Bipolar Disorder

Ball, J. R., Mitchell, P. B., Corry, J. C., Skillecorn, A., Smith, M., & Malhi, G. S. (2006). A randomized controlled trial of cognitive therapy for bipolar disorder: Focus on long-term change. Journal of Clinical Psychiatry, 67, 277-286.

Correspondence Address:
Jillian R. Ball, School of Psychiatry, University of New South Wales, Black Dog Institute, Hospital Rd., Prince of Wales Hospital, Randwick, NSW, Australia, 2031, jillian@unsw.edu.au.

Abstract
Background: This study reports the outcome of a randomized controlled trial of cognitive therapy (CT) for bipolar disorder. The treatment protocol differed from other published forms of CT for bipolar disorder through the addition of emotive techniques. Method: Fifty-two patients with DSM-IV bipolar I or II disorder were randomly allocated to a 6-month trial of either CT or treatment as usual, with both treatment groups also receiving mood stabilizers. Outcome measures included relapse rates, dysfunctional attitudes, psychosocial functioning, hopelessness, self-control, and medication adherence. Patients were assessed during treatment by independent raters blind to the patients' group status. Results: At posttreatment, patients allocated to CT had experienced less severe depression scores (Beck Depression Inventory and Montgomery-Asberg Depression Rating Scale) and less dysfunctional attitudes. After controlling for the presence of major depressive episode at baseline, there was a statistical trend toward a greater time to depressive relapse (p=.06) for the CT group. At 12-month follow-up, the CT group showed a trend toward lower Young Mania Rating Scale scores and improved behavioral self-control. The Clinical Global Impressions-Improvement scale, comparing the 18 months prior to treatment to the severity of illness status at follow-up, showed a substantial difference between groups in favor of CT. Conclusion: Our findings corroborate previous bipolar disorder research in demonstrating the value of CT, particularly immediately posttreatment, and indicate some continuation (albeit diminishing) of benefits in the succeeding 12 months. These findings suggest that psychological booster sessions may be crucial for maintaining the beneficial effects of cognitive therapy. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Lam, D. H., Hayward, P., Watkins, E. R., Wright, K., & Sham, P. (2005). Relapse prevention in patients with bipolar disorder: Cognitive therapy outcome after 2 years. American Journal of Psychiatry, 162(2), 324-329.

Correspondence Address:
Dominic Lam, Psychology Department, Institute of Psychiatry, DeCrespigny Park, London, United Kingdom, SE5 8AF, D.Lam@iop.kcl.ac.uk.

Abstract
Objective: In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months. Method: Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals. Results: Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition. Conclusions: Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Lam, D. H., McCrone, P., Wright, K., & Kerr, N. (2005). Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study. British Journal of Psychiatry, 186, 500-506.

Correspondence Address:
Dominic Lam, Psychology Department, Institute of Psychiatry, DeCrespigny Park, London, United Kingdom, SE5 8AF, D.Lam@iop.kcl.ac.uk.

Abstract
Background: We have reported the advantageous clinical outcome of adding cognitive therapy to medication in the prevention of relapse of bipolar disorder. Aims: This 30-month study compares the cost-effectiveness of cognitive therapy with standard care. Method: We randomly allocated 103 individuals with bipolar I disorder to standard treatment and cognitive therapy plus standard treatment. Service use and costs were measured at 3-month intervals and cost-effectiveness was assessed using the net-benefit approach. Results: The group receiving cognitive therapy had significantly better clinical outcomes. The extra costs were offset by reduced service use elsewhere. The probability of cognitive therapy being cost-effective was high and robust to different therapy prices. Conclusions: Combination of cognitive therapy and mood stabilisers was superior to mood stabilisers alone in terms of clinical outcome and cost-effectiveness for those with frequent relapses of bipolar disorder. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Szentagotai, A. and David, D. The efficacy of cognitive-behavioral therapy in bipolar disorder: A quantitative meta-analysis Journal of Clinical Psychiatry71,1 (2010): 66-72.

Correspondence Address:
Aura Szentagotai, Assistant Professor, Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania, AuraSzentagotai@psychology.ro .

Abstract
Objective: The goal of the current study was to conduct a quantitative meta-analysis investigating the role of cognitive-behavioral therapy (CBT) as adjunctive treatment to medication for patients diagnosed with bipolar disorder. Data Sources: Studies included in the sample were identified through a computer search of articles in English in the MEDLINE database from January 1980 to March 2008. Key terms entered were cognitive and bipolar disorder, cognitive therapy and bipolar disorder, cognitive behavioral therapy and bipolar disorder, psychotherapy and bipolar disorder, and psychosocial and bipolar disorder. Study Selection: Inclusion criteria were (1) randomized clinical trial investigating the role of adjunctive CBT in patients diagnosed with bipolar disorder, (2) clearly defined CBT intervention, (3) the inclusion of a control group, and (4) sufficient data reported to allow calculation of effect sizes. Twelve randomized clinical trials were selected for analysis on the basis of these criteria. Data Extraction: Effect sizes (Cohen d) were calculated according to published procedures. Data Synthesis: We found a low to medium overall effect size of CBT at posttreatment (d = -0.42, P < .05) and follow-up (d = -0.27, P < .05), and we found a positive impact of CBT on clinical symptoms (posttreatment d = -0.44, P < .05), cognitive-behavioral etiopathogenetic mechanisms (posttreatment d = -0.49, P < .05), treatment adherence (posttreatment d = -0.53, P < .05), and quality of life (posttreatment d =-0.36, P < .05). The impact was less evident in the case of relapse and/or recurrence (posttreatment d = -0.28). These effects on outcome categories were more evident at posttreatment compared to follow-up. Conclusions: Cognitive-behavioral therapy can be used as an adjunctive treatment to medication for patients with bipolar disorder, but new CBT strategies are needed to increase and enrich the impact of CBT at posttreatment and to maintain its benefits during follow-up. © Copyright 2010 Physicians Postgraduate Press, Inc.