Purpose and effectiveness of psychoeducation in patients with bipolar disorder in a bipolar clinic setting

The Efficacy of Psychoeducational Family Intervention for Major Depression: Study Protocol of a Randomized Controlled Trial

This study aims to assess the efficacy of a psychoeducational family intervention (PFI) to reduce the severity of depressive symptoms and to improve psychosocial functioning and to increase social contacts in a sample of patients with major depressive disorder (MDD). The degree to which PFI will reduce patients' relapses, hospitalizations, and self-stigmatization and will improve their quality of life will also be assessed. Other secondary outcomes include the improvement of relatives' coping strategies, family burden, expressed emotions and quality of life. This non-profit, unfunded, national, multicentric randomized controlled trial with blinded outcome assessments will be carried out in 24 Italian university outpatient units. Families will be assessed at baseline and at 6, 12, and 24 months post-randomization. Our working hypothesis is that the PFIs will reduce the patients' severity of depressive symptoms, their relapses, and their hospitalizations, and that they will improve their psychosocial functioning and quality of life. We expect these results to be maintained after 12 and 24 months, albeit with a reduction in magnitude. The sample will consist of 384 patients randomized at a 1:1 ratio and stratified according to center, age, gender, and educational level.

The longitudinal trajectory of emotional cognition in subgroups of recently diagnosed patients with bipolar disorder

Although cross-sectional studies show heterogeneity in emotional cognition in bipolar disorder (BD), the temporal course within subgroups is unclear. In this prospective, longitudinal study we assessed the trajectories of emotional cognition subgroups within a 16-month follow-up period in recently diagnosed BD patients compared to healthy controls (HC). Recently diagnosed BD patients and HC underwent comprehensive emotional and non-emotional testing at baseline and again at follow-up. We employed hierarchical cluster analysis at baseline to identify homogenous emotional cognition subgroups of patients, and changes across the subgroups of BD and HC were assessed with linear mixed-model analyses. We found two emotional cognition subgroups: subgroup 1 (65%, n = 179), showing heightened negative emotional reactivity in neutral and negative social scenarios and faster recognition of emotional facial expressions than HC (ps<0.001, n = 190), and subgroup 2 (35%, n = 96) showing blunted reactivity in positive social scenarios, impaired emotion regulation, poorer recognition of positive and slower recognition of all facial expressions than HC (ps≤.03). Subgroup 1 exhibited normalization of the initial emotional cognition abnormalities in follow-up. In contrast, subgroup 2 showed a lack of improvement in reactivity positively-valenced emotional information. Patients in subgroup 2 presented more and longer mixed episodes during the follow-up time and were more often prescribed lithium. One third of patients display blunted emotional reactivity, impaired emotion regulation abilities and facial expression recognition difficulties also show persistent impairments and poorer course of illness. This subgroup may indicate a need for earlier and more targeted therapeutic interventions.

Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature-A Pilot Study

In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals' connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered.

Preliminary effectiveness of an evidence-based mobile application to promote resilience among working adults in Singapore and Hong Kong: Intensive longitudinal study

Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application ('Intellect'); and (b) if daily engagement of 'Intellect' would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong (Mage = 32.4, SDage = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = -0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = -0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = -0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) (Mage = 32.2, SDage = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039-0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004-0.032), higher physical activity (β = 0.079; 95% CI 0.032-0.126), and mood levels (β = 0.020; 95% CI 0.012-0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.

