Psychoeducation for bipolar disorder and risk of recurrence and hospitalization – a within-individual analysis using registry data

Joas, Erik; Bäckman, Kristoffer; Karanti, Alina; Sparding, Timea; Colom, Francesc; Pålsson, Erik; Landén, Mikael

doi:10.1017/s0033291719001053

Cited by 22 publications

(29 citation statements)

References 24 publications

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“…The ability to identify triggers can also be regarded as a prerequisite for preventing relapse in affective episodes (30). Psychological interventions, such as add‐on psychoeducation to pharmacotherapy, prevent recurrences (12,32). One of the main objects with psychoeducation is early detection of prodromal symptoms with the aim of coping and thereby preventing recurrences.…”

Section: Discussionmentioning

confidence: 99%

“…Psychoeducation is an important adjunct treatment for relapse prevention and typically contains strategies to identify triggers for manic episodes and prevent relapse by minimizing the exposure to these risk factors. This intervention has been shown to reduce the risk for manic episodes (10‐13). It might, however, be difficult to distinguish between an external trigger and prodromal symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis

Smedler

Sparding

Hattab

et al. 2020

Acta Psychiatr Scand

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Smedler E, Sparding T, Hattab A, Sellgren CM, Land en M. Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis.Objective: To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a 7-year period. Method: This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately 7 years in order to evaluate clinical outcomes. Results: We found that 44% of the patients reported trigger factors, including sleep disturbance, work-or family-related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At 7-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic, or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline. Conclusions: Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at 7-year followup.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Significant outcomes• Around 40% of all bipolar disorder patients reported trigger factors for manic or hypomanic episodes.• Reporting trigger factors was not associated with personality • Reporting trigger factors was not associated with outcomes over a 7-year period. Limitations• Patients had on average long duration of illness and may be less sensitive to external stressors than persons with recent onset.• Trigger factors were identified retrospectively and may thus be prone to recall bias. • The number of affective episodes might be a too crude outcome measure as most subjects had not suffered any affective episodes at follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis

Smedler

Sparding

Hattab

et al. 2020

Acta Psychiatr Scand

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“…The first 2 points can however also be regarded as strengths since they contributed to a real-world evaluation of our program. Moreover, a post hoc analysis of the RCT by Colom et al (2009a) and an observational study using registry data (Joas et al 2019) found that PE was also effective in patients with bipolar II disorder. Because patients with bipolar II disorder were numerically overrepresented in our experimental compared to our control group and suffered from more episodes over the 2-year follow-up than those with bipolar I disorder, we included bipolar subtype in a multivariate confounder analysis, which did not change our results.…”

Section: Discussionmentioning

confidence: 99%

“…However, the program applied (Colom and Vieta 2006) has not reached dissemination in clinical practice (Hidalgo-Mazzei et al 2018), possibly due to its length and associated costs. Since a large observational study using a within-individual analysis of registry data indicates the effectiveness of short-term group programs (Joas et al 2019), these may help to expand the routine use of PE, yet there is insufficient evidence from randomized controlled trials (RCT).…”

Section: Introductionmentioning

confidence: 99%

Short group psychoeducation followed by daily electronic self-monitoring in the long-term treatment of bipolar disorders: a multicenter, rater-blind, randomized controlled trial

Petzold

Mayer-Pelinski

Pilhatsch

et al. 2019

Int J Bipolar Disord

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BackgroundDespite various pharmacological and psychological treatment interventions, bipolar disorders rank among the leading causes of global disease burden. Group psychoeducation has been demonstrated an effective add-on to pharmacotherapy, but it may be difficult to implement in practice depending on the clinical setting and available human resources.MethodsMulticenter, rater-blind, randomized controlled trial to investigate the efficacy of a new intervention program consisting of an initial 6-week psychoeducation protocol plus a subsequent structured daily computer-based self-charting program (ChronoRecord) over 54 weeks in remitted patients with bipolar disorders. The control condition included non-structured group sessions followed by daily computer-based self-reports (unstructured like a diary). Both groups received treatment-as-usual.ResultsOver 2 years, 41 mood episodes occurred in the experimental group (n = 39) compared to 27 in the control group (n = 34), without reaching statistical significance. Time to recurrence did not significantly differ between the experimental and control group (25% relapsed after 112 and 273 days, respectively). There were no significant group-by-time interactions in mood symptoms, quality of life, self-efficacy expectations or perceived involvement in care.ConclusionsSix weekly psychoeducational group sessions followed by daily self-monitoring via ChronoRecord for 54 weeks may not be superior to non-structured group meetings followed by unstructured self-reporting. Other psychotherapeutic interventions may be needed to optimize the treatment of patients with bipolar disorders, especially for those at later disease stages.Trial registration Retrospectively registered at German Clinical Trials Register on May 24, 2019; DRKS00017319

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“…Adding psychoeducation to other forms of psychiatric treatment has the advantage of helping patients and family members to understand their creative and positive role in the treatment and enhancing their ability to deal with daily stress ( Pitschel-Walz et al, 2001 ). Psychoeducation is an adjunctive approach that has the potential to reduce the incidence of relapse, as well as rehospitalization rates and the mental health costs involved in relapsing ( Shah et al, 2014 ; Joas et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement

et al. 2020

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Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant’Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8–12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.

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Psychoeducation for bipolar disorder and risk of recurrence and hospitalization – a within-individual analysis using registry data

Cited by 22 publications

References 24 publications

Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis

Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis

Short group psychoeducation followed by daily electronic self-monitoring in the long-term treatment of bipolar disorders: a multicenter, rater-blind, randomized controlled trial

Making Sense of the Unique Pain of Survivors: A Psychoeducational Approach for Suicide Bereavement

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