Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial

• Published in: European psychiatry Vol. 29; no. 3; pp. 134 - 141
• Main Authors: ISASI, A. González, ECHEBURUA, E, LIMINANA, J. M, GONZALEZ-PINTO, A
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01.03.2014; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety - drug therapy; Anxiety - physiopathology; Anxiety - therapy; Behavior therapy. Cognitive therapy; Biological and medical sciences; Bipolar Disorder - drug therapy; Bipolar Disorder - physiopathology; Bipolar Disorder - therapy; Bipolar disorders; Cognitive Behavioral Therapy - methods; Cognitive-behavioral model; Combined Modality Therapy; Combined therapy; Female; Follow-Up Studies; Humans; Internal Medicine; Long-term follow-up; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Patient Education as Topic - methods; Pharmacological treatment; Psychiatry; Psychoeducation; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy - methods; Refractory bipolar disorder; Time Factors; Treatment Outcome; Treatments; Cognitive-behavioral model; Refractory bipolar disorder; Pharmacological treatment; Long-term follow-up; Psychoeducation; Combined therapy; Mood disorder; Human; Cognitive therapy; Pharmacotherapy; Controlled therapeutic trial; Bipolar disorder; Cognition; Long term; Cognitive theory; Treatment; Behavioral analysis; Follow up study; Behavior therapy; Combined treatment
• ISSN: 0924-9338; 1778-3585
• DOI: 10.1016/j.eurpsy.2012.11.002

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.