IMU-Based Monitoring for Assistive Diagnosis and Management of IoHT: A Review

With the rapid development of Internet of Things (IoT) technologies, traditional disease diagnoses carried out in medical institutions can now be performed remotely at home or even ambient environments, yielding the concept of the Internet of Health Things (IoHT). Among the diverse IoHT applications, inertial measurement unit (IMU)-based systems play a significant role in the detection of diseases in many fields, such as neurological, musculoskeletal, and mental. However, traditional numerical interpretation methods have proven to be challenging to provide satisfying detection accuracies owing to the low quality of raw data, especially under strong electromagnetic interference (EMI). To address this issue, in recent years, machine learning (ML)-based techniques have been proposed to smartly map IMU-captured data on disease detection and progress. After a decade of development, the combination of IMUs and ML algorithms for assistive disease diagnosis has become a hot topic, with an increasing number of studies reported yearly. A systematic search was conducted in four databases covering the aforementioned topic for articles published in the past six years. Eighty-one articles were included and discussed concerning two aspects: different ML techniques and application scenarios. This review yielded the conclusion that, with the help of ML technology, IMUs can serve as a crucial element in disease diagnosis, severity assessment, characteristic estimation, and monitoring during the rehabilitation process. Furthermore, it summarizes the state-of-the-art, analyzes challenges, and provides foreseeable future trends for developing IMU-ML systems for IoHT.

What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis

Although meta-analyses have examined the association between patient education and health, the validity and quality of this evidence have not been comprehensively assessed. This second order meta-analysis combined previous meta-analyses that examined the effectiveness of patient education on health outcomes as an overall weighted grand mean d¯¯. Further, measures of methodological quality, meaningful variability across first order meta-analyses, and evidence for publication bias were examined. Forty meta-analyses were identified, investigating 156 associations between patient education and health summarizing data from over 776 studies including more than 74.947 patients. Quantitative analyses showed that patient education positively affects health outcomes with d¯¯ = 0.316 (95% CI [0.304, 0.329]). Summarizing data exclusively from randomized controlled trials indicated a causal effect. Patient education was effective for patients with neoplasms, diabetes, mental and behavioral disorders, diseases of the circulatory system, the respiratory system, and the musculoskeletal system. Patient education was effective in the reduction of medication use, pain, and visits to medical facilities, and significantly improved physiological, physical, psychological outcomes, and patients' general function. Overall, the findings reveal firm evidence for the effectiveness of patient education on health outcomes. However, theory-based interventions are lacking and need to be implemented to enable a successful transfer from theory to practice.

The impact of caffeine consumption on clinical symptoms in patients with bipolar disorder: A systematic review

OBJECTIVES

In healthy populations, caffeine appears to have beneficial effects on health; however, patients with bipolar disorder (BD) are routinely advised to limit caffeine use in psychoeducation programmes. We aimed to examine all literature reporting whether caffeine intake/withdrawal impacts the natural course of BD, in terms of clinical outcomes.

METHODS

PubMed, Embase and PsycINFO were searched (up to 17/07/2020) and all studies reporting data on individuals with BD comparing a measure of caffeine use with illness severity (symptoms of mania, depression, psychosis, anxiety, sleep or suicidality) were included.

RESULTS

Of the 1678 records reviewed, 17 studies met inclusion criteria (10 case reports, 1 retrospective cohort study, 5 cross-sectional studies, 1 interventional study). Most case reports described people with BD switching to manic, hypomanic or mixed states after consuming caffeine in variable amounts and/or whose serum lithium concentrations increased after reducing caffeine consumption. The interventional study found that caffeine may suppress lithium concentrations, while the retrospective cohort study reported that participants who drank coffee had more suicidality than non-drinkers.

CONCLUSIONS

The literature examining clinical effects of caffeine in patients with BD is not conclusive. Acute increases in caffeine consumption may precede the occurrence of manic symptoms in patients with BD, potentially through a direct stimulant effect, affecting sleep patterns and/or the metabolism of lithium or other medications, although increases in caffeine intake could also be a consequence of an ongoing manic relapse or a prodromal sign. Further research is needed to determine whether caffeine use impacts the long-term prognosis of BD.

Adapting practice in mental healthcare settings during the COVID-19 pandemic and other contagions: systematic review

BACKGROUND

During the global COVID-19 pandemic, there has been guidance concerning adaptations that physical healthcare services can implement to aid containment, but there is relatively little guidance for how mental healthcare services should adapt service provision to better support staff and patients, and minimise contagion spread.

AIMS

This systematic review explores service adaptations in mental health services during the COVID-19 pandemic and other contagions.

