Bipolar disorder in adults: Psychoeducation and other adjunctive maintenance psychotherapies
- Eduard Vieta, MD, PhD
Eduard Vieta, MD, PhD
- Professor of Psychiatry
- University of Barcelona
- Francesc Colom, PhD, PsyD, MSc
Francesc Colom, PhD, PsyD, MSc
- Senior Researcher
- Mental Health Program
- Hospital del Mar Medical Research Institute
Psychoeducation includes helping patients accept their condition, explaining the clinical features and treatment options, and encouraging them to anticipate problems and be proactive in managing the illness. Educating bipolar patients about their illness can improve adherence to treatment and the course of illness. The word “doctor” is derived from the Latin verb docere, which means to teach.
This topic reviews psychoeducation and other adjunctive maintenance psychotherapies for preventing or delaying recurrent bipolar mood episodes. Choosing maintenance treatment (including pharmacotherapy) for bipolar disorder is discussed separately. (See "Bipolar disorder in adults: Choosing maintenance treatment".)
DEFINITION OF BIPOLAR DISORDER
Bipolar disorder is a mood disorder that is characterized by episodes of mania (table 1), hypomania (table 2), and major depression (table 3) . The subtypes of bipolar disorder include bipolar I and bipolar II. Patients with bipolar I disorder experience manic episodes, and nearly always experience hypomanic and major depressive episodes. Bipolar II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes. Additional information about the clinical features and diagnosis of bipolar disorder is discussed separately. (See "Bipolar disorder in adults: Clinical features" and "Bipolar disorder in adults: Assessment and diagnosis", section on 'Diagnosis'.)
Psychotherapies that are used as adjunctive maintenance treatment for bipolar disorder include [2,3]:
●Group and individual psychoeducationTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet 2013; 381:1672.
- Anderson IM, Haddad PM, Scott J. Bipolar disorder. BMJ 2012; 345:e8508.
- Colom F, Vieta E. Psychoeducation Manual for Bipolar Disorder, Cambridge University Press, Cambridge 2006.
- Miklowitz DJ. Bipolar Disorder: A Family Focused Treatment Approach, Second Edition, The Guilford Press, New York 2008.
- Frank E. Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy, The Guilford Press, New York 2005.
- Malhi GS, Adams D, Lampe L, et al. Clinical practice recommendations for bipolar disorder. Acta Psychiatr Scand Suppl 2009; :27.
- National Institute for Health and Care Excellence (NICE). Bipolar disorder: The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. Updated edition. National Clinical Guideline Number 185; appendix 26. 2014. https://www.nice.org.uk/ (Accessed on November 22, 2016).
- Oud M, Mayo-Wilson E, Braidwood R, et al. Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry 2016; 208:213.
- Kallestad H, Wullum E, Scott J, et al. The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders. J Affect Disord 2016; 202:32.
- Bilderbeck AC, Atkinson LZ, McMahon HC, et al. Psychoeducation and online mood tracking for patients with bipolar disorder: A randomised controlled trial. J Affect Disord 2016; 205:245.
- Jauhar S, McKenna PJ, Laws KR. NICE guidance on psychological treatments for bipolar disorder: searching for the evidence. Lancet Psychiatry 2016; 3:386.
- Colom F. Keeping therapies simple: psychoeducation in the prevention of relapse in affective disorders. Br J Psychiatry 2011; 198:338.
- Kendall T, Morriss R, Mayo-Wilson E, et al. Assessment and management of bipolar disorder: summary of updated NICE guidance. BMJ 2014; 349:g5673.
- National Institute for Health and Care Excellence. Bipolar disorder: The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. September 2014. http://www.nice.org.uk/guidance/cg185 (Accessed on May 31, 2015).
- Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1.
- Goodwin GM, Haddad PM, Ferrier IN, et al. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495.
- Bond K, Anderson IM. Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar Disord 2015; 17:349.
- Colom F, Vieta E, Martinez-Aran A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60:402.
- Colom F, Vieta E, Sánchez-Moreno J, et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009; 194:260.
- Colom F, Vieta E, Sánchez-Moreno J, et al. Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome subanalysis. J Affect Disord 2009; 112:30.
- Colom F, Vieta E, Sánchez-Moreno J, et al. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004; 6:294.
- Morriss R, Lobban F, Riste L, et al. Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial. Lancet Psychiatry 2016; 3:1029.
