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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: anagonis@hotmail.com (A. González Isasi).
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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

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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
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