METHOD

The Allied and Complementary Medicine database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, PsycINFO and Web of Science were systematically searched for published studies from database inception to April 2020. Data were extracted focusing on changes to mental health services during contagion outbreaks. Data were analysed with thematic analysis.

RESULTS

Nineteen papers were included: six correspondence/point-of-view papers, five research papers, five reflection papers, two healthcare guideline documents and one government document. Analysis highlighted four main areas for mental health services to consider during contagion outbreaks: infection control measures to minimise contagion spread, including procedural and practical solutions across different mental health settings; service delivery, including service changes, operational planning and continuity of care; staff well-being (psychological and practical support); and information and communication.

CONCLUSIONS

Mental health services need to consider infection control measures and implement service changes to support continuity of care, and patient and staff well-being. Services also need to ensure they are communicating important information in a clear and accessible manner with their staff and patients, regarding service delivery, contagion symptoms, government guidelines and well-being.

Improving functional outcomes in early-stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial

AIM

Young people with bipolar disorder (BD) commonly experience reduced quality of life, persistent symptoms and impaired functional recovery despite often superior school performance. Compromised long-term functioning can ensue. There is evidence that psychological therapies alongside pharmacology may be more efficacious earlier in the course of the disorder. Intervention in the early stages may thus reduce the burden and risk associated with BD and mitigate the impact of the disorder on normal developmental trajectories. To date, however, the availability of evidence-based psychological therapies for young people with early BD is limited. Furthermore, there are no large-scale randomized controlled trials (RCTs) of such interventions.

METHODS

The study is a prospective, single-blind, RCT examining the effectiveness of an adjunctive individualized and manualized psychological intervention, compared with treatment as usual within youth-specific early intervention services. The REsearch into COgnitive and behavioural VERsatility (RECOVER) intervention is delivered over a 6-month period. About 122 young people in the early stages of BD-I (at least one manic episode in the previous 2 years, with no more than five lifetime treated/untreated manic or hypomanic episodes) will be recruited. The assessments will occur at baseline, 3, 6 (primary endpoint, end of treatment), 9, 12, 15 and 18 months.

RESULTS

Recruitment will commence in January 2019 and is anticipated to occur over a 3.5-year period.

CONCLUSIONS

To date, there are no evidence-based psychological therapies tailored to young people with early BD. We will test whether early psychological intervention in the course of BD can reduce the symptomatic, psychological, vocational and social impacts that are seen in entrenched disorder.

Participation in decision-making about medication: A qualitative analysis of medication adherence

Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18-64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients' views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.

Substance use comorbidity in bipolar disorder: A qualitative review of treatment strategies and outcomes

BACKGROUND AND OBJECTIVES

Substance use disorders (SUDs) are present in up to 70% of patients with bipolar disorder (BD) and contribute to high rates of disability, morbidity, and treatment non-adherence. Despite this prevalence, few trials have investigated targeted psychosocial interventions for comorbid BD and SUDs.

METHODS

Using PubMed and PsycINFO, we conducted a search of the literature up to January 2018 for psychosocial interventions targeted to patients with comorbid BD and SUDs. We identified eight total trials. Of these studies, four randomized and two open trials targeted the types of substance use (alcohol and illicit drugs) of primary concern to mood stability; the remaining two studies, both open trials, targeted smoking cessation.

RESULTS

None of the randomized trials provided consistent evidence for management of both mood symptoms and substance use though integrated group therapy (IGT) demonstrated consistent beneficial effects on substance use outcomes. Other treatments showed benefit for mood symptoms without benefits for alcohol or illicit substance use. Small pilot studies of combined treatments for smoking cessation provided some initial promise.

CONCLUSIONS

At present, IGT is the most-well validated and efficacious approach if substance use is targeted in an initial treatment phase. For a subsequent phase, additional psychosocial BD treatments may be needed for mood and functioning benefits.

SCIENTIFIC SIGNIFICANCE

This review synthesizes the psychosocial interventions that have been conducted in comorbid BD and SUDs while also providing a perspective on which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. (Am J Addict 2018;27:188-201).

