Medical burden, body mass index and the outcome of psychosocial interventions for bipolar depression

Abstract

Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.

A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: Results from STEP-BD

“…Our results suggest that illness history deserves considerable attention in a baseline evaluation as it affects patients’ likely responses to psychotherapy. Importantly, our findings suggest that illness course and history characteristics more strongly influence response to psychotherapy than current level of symptoms, diagnostic subgroup, anxiety (Deckersbach et al, 2014), medical illnesses, or weight problems (Peters et al, 2015). …”

“…Odds ratios are reported as the measure of effect size. For binary logistical regressions (and consistent with our previous studies (Deckersbach et al, 2014; Peters et al, 2014a; Peters et al, 2015)), we computed Number Needed to Treat (NNT) as an additional measure of treatment effects (Kraemer and Kupfer, 2006). In this study, NNT can be interpreted as the number of patients one would expect to treat with intensive psychotherapy to have one more responder (or one less non-responder) than if the same number were treated with collaborative care.…”

“…In prior studies, our group has investigated clinical predictors and moderators of response to adjunctive psychotherapy (Deckersbach et al, 2014; Peters et al, 2014a; Peters et al, 2015) using a large, cross-national randomized controlled trial that was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). In STEP-BD, acutely depressed individuals with bipolar disorder were randomized to one of three intensive (up to 30 sessions over 9 months) psychotherapies (CBT, IPSRT, or FFT) plus pharmacotherapy or to collaborative care (a 3-session psychoeducation intervention) plus pharmacotherapy (Miklowitz et al, 2007a).…”

“…Thus, STEP-BD contains a large, nationally representative sample in a controlled trial of multiple psychotherapies. Our previous work has shown that repeated mood episodes and prolonged illness duration (Peters et al, 2014b), as well as medical co-comorbidity (Peters et al, 2015) are associated with overall treatment resistance, and that patients with co-morbid anxiety disorders and body mass index within a normal range respond better to intensive psychotherapy than those without comorbid anxiety disorders (Deckersbach et al, 2014). …”

Early intervention for bipolar disorder in adolescents: A psychosocial perspective

“…As well as the associated risks of second-generation antipsychotics (SGAs), which are routinely prescribed despite typically inducing weight gain (Malhi, Mitchell, & Caterson, 2001), those with BD are more likely to smoke, be physically inactive, have poor fruit and vegetable intakes, and be overweight. Health risk behaviours such as these have been linked to worsened psychiatric status (Cerimele & Katon, 2013;Melo, Daher, Albuquerque, & de Bruin, 2016;Sylvia et al, 2014), and obesity is associated with poorer response to psychotherapy (Peters et al, 2016). In addition, binge eating disorders and symptoms are overrepresented and underdiagnosed in this population (Krüger, Shugar, & Cooke, 1996;Wildes, Marcus, & Fagiolini, 2008).…”