Validación Programa de Psicoeducación. II

International Journal of Neuropsychopharmacology (2007), 10, 123–129. Copyright 2006 CINP
doi:10.1017/S1461145706006900
SPECIAL SECTION
CINP


A meta-analysis of relapse rates with adjunctive
psychological therapies compared to usual
psychiatric treatment for bipolar disorders


Jan Scott(a), Francesc Colom(B) and Eduard Vieta(b)
(a) Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK
(b) Stanley Center for Bipolar Disorders, Hospital Clinic University of Barcelona, IDIBAPS, Barcelona, Spain


Abstract
This paper reviews published randomized controlled treatment trials of psychological therapies added to standard psychiatric treatment vs. standard psychiatric treatment alone to explore whether adjunctive psychotherapy reduces relapse rates in individuals with bipolar disorders. Core components and characteristics of efective psychological therapies were identified from descriptions in the literature. Relapse rates were calculated for selected treatment trials and then pooled odds ratios were calculated using meta-analytical techniques that explored differences in outcome according to therapy model, type of relapse experienced and whether the subject was euthymic at entry to the study. The different therapy models have a number of similar components. A meta-analysis of eight recent studies demonstrates a significant reduction in relapse rates (of about 40%) compared to standard treatment alone. Therapies were most effective in preventing relapses in subjects who were euthymic when recruited into the treatment trial, and may be less effective in those with a high number of previous episodes (previous relapses>12). Efficacy studies demonstrate that adjunctive psychological treatments for individuals with bipolar disorders reduce relapse risk, but there is a need to undertake pragmatic effectiveness studies to determine which individuals with bipolar disorders are most likely to benefit from such interventions.


Received 22 January 2006; Reviewed 10 February 2006; Revised 27 April 2006; Accepted 3 May 2006;
First published online 20 June 2006

Validación Programa de Psicoeducación. I

Original Article
Stabilizing the stabilizer: group psychoeducation enhances the
stability of serum lithium levels

Colom F, Vieta E, Sánchez-Moreno J, Martínez-Arán A, Reinares M,
Goikolea JM, Scott J. Stabilizing the stabilizer: group psychoeducation
enhances the stability of serum lithium levels.
Bipolar Disord 2005: 7 (Suppl. 5): 32–36. ª Blackwell Munksgaard, 2005

Objective: To determine the effect on the serum lithium levels of a
psychoeducational program in patients with bipolar disorder.

Method: This is a subanalysis of data obtained from a larger study on
the effcacy of group psychoeducation in the prophylaxis of recurrences
in bipolar disorders. Data on plasma lithium levels were obtained at five
time points: baseline, 6, 12, 18 and 24 months. Serum lithium levels of
patients who had received psychoeduction (psychoeducated) (N = 49)
and non-psychoeducated patients (N = 44) were compared.

Results: Mean serum lithium levels were significantly higher and more
stable for the psychoeducation group.

Conclusions: As changes in serum lithium level may be a powerful
predictor of recurrence for bipolar patients, the addition of group
psychoeducation to standard pharmacological treatment may be
beneficial to optimize serum lithium levels and, thereby improve
outcome.

F Colom 1),4), E Vieta 1), 2), J Sánchez-Moreno 1), 3), A Martínez-Arán 1),
M Reinares 1), JM Goikolea 1), 2) and J Scott 4)

1) Bipolar Disorders Program, Institut d’Investigacions Biome´diques Agustý´ Pi Sunyer,
Barcelona Stanley Foundation Center, Barcelona,
2)Department of Psychiatry, Hospital Clinic, University of Barcelona, Barcelona,
3)Psychiatry Department, Universidad Autonoma de Madrid, Madrid, Spain,
4) Psychological Treatments Research, Division of Psychological Medicine,
Institute of Psychiatry, London, UK

Key words: bipolar disorder – blood serum –
lithium – patient non-adherence – psychotherapy

Corresponding author: Eduard Vieta, MD, PhD,
Director Bipolar Disorders Program, Clinical
Institute of Neuroscience, University Clinic
Hospital of Barcelona, Villarroel 170, 08036
Barcelona, Spain. Fax: +34932275477;
e-mail: evieta@clinic.ub.es

Bipolar Disorders 2005: 7(Suppl. 5): 32–36
Copyright (C) Blackwell Munksgaard 2005
BIPOLAR DISORDERS