Family therapy useful in bipolar disorder

By Laura Cowen, medwireNews Reporter

Psychoeducational family intervention (PFI) improves social functioning in patients with bipolar I disorder and reduces burden among close relatives, Italian study data show.

If the findings are replicated in other studies, “psychoeducation should become an integral part of the therapeutic armamentarium of every mental health professional”, say Andrea Fiorillo (University of Naples SUN) and co-authors of the study.

They assessed the efficacy of the Falloon psychoeducational intervention (1985) adapted to bipolar I disorder as add-on therapy to treatment as usual (TAU) and compared it with TAU alone in 137 clinically stable patients with bipolar I disorder who were recruited from 10 Italian community mental health centres.

The patients and their key relatives (those spending the most time in contact with the patients in the previous year) either attended 12 to 18, 90-minute PFI sessions focusing on individual and family assessment, information on characteristics of the disorder, its treatment, early warning signs, management of suicidal behaviours, communication skills and problem solving skills or were assigned to a waiting list.

At the end of the intervention period, the 70 patients in the PFI group reported significant improvements in social function, assessed using the global score on the Disability Assessment Scale (DAS). The average score fell from 2.9 at baseline to 2.6 following PFI.

The patients also reported reductions in objective and subjective burden of illness and showed clinical improvements when assessed with the Brief Psychiatric Rating Scale.

Among the relatives, there were significant post-intervention reductions on the Family Problem Questionnaire in the levels of family subjective (from 1.9 at baseline to 1.7 post-PFI) and objective (from 1.6 to 1.5) burden, and a significant improvement in perceived professional support (from 2.9 to 3.3).

This finding confirms that “psychoeducation is effective in improving relatives’ well-being and family environment” and shows that “researchers, clinicians, users and carers should work synergically to identify patients’ and relatives’ needs in order to target interventions”, Fiorillo et al remark in the Journal of Affective Disorders.

By contrast, no statistically significant differences in patients’ social functioning and clinical status, and relatives’ family burden were observed between baseline and the end of the study period among the 67 families who received TAU while on the waiting list for PFI.

Therefore, at the end of the intervention, patients in the PFI group had significantly higher DAS global scores and fewer depressive/anxiety symptoms than patients in the control group, while treated relatives had lower levels of objective and subjective burden and higher levels of perceived professional support. And this difference remained after controlling for several confounding sociodemographic and clinical factors.

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