4.2 treatment of bipolar disorder Flashcards
the social zeitgeber hypothesis
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
posits that unstable or disrupted daily routines lead to circadian rhythm instability and, in vulnerable individuals, to affective episodes
- evidence shows that such events are implicated in the onset of bipolar
method
conditions and procedure
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
conditions: acutely ill patients were randomly assigned to 1 of 4 treatments:
- Acute and maintenance IPSRT (IPSRT/IPSRT)
- Acute and maintenance ICM (ICM/ICM)
- Acute IPSRT followed by maintenance ICM (IPSRT/ICM)
- Acute ICM followed by maintenance IPSRT (ICM/IPSRT)
All participants received protocol-driven pharmacotherapy
procedure:
- 2 phases → acute treatment phase and maintenance phase
- Participants were seen weekly until stabilization was achieved → 4 consecutive weeks
- Visits in preventive phase were scheduled every other week for 12 weeks, and then monthly until the end of the 2-year maintenance phase
method
treatments - IPSRT
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
interpersonal social rhythm therapy (IPSRT): an adaptation of interpersonal psychotherapy based on the social zeitgeber hypothesis
the regularity of social routines and stability of interpersonal relations have a protective effect in recurrent mood disorders
IPSRT focuses on:
- Links between mood symptoms and quality of social relationships and social roles
- The importance of maintaining regularity in daily routines, and the identification and management of potential precipitatns of rhythm disruption
The interpersonal aspect: focuses on resolution of current interpersonal problems and their future prevention
method
treatments - ICM
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
intensive clinical management (ICM): a manual-driven approach to the medical management of BD that the authors developed based on the clinical management strategies
Elements:
- Education about BD
- Education about the medications used to treat BD
- Education about basic sleep hygiene
- Careful review of symptoms
- Careful review of adverse effects
- Medical and behavioral management of adverse effects
- Nonspecific support
Short sessions of 20-25 minutes
results
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
Participants who received IPSRT in the acute treatment phase experienced longer survival time with no new affective episode
Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment
IPSRT was not beneficial to all participants in this condition → those with higher levels of medical burden were better off in the ICM condition
No difference was found between the 2 psychosocial treatments in terms of time to remission
conclusion
(Frank,2005)
Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder
Interpersonal and social rhythm therapy appears to add to the clinical resources for the management of bipolar I disorder, particularly with respect to prevention of new episodes.
Findings are in line with the social zeitgeber hypothesis
- suggested IPSRT should be initiated when an individual is in an acute episode
Results suggest that the patient who is most likely to benefit from IPSRT as it is currently conceptualized is: medically healthy with no history of an anxiety disorder
cognitive therapy
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
Based on the assumption that thinking, mood, and behavior affects one another
Therapists aim to teach patients techniques to monitor, examine, and change their dysfunctional thinking and behavior associated with undesirable mood states
Less frequent relapses and better control of symptoms will improve level of social functioning in BD patients
aim & hypotheses
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
Aim: study the efficacy of CT (in combination with mood stabilizers) in a large sample of patients with BD experiencing frequent relapses
Primary hypotheses - CT group will have:
- fewer bipolar episodes and fewer days in the episodes
- higher social functioning
- better coping strategies for prodromes
- lower scores in dysfunctional attitudes relating to high goal-attainment
Secondary hypotheses - CT group will have:
- fewer bipolar depressive episodes
- fewer manic or hypomanic episodes
- lower depression and mania mood scores, less manic mood fluctuations, and less hopelessness
- show better medication compliance
method
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
Patients were randomly allocated either to control group or CT group
The control group received minimal psychiatric care (mood stabilizers and regular psychiatric follow-up as outpatients)
The CT group received CT + minimal psychiatric care
results
episodes
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
Primary hypothesis 1 - fewer episodes:
- Significantly fewer patients in the CT group experienced depressive, manic, and mixed episodes
- Significantly fewer patients in CT were admitted for bipolar episodes
Primary hypothesis 1 - fewer days in episodes:
- The CT group had fewer days in bipolar episodes as a whole, after controlling for previous episodes
results
monthly return of mood questionnaires
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
The BDI (Beck’s depression inventory) scores for CT dropped across time, whereas those of the control group increased
At no time did the control group have a significantly lower mood score than the CT group
results
mood fluctuations & medication compliance
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
Mood fluctuations: greater degree of mood fluctuations in the control group than the CT group
Medication compliance: at 6 months, a sig greater proportion of patients in CT reported good compliance
discussion & conclusion
(Lam, 2003)
A Randomized Controlled Study of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder
The CT group had significantly less bipolar episodes and less hospitalizations
Evidence that CT can be protective for both bipolar depression and mania when patients are taught full CT skills to cope with their illness
Conclusion: CT (in addition to pharmacotherapy) was useful in preventing relapses, alleviating symptoms, and promoting social functioning in those with BD who experienced frequent relapses despite taking mood stabilizers
aims
(Kessing, 2018)
Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies
To assess the effectiveness of lithium monotherapy in comparison w/other mood stabilizers (i.e., anticonvulsant or antipsychotic) in maintenance monotherapy for BD
To assess the effectiveness of lithium in comb w/ other mood stabilizers in comparison w/ lithium in maintenance monotherapy
results
(Kessing, 2018)
Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies
In 8/9 identified studies, maintenance lithium monotherapy was associated with improved outcome compared with another mood stabilizer in monotherapy
Among the 4 identified studies comparing maintenance combination therapy with maintenance monotherapy, a few combination therapies were found to be superior to monotherapy in some analyses, but many were not
