Table 3.

Bipolar Disorder (Adult and Geriatric)

Study	Treatment/s	Number of Sessions	Control Condition/s	Age of subjects	Sample size	Diagnosis	Setting	Therapists' qualification	Results
Psychoeducation:
Perry et al 1999[170]	Patient education (PE) added to routine care with most but not all on medication	7-12 sessions	Routine care with most but not all on medication	Adults aged 18-75	69 assigned of whom 68 completed	DSM-III-R bipolar disorder I or II remitted with at least one relapse in last year	NHS mental health services	Research psychologists	PE significantly decreased number of subsequent manic but not depressive episodes, improved social functioning, and increased performance at work
Colom et al 2003[171]	Group patient education (PE) added to routine care including medication	21 90-minute weekly sessions	Unstructured groups added to routine care including medication	Adults aged 18-65	120 of whom 97 completed	DSM-IV bipolar I or II disorder euthymic last six months and no comorbidity	University hospital clinic	Experienced psychologists	PE reduced recurrence rates for depression and mania/hypomania and number of times patients were hospitalized
Colom et al 2009[172] (5-year follow-up)									PE reduced recurrence within bipolar II patients considered as subgroup
Reinares et al 2008[173]	Patient education (PE) for caregivers added to treatment as usual with medication	12 90-minute sessions	Treatment as usual with medication	Adult caregivers of medicated bipolar patients	113 assigned	DSM-IV bipolar disorder I and II euthymic last three months and living with caregiver	University based research clinic	Research psychologists	PE provided to caregivers reduced rates of relapse/recurrence with respect to mania/hypomania but not depression
Interpersonal:
Frank et al 2005[175]	Medication plus either interpersonal social rhythm therapy (IPSRT) or intensive clinical management (ICM) during acute phase with patients either continued on same or switched to other during maintenance	Weekly during acute phase until stabilized for four weeks and monthly thereafter during 2-year maintenance	None	Adults aged 18-60	175 assigned of whom 125 achieved stabilization and entered maintenance phase and 93 completed all treatment	RDC/DSM-IV Bipolar I (manic, depressed, or mixed) with 9% schizoaffective manic subtype	Outpatient research clinic in university medical center	Social workers, nurses, and psychologists	Time to stabilization did not differ during acute treatment but patients who received IPSRT during acute phase went longer without new episodes than patients who received ICM regardless of what they received during the maintenance phase
Miklowitz et al 2007[177]	Medication plus either interpersonal and social rhythm therapy (IPSRT), cognitive behavior therapy (CBT) or family-focused therapy (FFT)	Up to 30 sessions across 9 months	Medication plus collaborative care (3 sessions across 6 weeks)	Adults aged 18 and above	293 assigned of whom 195 completed study year	DSM-IV bipolar disorder (I or II) with current MDE	Fifteen outpatient clinics participating in STEP-BD program	Therapists of unspecified background who completed six hour workshops in the respective modalities	Pooled intensive treatments superior to collaborative care in terms of recovery with no differences between treatments and no specific comparisons to collaborative care
Cognitive:
Cochrane 1984[178]	Cognitive therapy added to lithium (CT/L) vs lithium alone (L)	6 weekly 1 hour sessions	None	Adults aged 24-60	28 assigned of whom 26 completed	RDC Bipolar I or II and stable	Outpatient research clinic	Pre-doctoral clinical psychologists	Adding CT to L enhanced drug compliance and reduced hospitalizations
Lam et al., 2000[183]	Cognitive therapy added to mood stabilizer medication (CT/MSM) vs mood stabilizer medication alone (MSM)	12-20 sessions	None	Adults aged 18-65	25 assigned of whom 23 completed	DSM-IV Bipolar I (currently euthymic)	Outpatient research clinic in university medical center	Experienced clinical psychologists	Adding CT to medications led to fewer bipolar episodes and improved social functioning relative to medications alone
Scott et al 2001[186]	Cognitive therapy (CT) added to treatment as usual (93% on mood stabilizers)	Up to 25 sessions over 6 months	Treatment as usual and CT waiting-list	Adults with mean age in late 30's	42 assigned of whom 33 completed	Bipolar I or II disorder (about 40% in episode most depression)	Outpatient research clinic	Experienced therapists with expertise in CT for mood disorders (first two authors)	Adding CT to treatment as usual reduced depressive symptoms and improved global functioning