Socio-demographic and clinical characterization of patients with Bipolar Disorder I vs II: a Nationwide Italian Study

Bipolar disorders (BDs) are prevalent, comorbid and disabling conditions, associated with the highest suicide risk among psychiatric illnesses. In the last few years, new efforts to better characterize the socio-demographic and clinical profiles of BD type I vs II have been documented by several reports, with novel and insightful findings in the field. The present multicenter study aimed to provide a comprehensive and reliable representation of the Italian reality, through the analysis of the largest national sample of bipolar patients collected so far. A total of 1500 patients (BD I n = 963 and BD II n = 537) from different psychiatric departments, participating in the Italian Chapter of the "International Society of Bipolar Disorders" (ISBD), were assessed and divided into two groups on the basis of their diagnostic subtype, and different socio-demographic and clinical variables were compared between the two subgroups. Chi-squared tests for categorical variables and t tests for continuous variables were performed for group comparison. Furthermore, a multivariable logistic regression was performed, considering diagnostic bipolar subtype (type I or II) as dependent variable, and socio-demographic/clinical characteristics as independent variables. BD I vs II patients showed an overall less favorable socio-demographic and clinical profile. In addition, the multivariable logistic regression showed that BD II vs BD I was predicted by the absence of lifetime suicide attempts (OR = 1.58, p = 0.01), a later age of diagnosis (OR = 1.03, p < 0.01), less hypomanic episodes in the last year (OR = 2.29, p < 0.0001) and absence of psycho-educational interventions in the last year (OR = 0.51, p < 0.01). BD I and II patients were found to significantly differ in relation to specific clinical variables, which should be considered within updated diagnostic-therapeutic algorithms.

Psychoeducation for bipolar disorder: A discourse analysis

Psychoeducation has become a common intervention within mental health settings. It aims to increase people's ability to manage a life with a long-term illness. For people with bipolar disorder, psychoeducation is one of a range of psychosocial interventions now considered part of contemporary mental health practice. It has taken on a 'common sense' status that results in little critique of psychoeducation practices. Using a published manual on psychoeducation and bipolar disorder as its data, Foucauldian discourse analysis was used in the present study for a critical perspective on psychoeducation in order to explore the taken-for-granted assumptions on which it is based. It identifies that the text produces three key subject positions for people with bipolar disorder. To practice self-management, a person must: (i) accept and recognize the authority of psychiatry to know them; (ii) come to see that they can moderate themselves; and (iii) see themselves as able to undertake a reflexive process of self-examination and change. These findings highlight the circular and discursive quality to the construct of insight that is central to how psychoeducation is practiced. Using Foucault's construct of pastoral power, it also draws attention to the asymmetrical nature of power relations between the clinician and the person with bipolar disorder. An effect of the use of medical discourse in psychoeducation is to limit its ability to work with ambivalence and contradiction. A critical approach to psychotherapy and education offers an alternate paradigm on which to basis psychoeducation practices.

Is a SIMPLe smartphone application capable of improving biological rhythms in bipolar disorder?

BACKGROUND

Biological rhythms (BR) disturbance has been suggested as a potential mediator of mood episodes in Bipolar Disorder (BD). The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was designed as an assessment tool to evaluate BR domains comprehensively. In the context of a trial evaluating a smartphone application delivering personalized psychoeducational contents for BD (SIMPLe 1.0), the main aim of this study is to evaluate the potential impact of SIMPLe 1.0 in BR regulation using the BRIAN scale.

METHODS

51 remitted BD patients were asked to use the application for 3 months. Paired t-test analyses were employed to compare baseline and follow-up BRIAN´s total and domains scores. The sample was divided into completers and non-completers of the study to evaluate differences between groups regarding BRIAN scores using ANCOVA analyses.

RESULTS

The BRIAN's mean total score of the whole sample significantly decreased from baseline to post-intervention (35.89 (SD 6.64) vs. 31.18 (SD 6.33), t = 4.29, p = 0.001). At post-intervention, there was a significant difference between groups regarding the total BRIAN mean score (29.47 (SD 6.21) completers vs. 35.92 (SD 3.90) non-completers, t = 2.50, p = 0.02). This difference was maintained after conducting a one-way ANCOVA controlling for pre-intervention BRIAN scores, F (1, 46) = 10.545, p=0.002.

