Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial |
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| Institution: | 1. Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8553, Japan;2. Department of Health Sciences, Kitasato University School of Allied Health Sciences, 1-15-1, Kitasato, Sagamihara, Kanagawa 252-0373, Japan;3. Department of Clinical Engineering, Kitasato University School of Allied Health Sciences, 1-15-1, Kitasato, Sagamihara, Kanagawa 252-0373, Japan;4. Department of Radiology, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Kanagawa 252-0373, Japan;5. Department of Medical Radiological Technology, Kyorin University School of Health Sciences, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan;6. Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8553, Japan;7. Department of Human Science, Kyushu University, 4-9-1, Shiobaru, Fukuoka-shi, Fukuoka 815-8540, Japan;8. Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Ibaraki, Tsukuba 305-8577, Japan;9. Occupational Stress Research Group, National Institute of Occupational Safety and Health, 6-21-1, Noborito, Kawasaki, Kanagawa 214-8585, Japan;10. Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8551, Japan;11. Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 252-0373, Japan;1. Department of Psychiatry, University of Melbourne, Parkville, Australia;2. Federation University Australia, Ballarat, Australia;3. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States;4. Bipolar and Depression Research Program, VA Palo Alto Health Care System, United States;5. Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia;6. School of Psychology, Deakin University, Burwood, Australia;7. Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia;8. Orygen Youth Health Research Centre, Centre for Youth Mental Health, Melbourne, Australia;1. Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia;2. School of Psychology, University of Adelaide, Level 4 Hughes Building, SA 5005, Australia;3. Oliva Newton John Cancer Wellness and Research Centre, 145 Studley Road, Heidelberg, VIC 3084, Australia;4. La Trobe University, Plenty Road, Bundoora, VIC 3083, Australia |
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| Abstract: | ObjectiveThe aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological + psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder.MethodForty patients were randomly assigned to either an Experimental group–under combined treatment — or a Control group — under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points.ResultsBetween-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P = 0.015). The Experimental group showed lower depression and anxiety in the 6-month (P = 0.006; P = 0.019), 12-month (P = 0.001; P < 0.001) and 5-year (P < 0.001, P < 0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P = 0.009; P < 0.001) and were sustained throughout the study (6-month: P = 0.006, P < 0.001; 12-month: P < 0.001, P < 0.001; 5-year: P = 0.004, P < 0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning.ConclusionsA combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented. |
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