Psychosocial interventions for maintenance treatment of bipolar disorders
Brief summary
Evidence from systematic reviews
What is the current evidence for the use of psychosocial interventions (Cognitive Behavioural Therapy - CBT, psychoeducation or family therapy) in the prevention of relapses of bipolar disorders?
Psychosocial interventions have a small, but consistent positive impact on the prevention of all relapses of bipolar disorders. When CBT is compared to treatment as usual, CBT performs slightly better in preventing all relapses, particularly relapses of depressive symptoms of bipolar disorders. Compared to non-structured meeting groups, group psychoeducation had a consistent impact on the prevention of all relapses of bipolar disorders, regardless if manic or depressive relapses. Family therapy was significantly better in preventing all relapses, particularly relapses of depressive symptoms of bipolar disorders. Yet all of the primary studies provided limited or no information on relevant outcomes.
Is there any group of patients that respond better to psychosocial interventions (CBT, psychoeducation or family therapy) than the others?
Patients with rapid cycling, substance abuse or serious risk of suicide were excluded in most studies.
For how long should psychosocial interventions (CBT, psychoeducation or family therapy) be used?
- CBT: varied from 6 sessions of one hour, once a week to 25 sessions (45 minutes each) in the studies that went on for 18 months.
- PSYCHOEDUCATION: 21 structured sessions of 90 minutes each for two studies with group therapy or 7 to 12 individuals sessions of one hour (1 study)
- FAMILY THERAPY: 21 structured sessions of one hour each (12 weekly, 6 biweekly, and 3 monthly)
Is there evidence that a specific psychosocial intervention is more efficacious than the others as add-on maintenance treatment of bipolar disorders?
It is not clear from the systematic reviews and/or the primary studies whether any one specific psychosocial intervention is more efficacious than the others.
Is the balance between harm and benefit favourable to the use of psychosocial interventions?
It is not clear from the systematic reviews and/or the primary studies whether the balance between harm and benefit favours the use of any one particular psychosocial intervention.
What type of research (if any) is needed to clarify the benefits and harms of using psychosocial interventions (CBT, psychoeducation or family therapy) as add-on maintenance treatment of bipolar disorders?
Trials performed in heterogeneous populations (including those with substance abuse), regardless of risk of suicide, measuring relevant outcomes, such as preventing a relapse of symptoms of bipolar disorder. In addition understanding the issues which determine acceptability of particular treatment approaches to individuals and groups is important.