LIMITATIONS

A limited sample, pre-post measures, and a short study timeframe could have affected the results. Additional factors affecting BR, such as medication, could not be ruled out.

CONCLUSION

Our results suggest that there are potential positive effects of a psychoeducational smartphone application as an adjunctive to treatment as usual on BD patients' BR.

Mindfulness-Based Treatment for Bipolar Disorder: A Systematic Review of the Literature

Despite the increasing number of studies examining the effects of mindfulness interventions on symptoms associated with Bipolar Disorder (BD), the effectiveness of this type of interventions remains unclear. The aim of the present systematic review was to (i) critically review all available evidence on Mindfulness Based Cognitive Therapy (MBCT) as a form of intervention for BD; (ii) discuss clinical implications of MBCT in treating patients with BD; and (iii) provide a direction for future research. The review presents findings from 13 studies (N = 429) that fulfilled the following selection criteria: (i) included BD patients; (ii) presented results separately for BD patients and control groups (where a control group was available); (iii) implemented MBCT intervention; (iv) were published in English; (v) were published in a peer reviewed journal; and (vi) reported results for adult participants. Although derived from a relatively small number of studies, results from the present review suggest that MBCT is a promising treatment in BD in conjunction with pharmacotherapy. MBCT in BD is associated with improvements in cognitive functioning and emotional regulation, reduction in symptoms of anxiety depression and mania symptoms (when participants had residual manic symptoms prior to MBCT). These, treatment gains were maintained at 12 month follow up when mindfulness was practiced for at least 3 days per week or booster sessions were included. Additionally, the present review outlined some limitations of the current literature on MBCT interventions in BD, including small study sample sizes, lack of active control groups and idiosyncratic modifications to the MBCT intervention across studies. Suggestions for future research included focusing on factors underlying treatment adherence and understanding possible adverse effects of MBCT, which could be of crucial clinical importance.

Psychoeducational intervention focused on healthy living improves psychopathological severity and lifestyle quality in psychiatric patients: preliminary findings from a controlled study

BACKGROUND

Individuals with psychiatric disorders incur an increased risk of morbidity and mortality, with higher prevalence of cardio-metabolic risk factors s largely contributing to a significant reduction in life expectancy.

OBJECTIVES

The aim of the present study was at evaluating the clinical effectiveness of an educational intervention targeting lifestyle habits in patients with mood and psychotic disorders.

METHODS

Patients (n = 32) were randomly assigned to receive, in addition to the pharmacological treatment, either five sessions of group psychoeducation focused on healthy lifestyle or five sessions of a control group therapy.

RESULTS

Both psychopathological severity (i.e. the brief psychiatric rating scale) and lifestyle quality (i.e. physical activity, sleep quality and adherence to the Mediterranean diet) improved significantly over time in patients who underwent specific psychoeducational sessions but not in the controls.

CONCLUSIONS

These findings add to the accumulating evidence that educational interventions focused on lifestyle habits can ameliorate general and mental health in patients with psychiatric disorders and suggest that educational programs represent an effective non-pharmacological intervention to manage drug-induced cardiometabolic disturbances.

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan

BACKGROUND

Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.

AIM

The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.

METHODS

Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.

RESULTS

Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).

CONCLUSIONS

Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT02210390.

Empirically supported psychosocial interventions for bipolar disorder: Current state of the research

OBJECTIVES

Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocial interventions for bipolar disorder.

METHODS

We conducted a search of the literature to examine recent (2007-present), randomized controlled studies of the following psychotherapy interventions for bipolar disorder: psychoeducation (PE), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and family therapies such as family focused therapy (FFT).