Lam et al., 2003[184]	Cognitive therapy added to mood stabilizer medication (CT/MSM) vs mood stabilizer medication alone (MSM)	12-18 sessions over 1st six months and 2 boosters over 2nd six months	None	Adults aged 18-70	103 assigned of whom 87 completed	DSM-IV Bipolar I in full or partial remission with at least two episodes in last two years	Outpatient research clinic in university medical center	Doctoral level clinical psychologists (minimum 5 years experience)	Adding CT to medications led to fewer bipolar episodes and improved social functioning relative to medications alone
Lam et al 2005[185]		Subsequent 18-month follow-up sans CT							CT gains extend over subsequent 18-month follow-up but with no indication of effect on recurrence prevention
Ball et al 2006[181]	Cognitive therapy with emotive techniques added (CT) plus mood stabilizers	20 weekly sessions over 6 months	Treatment as usual (TAU) plus mood stabilizers	Adults	52 assigned	DSM-IV Bipolar Disorder I or II in full or partial remission	Outpatient research clinic		CT reduced levels of depression and rates of relapse (trend) relative to TAU
Scott et al 2006[186]	Cognitive-behavioral therapy (CBT) plus treatment as usual with medication	20 sessions weekly through week 15 and less frequently until week 26 with two subsequent booster sessions	Treatment as usual with medication	Adults aged 18 and above	253 assigned of whom 200 completed	DSM-IV Bipolar Disorder I or II with about a third currently in episode (mostly depressed)	Outpatient clinics (x5) including teaching and nonteaching	Therapists profession unspecified with 1-year post-qualification training in CBT with additional 3 months training in CBT for bipolar disorder	Adding CBT did not enhance response to treatment as usual including medications across whole sample; number of prior episodes moderates effects of CBT in post hoc analysis (CBT better for less and worse for more)
Zaretsky et al 2008[182]	Cognitive behavior therapy added to patient education plus mood stabilizer medication (CBT/PE/MSM) vs patient education plus mood stabilizer medication alone (PE/MSM)	14 sessions of CBT added to 6 sessions of PE vs 6 sessions of PE alone over 20 weeks in patients on mood stabilizer followed twelve months	None	Adults aged 18-60	79 assigned of whom 53 completed treatment and 46 completed 12-month follow-up	Bipolar I (66%) or II (34%) in full or partial remission	University teaching hospital	Therapists not specified	Participants who received CBT had reduced depressive symptoms, 50% fewer depressed days, and fewer medication increases
Family:
Miklowitz et al 2000[189] Miklowitz et al 2003[190]	Family-focused therapy (FFT) vs crisis management (CM) in medicated patients	21 hourly sessions (12 weekly/ 6 biweekly/ 3 monthly)	None	Adults aged 18-62	101 assigned of whom 78 completed	DSM-III-R Bipolar I recently hospitalized and partially stable	Outpatient research clinic	Doctoral, masters', and bachelors level psychologists	FFT led to fewer relapses and fewer depressed symptoms than CM (crisis management) in medicated patients
Rea et al., 2003[191]	Family-focused therapy (FFT) vs individual focus therapy (IFT) in medicated patients	21 sessions (12 weekly/ 6 biweekly/ 3 monthly) over 9 months of one year active treatment with subsequent one year follow-up	None	Adults aged 18-46	53 assigned	DSM-III-R Bipolar I manic type recently hospitalized and partially stable	Outpatient research clinic	Professional discipline not specified	No differences in time to first relapse but FFT led to fewer total relapses when multiple relapses considered and fewer recurrences during post-treatment follow-up; fewer FFT patients hospitalized overall but differences largely due to post-treatment follow-up
Miller et al 2004[187]	Medication alone or in combination with family therapy (FT) or multi-family psychoeducational group therapy (MFPE)	FT: mean 12 (SD 13) sessions MFPE: 6 sessions	None	Adults aged 18-65	92 assigned of whom 60 completed	DSM-III-R bipolar I disorder mostly manic and all in acute episode	University-affiliated psychiatric hospital	Social workers and doctoral level psychologists	Adding family therapy did not enhance the efficacy of medications