Family-focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial.

Rea, Margaret; Tompson, Martha C.; Miklowitz, David J.; Goldstein, Michael J.; Hwang, Sun; Mintz, Jim

doi:10.1037/0022-006x.71.3.482

Cited by 326 publications

(246 citation statements)

References 44 publications

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“…89 Two randomised controlled trials including symptomatic patients with bipolar I and II found that, in the 1-2 years after a manic, mixed, or depressive episode, patients with bipolar disorder who received familyfocused therapy and pharma cotherapy had 30-35% lower rates of relapse and rehospitalisation and less severe symptoms than did patients in case manage ment 28 or equally intensive individual treatment. 63 Two randomised controlled trials in paediatric populations-one in adolescents (aged 12-18 years) with bipolar disorder 64 and one in children and adolescents (aged 9-17 years) with depression or hypomania with a first degree relative with bipolar disorder 65 -found that children and adolescents who received familyfocused therapy and pharmacotherapy recovered more rapidly from depressive episodes (HR 0·37-0·54) than did children and adolescents in brief psychoeducation and pharmacotherapy.…”

Section: Family-focused Therapymentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

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Section: Family-focused Therapymentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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“…Rea ve arkadaşları, Bipolar I tanısı almış 53 yatan hastanın 28 tanesine aileleriyle birlikte psikoeğitim vermiş, 25 kişilik kontrol grubuna ise sadece bireysel psikoeğitim vermişlerdir. [58] Yirmi bir oturumluk Psikiyatride Güncel Yaklaşımlar -Current Approaches in Psychiatry çalışma yaklaşık 9 ay devam etmiş, sonrasında 2 yıllık bir takip çalışması yapılmıştır. Sonuçta aileleri psikoeğitim almış gruptaki hastalarda yineleme sayısı ve hastaneye yatış sayısında anlamlı düzeyde azalma olduğu bulunmuş-tur.…”

Section: Bilişsel Davranışçı Psikoeğitimunclassified

Cognitive Behavioral Therapy in Bipolar Disorder

Maçkalı¹,

Tosun²

2011

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖZETBipolar bozukluk, erken başlangıçlı ve kronik seyri nedeniyle kişinin mesleki, sosyal ve yakın ilişki alanlarında bozulmalara yol açan, hastalığa ve hastalığın tedavisine uyum yapmayı öğrenmenin kritik öneme sahip olduğu bir bozukluktur. Bu nedenle bipolar bozukluğun tedavisinde, biyolojik müdahalelerin yanında psikososyal müdahalelerin de gerekli olduğu görüşü giderek yaygınlık kazanmaktadır. Bunun bir sonucu olarak, bipolar bozuklukta hangi psikososyal müdahalelerin etkili olduğunun belirlenmesi konusu önem taşı-maktadır. Bu yazıda bipolar bozuklukta ilaç tedavisine ek olarak uygulanan bilişsel davranışçı terapi uygulamaları ele alınıp, bu uygulamaların bipolar bozukluktaki etkinliğini inceleyen araştırmalar değerlendirilmiştir. Anahtar Sözcükler: bipolar bozukluk, bilişsel davranışçı terapi, tedavi ABSTRACT Bipolar disorder is an early-onset, chronic disorder. It impairs occupational, social, and family functioning, which makes learning to adapt living with the disorder and its treatment critically important. Therefore, it has now become common knowledge that psychosocial interventions are also necessary in the treatment of bipolar disorder adjunctive to pharmacotherapy. Thus, whichever psychosocial interventions are more effective in bipolar disorder is a crucial research question. In this article, cognitive-behavioral therapy, which is applied adjunctive to pharmacotherapy, will be addressed and the findings of research about the effectiveness of these applications will be reviewed.

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“…92 Over the first year of followup, FFT demonstrated some weakly greater treatment efficacy compared to individual therapy. Over the 2-year study period (including 1 year of treatment and another year of followup) however, FFT was associated with significantly fewer total relapses and fewer hospitalizations.…”

Section: Family-focused Treatmentmentioning

confidence: 99%

Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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Family-focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial.

Cited by 326 publications

References 44 publications

The Treatment of Bipolar Disorder

The Treatment of Bipolar Disorder

Cognitive Behavioral Therapy in Bipolar Disorder

Treatment-resistant bipolar disorder

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