RESULTS

All of the psychotherapy interventions appear to be effective in reducing depressive symptoms. Psychoeducation and CBT are associated with increased time to mood episode relapse or recurrence. MBCT has demonstrated a particular effectiveness in improving depressive and anxiety symptoms. Online psychotherapy interventions, programs combining one or more psychotherapy interventions, and targeted interventions centering on particular symptoms have been the focus of recent, randomized controlled studies in bipolar disorder.

CONCLUSIONS

Psychotherapy interventions for the treatment of bipolar disorder have substantial evidence for efficacy. The next challenge will to disseminate these psychotherapies into the community.

Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review

OBJECTIVES

Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web.

METHODS

A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed.

RESULTS

The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers.

CONCLUSIONS

Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.

Efficacy of psychoeducational family intervention for bipolar I disorder: A controlled, multicentric, real-world study

BACKGROUND

This study assessed the efficacy of the Falloon model of psychoeducational family intervention (PFI), originally developed for schizophrenia management and adapted to bipolar I disorder. The efficacy of the intervention was evaluated in terms of improvement of patients׳ social functioning and reduction of family burden.

METHODS

This was a multicentre, real-world, controlled, outpatient trial carried out in 11 randomly recruited Italian mental health centres. Enroled patients and key-relatives were consecutively allocated either to receive PFI and Treatment As Usual (TAU) or to a waiting list receiving TAU alone. The efficacy of the intervention was evaluated in terms of improvement in patients׳ social functioning (primary outcome) and reduction of family burden (secondary outcome).

RESULTS

Of the 137 recruited families, 70 were allocated to the experimental group and 67 to the control group. At the end of the intervention, significant improvements in patients׳ social functioning and in relatives׳ burden were found in the treated group compared to TAU. This effect of the intervention remained also after controlling for several confounding patient׳s socio-demographic and clinical factors. The experimental intervention had an impact also on other outcome measures, such as patients׳ clinical status and personal burden.

LIMITATIONS

Lack of an active control group.

CONCLUSIONS

The results of this study clearly show that the psychoeducational family intervention according to the Falloon model is effective in improving the social outcome of patients with bipolar I disorder.

Psychoeducation to facilitate return to work in individuals on sick leave and at risk of having a mental disorder: protocol of a randomised controlled trial

Background

Sickness absence due to poor mental health is a common problem in many Western countries. To facilitate return to work, it may be important to identify individuals on sick leave and at risk of having a mental disorder and subsequently to offer appropriate treatment. Psychoeducation alone has not previously been used as a return to work intervention, but may be a promising tool to facilitate return to work. Therefore, the aim of the study is to evaluate the effectiveness of psychoeducation designed specifically to facilitate return to work for individuals on sick leave and at risk of having a mental disorder. The psychoeducation was a supplement to the various standard offers provided by the job centres.

Methods/Design

The study is a randomised controlled trial, in which individuals on sick leave either receive psychoeducation and standard case management or standard case management alone. Participants were individuals with mental health symptoms, who had been on sick leave from part-time or full-time work or unemployment for about 4–8 weeks. The psychoeducational intervention was group-based and the course consisted of 2 hour sessions once a week for 6 weeks. The course was given by psychiatric nurses, a psychologist, a social worker, a physiotherapist and a person who had previously been on sick leave due to mental health problems. The sessions focused on stress and work life, and the purpose was to provide individuals on sick leave the skills to understand and improve their mental functioning.

The primary outcome is the duration of sickness absence measured by register data. Secondary outcomes include psychological symptoms, mental health-related quality of life, and locus of control. These outcomes are measured by questionnaires at the start of the intervention and at 3 and 6 months follow-up.

Discussion

On the basis of this trial, the effect of psychoeducation for individuals on sick leave and at risk of having a mental disorder will be studied. The results will contribute to the continuing research on sickness absence and mental health. It will primarily show whether psychoeducation can lead to faster and sustainable return to work.

Trial Registration

Clinical Trial.gov NCT01637363. Registered 6 July 2012.

