Table 2.
Randomised trials of adjunctive psychosocial intervention in bipolar disorder
| Sample size | Experimental treatment | Control treatment | Major outcomes | |
|---|---|---|---|---|
| STEP-BD | ||||
| Miklowitz et al, 200760,61 | 293 adults | FFT, IPSRT, and CBT (up to 30 sessions) | Brief psychoeducation (3 sessions) |
Patients given more intensive treatment recovered more rapidly from depression and stayed well for more months |
| Family-focused approaches | ||||
| Clarkin et al, 199862 | 33 adults | 25 marital psychoeducation sessions over 11 months |
Treatment as usual | Better global functioning and drug adherence in patents given marital psychoeducation |
| Miklowitz et al, 200328 | 101 adults | FFT (21 sessions) | Crisis management (2 sessions) |
FFT associated with delayed recurrences and lower symptom severity over 2 years |
| Rea et al, 200363 | 53 adults | FFT (21 sessions) | Individual psychoeducation (21 sessions) |
FFT associated with delayed recurrences and fewer hospitalisations over 2 years |
| Miklowitz et al, 200864 | 58 adolescents | FFT (21 sessions) | Brief psychoeducation (3 sessions) |
FFT associated with more rapid recovery from depression and less severe symptoms of depression over 2 years |
| Miklowitz et al, 201365 | 40 children and adolescents |
FFT (12 sessions) | Brief psychoeducation (1–2 sessions) |
FFT associated with more rapid recovery from depression, less time ill, and less severe manic symptoms over 1 year |
| Perlick et al, 201066 | 46 family caregivers of adult patients |
FFT-health promoting intervention (12–15 sessions) |
8–12 health education sessions |
FFT associated with greater decreases in caregiver depression and health risk behaviour and greater reductions in symptoms of depression in patients over 4 months |
| Multifamily groups | ||||
| Miller et al, 200867 | 92 adults | Single family treatment, multifamily group psychoeducation |
Treatment as usual | No group differences in primary analyses; patients with impaired families had greater decreases in depression in both family treatments than in treatments as usual |
| Reinares et al, 200868 | 113 adults | 12 weekly caregiver group sessions over 3 months |
Treatment as usual | Over 15 months, fewer patients whose caregivers attended groups had manic or hypomanic relapses |
| Fristad et al, 200969 | 165 children (ages 8–11 years) |
8 multifamily group sessions | 6-month waiting list | Children with mood disorders assigned to multifamily groups showed greater mood improvement over 6 months than did children on the waiting list |
| CBT | ||||
| Cochran et al, 198470 | 28 adults | 6 weekly individual sessions | Drugs only | CBT associated with fewer hospitalisations by 6 months |
| Lam et al, 200571 | 103 adults | 12–18 individual sessions of CBT | Minimal psychiatric care | Fewer depressive relapses and better social functioning in patients given CBT over 24–30 months |
| Ball et al, 200672 | 52 adults | 20 weekly sessions in 6 months | Treatment as usual | Less severe depression scores in CBT at 6 months, but not 18 months |
| Scott et al, 200673 | 253 adults | 22 sessions in 26 weeks | Treatment as usual | No differences in time-to-recurrence over 18 months; subgroup of patients with <12 episodes had longer time-to-recurrence in CBT |
| Zaretsky et al, 200874 | 79 adults | 20 weekly sessions | Individual psychoeducation (7 sessions) |
No group differences in relapse rates over 1 year; 50% fewer days of depressed mood in CBT |
| Parikh et al, 201275 | 204 adults | 20 weeks of individual CBT | 6 sessions of group psychoeducation |
No differences in relapses or symptom severity over 18 months |
| Meyer & Hautzinger, 201276 | 76 adults | 20 sessions over 9 months of CBT | 20 sessions over 9 months of supportive treatment |
No differences in relapse rates over 33 months |
| IPSRT | ||||
| Frank et al, 200821 | 175 adults | Weekly sessions during acute treatment until recovered, monthly during maintenance treatment |
Active clinical management (same frequency) |
IPSRT during acute phase associated with longer time to recurrence during maintenance phase |
| Swartz et al, 201277 | 25 adults with bipolar II depression |
Weekly sessions for 12 weeks (no drugs) | Quetiapine monotherapy 25–300 mg |
No differences in depression response rates over 12 weeks |
| Group psychoeducation | ||||
| Colom et al, 2003, 200929,78 | 120 adults | 21 weekly structured group psychoeducation sessions |
21 weekly unstructured group sessions |
Lower recurrence rates in structured groups over 5 years |
| Torrent et al, 201379 | 239 adults | 21 weekly sessions of functional remediation |
21 group psychoeducation sessions or treatment as usual |
Functional remediation associated with improved functional outcomes compared to usual treatment |
| Weiss et al, 200780 | 62 adults with comorbid substance misuse |
20 weekly sessions of integrated cognitive behavioural groups |
Drug counselling groups | Fewer days per month of alcohol use but more severe mood symptoms in integrated groups |
| Individual psychoeducation | ||||
| Perry et al, 199981 | 69 adults | Seven to 12 sessions of individual psychoeducation |
Routine care | Increased time-to-manic-recurrence and improved social- occupational functioning in individual psychoeducation |
| Systematic care management | ||||
| Simon et al, 200682 | 441 adults | 2 year multicomponent intervention | Care as usual | Decreased severity and duration of manic episodes |
| Bauer et al, 200683 | 306 adults | 3 year multicomponent intervention | Care as usual | Decreased duration of manic episodes, better social functioning and quality of life |
FFT=family-focused treatment. CBT=cognitive-behavioural therapy. IPSRT=interpersonal and social rhythm therapy.