulting Psychologist Press; 1970 [Traducido al español por N. Seisdedos y publicado por TEA Ediciones].Google Scholar
Stahl, SPsicofarmacología esencial de la depresión y del trastorno bipolar. Barcelona: Ariel; 2002.Google Scholar
Tolin, DFIs cognitive-behavioural therapy more effective than other therapies?: a meta-analytic review. Clin Psychol Rev 2010;30:710–720.CrossRefGoogle ScholarPubMed
Vázquez, C, Sanz, JFiabilidad y valores normativos de la versión española del Inventario para la Depresión de Beck de 1978. Clínica y Salud 1997;8:403–422.Google Scholar
Vieta, E, Pacchiarotti, I, Valentí, M, Berk, M, Scott, J, Colom, FA critical update on psychological interventions for bipolar disorders. Curr Psychiatry Rep 2009;11:494–502.CrossRefGoogle ScholarPubMed
Yatham, LN, Bowden, CL, Calabrese, JRThe impact of polarity of subsyndromal symptoms in bipolar maintenance studies. Symposium IV: the burden of bipolar disorder; medical illness, suicide and cognitive impairment. Bipolar Disord 2005;7:113.Google Scholar
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DAA rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;1:429–435.CrossRefGoogle Scholar
Zaretsky, A, Lancee, W, Miller, C, Harris, A, Parikh, SVIs cognitive-behavioral therapy more effective than psychoeducation in bipolar disorder?. Can J Psychiatry 2008;53:441–448.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.