1
|
Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
Collapse
Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|