PITTSBURGH — Psychosocial therapy can be a useful adjunct to drug therapy in patients with bipolar disorder, based on results from a study with 175 patients.
The study's findings also documented the high prevalence of medical comorbidities in patients with bipolar disorder. Identifying comorbidities is an important part of devising an appropriate management strategy for bipolar patients, Ellen Frank, Ph.D., said at the Sixth International Conference on Bipolar Disorder.
“We have enough data to say that adding a bipolar disorder-specific psychosocial therapy is much more likely to have benefit than not. But this does not mean that adding any therapy will [be beneficial].” The psychosocial therapy used needs to be specific for treating bipolar disorder, Dr. Frank said in an interview. “The effect of adding psychosocial therapy to monotherapy with a drug is greater than adding a second drug.”
The Pittsburgh Study of Maintenance Therapies in Bipolar Disorder involved 175 patients diagnosed with bipolar disorder, with an average age of 35 years old. All patients were treated with pharmacotherapy. The study was designed to compare the efficacy of interpersonal and social rhythm therapy (IPSRT) with intensive clinical management (ICM) as both acute and maintenance therapies.
IPSRT involved a regularization of daily routines, and psychotherapy that focused on interpersonal problem areas such as grief, role transitions, and role disputes. The psychotherapy was designed as a link between mood changes and life events. The strategy also used a social rhythm measure to monitor changes in the patient.
ICM involved teaching patients about bipolar disorder and the medications used to treat it, as well as educating them about the warning signs of impending bipolar episodes, the use of rescue medication, and the availability of a 24-hour call service.
After adjustment for the effects of marital status, anxiety, and medical burden, patients who were acutely treated with interpersonal and social rhythm therapy went significantly longer without new episodes during 2 years of maintenance therapy, compared with patients treated with intensive clinical management. The advantage of IPSRT was seen regardless of the treatment strategy used during maintenance, reported Dr. Frank, professor of psychiatry and psychology at the University of Pittsburgh, which sponsored the conference.
“For patients without high medical burdens, IPSRT seems to prevent recurrences of mania and depression,” she said in an interview. “ICM is also a reasonable strategy. There was a relatively low level of recurrence in both [the IPSRT and ICM] groups. But the modified form of IPSRT works well for bipolar patients with comorbid anxiety or anxiety spectrum conditions.”
Psychosocial therapies for bipolar disorder are just starting to be used. “There have now been eight randomized, controlled trials of psychosocial therapies in patients with bipolar disorder, and in seven studies, they produced significant benefits,” said Dr. Frank, who is also director of the depression and manic-depression prevention program at the Western Psychiatric Institute and Clinic in Pittsburgh.
The successful studies have also tested other forms of psychosocial interventions, such as cognitive therapy and family-focused therapy. A unifying thread of the successful interventions was that they were modified to be relevant to patients with bipolar disorder, she said.