Friday, November 14, 2008

Psychotherapy for bipolar disorder

Despite advances in drug treatment most people with bipolar disorder cannot be treated with medication alone. Up to 50% of bipolar patients do not recover from acute manic episodes within a year and only 25% achieve full recovery of function. Rates of recurrence average 40-60% in 1-2 years even when patients undergo pharmacotherapy. Patients spend as much as 47% of their lives in symptomatic states, especially depressive states and only about 40% of patients are fully adherent with medication regimes in the year following an episode. So psychotherapy still has a crucial role to play in this condition. A review of 18 trials into the effectiveness of psychological interventions by David J. Miklowitz from the University of Colorado found that family therapy, interpersonal therapy and systemic care were the most effective at preventing recurrences when initiated after an acute episode, whereas cognitive behavioural therapy and group psychoeducation were most effective when initiated during a period of recovery. Individual psychoeducational and systematic care programmes were more effective for manic than for depressive symptoms whereas family therapy and cognitive behavioural therapy were more effective for depressive than for manic symptoms.

Miklowitz, David J. - Adjunctive psychotherapy for bipolar disorder: state of the evidence American Journal of Psychiatry November 2008, 165(11), 1408-1419

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