Self-management and bipolar disorder--a clinician's guide to the literature 2011-2014

This review provides clinicians and individuals with bipolar disorder (BD) with an overview of evidence-based skills shown to be effective in BD and amenable to self-management including psychoeducation; monitoring moods, medications, and social function; sleep hygiene; setting goals and relapse plans; and healthy lifestyles (physical activity, healthy eating, weight loss and management, medical comorbidities). Currently available self-management resources for BD are summarized by mode of delivery (workbooks, mobile technologies, internet, and peer-led interventions). Regardless of the self-management intervention/topic, the research suggests that personally tailored interventions of longer duration and greater frequency may be necessary to achieve the maximal benefit among individuals with BD. Means to support these self-management interventions as self-sustaining identities are critically needed. Hopefully, the recent investment in patient-centered research and care will result in best practices for the self-management of BD by mode of delivery. Since self-management of BD should complement rather than replace medical care, clinicians need to partner with their patients to incorporate and support advances in self-management for individuals with BD.

Modulation of fronto-limbic activity by the psychoeducation in euthymic bipolar patients. A functional MRI study

Bipolar disorders (BD) are mainly characterized by emotional and cognitive processing impairment. The cerebral substrate explaining BD impairment and the action mechanisms of therapies are not completely understood, especially for psychosocial interventions. This fMRI study aims at assessing cerebral correlates of euthymic bipolar patients (EBP) before and after psychoeducation therapy. Sixteen EBP and 16 matched healthy subjects (HS) performed a word-face emotional Stroop task in two separate fMRI sessions at 3-month interval. Between fMRI sessions, EBP underwent psychoeducation. Before psychoeducation, the comparison of EBP vs. HS in fMRI data revealed (a) significant decreased activity of cognitive control regions such as bilateral inferior and left superior frontal gyri, right insula, right fusiform gyrus and bilateral occipital gyri and (b) significant increased activity of emotion-related processing regions such as bilateral hippocampus, parahippocampal gyri and the left middle temporal gyrus. After psychoeducation, EBP showed significant clinical improvement, increased activity of inferior frontal gyri and a tendency toward decreased activity of right hippocampus and parahippocampal gyrus. These results suggest that the imbalance between cognitive control and emotion processing systems characterizing BD acute episodes may persist during euthymic periods. Moreover, this imbalance may be improved by psychoeducation, which enhances the cognitive control and modulates emotional fluctuations in EBP.

The Effect of Psychoeducation on the Functioning Level of Patients With Bipolar Disorder

Bipolar disorder has adverse effects on the lives of the individuals and the people around them and causes disability due to impaired social and occupational functioning, risk of suicide, and frequent relapses. This study was conducted as a two-group pretest–posttest design to determine the effect of psychoeducation on the functioning levels of patients with bipolar disorder. A total of 80 patients were assigned to either the experimental ( n = 40) or the control group ( n = 40). The data were collected using a questionnaire form, and the Bipolar Disorder Functioning Questionnaire. The experimental group scored significantly higher on the functioning levels (emotional functioning, intellectual functioning, feelings of stigmatization, social withdrawal, household relations, relations with friends, participating in social activities, daily activities and recreational activities, taking initiative and self-sufficiency, and occupation) ( p < .05) compared with the control group after psychoeducation. Psychoeducation has become considerably effective in increasing the functioning levels of patients with bipolar disorder.

Future directions for research on youth with bipolar spectrum disorders

The past 25 years has witnessed significant advances in our knowledge of Bipolar Spectrum Disorders (BPSD) in youth. Cross-sectional and longitudinal studies are clarifying the unique features of its pediatric presentation, including continuities and discontinuities across the spectrum of severity. Advances have been made, both in the pharmacological and psychological management of BPSD in youth. Current investigations may ultimately shed light on new treatment strategies. Future research is anticipated to be influenced by NIMH's Research Domain Criteria (RDoC). With this article, we summarize what is currently known about the basic phenomenology of pediatric BPSD, its clinical course, assessment and treatment, beginning with a summary of the major studies that have shed light on the topic. Next, we present a tally and content review of current research as an indicator of trends for the future. Then, we describe what we believe are important future directions for research. Finally, we conclude with implications for contemporary clinicians and researchers.