Psychoeducation and cognitive behavioral therapy combined with pharmacologic treatment provides significant long-term benefits for patients with refractory bipolar disorder (BD), researchers report.
The team found that the 20 BD patients randomly assigned to the combined therapy group showed significant reductions in persistent affective symptoms and improvements in social-occupational functioning over 5 years of follow up compared with the 20 control patients assigned to receive pharmacologic treatment alone.
Patients in the combined therapy group also showed significant reductions in hospitalization rates over the study period compared with controls.
"As far as we know, this is the first study to show such long-term maintained efficacy of a combined pharmacological plus psychoeducation and cognitive-behavioral therapy program in subjects with refractory bipolar disorder," comment the researchers in European Psychiatry.
There were no significant between-group differences regarding gender distribution, number of hospitalizations, use of lithium or other mood stabilizers, or adherence rates at baseline.
Overall, 75% of patients in each group had persistent affective symptoms (Beck's Depression Index score >7; Young Mania Rating Scale score >6) and/or severe difficulties in social-occupational functioning (Misadjustment Scale score >14) at baseline. The remaining patients had experienced two or more relapse events during the previous year.
However, the percentage of patients with such symptoms at the 6-month, 12-month, and 5-year evaluations was significantly lower in the combined treatment than control group, at 40% versus 80%, 30% versus 83%, and 20% versus 89%, respectively.
Patients in the combined treatment group also had a lower mean number of recent hospitalizations than those in the control group at the 12-month and 5-year evaluations, at 0.00 versus 0.39, and 0.02 versus 1.06, respectively.
In addition, anxiety levels, as assessed using the State Trait Anxiety Inventory, were significantly lower in the combined treatment than control group at all follow-up evaluations.
Ana González-Isasi (Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain) and team conclude: "Combined treatment proved better than pharmacological treatment in relieving mania, depression and anxiety symptoms after 6 months and in producing better adjustment to everyday life upon termination of treatment. These benefits were maintained after 5 years."
They add: "Our results support the view that the benefits of a psychological treatment do not dissipate over time."
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