- Vieta E, Morilla I. Early group psychoeducation for bipolar disorder. Lancet Psychiatry 2016; 3:1000.
- Reinares M, Colom F, Sánchez-Moreno J, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar Disord 2008; 10:511.
- Scott J, Colom F, Popova E, et al. Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. J Clin Psychiatry 2009; 70:378.
- Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA 2002; 288:2469.
- Colom F, Berk L. Psychoeducation as a core element of psychological approaches for bipolar disorders. In: Bipolar Disorder: Clinical and Neurobiological Foundations, Yatham LN, Maj M. (Eds), Wiley-Blackwell, West Sussex, UK 2010. p.412.
- Colom F, Reinares M, Pacchiarotti I, et al. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. Acta Neuropsychiatr 2010; 22:50.
- Craddock N, Sklar P. Genetics of bipolar disorder. Lancet 2013; 381:1654.
- Colom F, Vieta E, Reinares M, et al. Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry 2003; 64:1101.
- Scott J, Colom F, Vieta E. A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. Int J Neuropsychopharmacol 2007; 10:123.
- Reinares M, Sánchez-Moreno J, Fountoulakis KN. Psychosocial interventions in bipolar disorder: what, for whom, and when. J Affect Disord 2014; 156:46.
- Castle D, White C, Chamberlain J, et al. Group-based psychosocial intervention for bipolar disorder: randomised controlled trial. Br J Psychiatry 2010; 196:383.
- Parikh SV, Zaretsky A, Beaulieu S, et al. A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety treatments (CANMAT) study [CME]. J Clin Psychiatry 2012; 73:803.
- Perry A, Tarrier N, Morriss R, et al. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999; 318:149.
- Weiss RD, Griffin ML, Kolodziej ME, et al. A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Am J Psychiatry 2007; 164:100.
- Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 2016; 387:1123.
- Morriss RK, Faizal MA, Jones AP, et al. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev 2007; :CD004854.
- Jones SH, Smith G, Mulligan LD, et al. Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder: randomised controlled pilot trial. Br J Psychiatry 2015; 206:58.
- Beynon S, Soares-Weiser K, Woolacott N, et al. Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. Br J Psychiatry 2008; 192:5.
- Kendall T, Morriss R, Mayo-Wilson E, et al. NICE guidance on psychological treatments for bipolar disorder. Lancet Psychiatry 2016; 3:317.
- Lynch D, Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychol Med 2010; 40:9.
- Szentagotai A, David D. The efficacy of cognitive-behavioral therapy in bipolar disorder: a quantitative meta-analysis. J Clin Psychiatry 2010; 71:66.
- Gomes BC, Abreu LN, Brietzke E, et al. A randomized controlled trial of cognitive behavioral group therapy for bipolar disorder. Psychother Psychosom 2011; 80:144.
- Meyer TD, Hautzinger M. Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychol Med 2012; 42:1429.
- Perich T, Manicavasagar V, Mitchell PB, et al. A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder. Acta Psychiatr Scand 2013; 127:333.
- Harvey AG, Soehner AM, Kaplan KA, et al. Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. J Consult Clin Psychol 2015; 83:564.
- Crowe M, Whitehead L, Wilson L, et al. Disorder-specific psychosocial interventions for bipolar disorder--a systematic review of the evidence for mental health nursing practice. Int J Nurs Stud 2010; 47:896.
- Justo LP, Soares BG, Calil HM. Family interventions for bipolar disorder. Cochrane Database Syst Rev 2007; :CD005167.
- Miklowitz DJ. Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry 2008; 165:1408.
- Reinares M, Bonnín CM, Hidalgo-Mazzei D, et al. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev 2016; 43:47.
- Frank E, Kupfer DJ, Thase ME, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005; 62:996.
- Goracci A, Rucci P, Forgione RN, et al. Development, acceptability and efficacy of a standardized healthy lifestyle intervention in recurrent depression. J Affect Disord 2016; 196:20.
- Torrent C, Bonnin Cdel M, Martínez-Arán A, et al. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry 2013; 170:852.
- Vieta E, Torrent C, Martinez-Aran A. Functional Remediation for Bipolar Disorder, Cambridge University Press, Cambridge, UK 2014.
- Bonnin CM, Torrent C, Arango C, et al. Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome. Br J Psychiatry 2016; 208:87.
- Hidalgo-Mazzei D, Mateu A, Reinares M, et al. Internet-based psychological interventions for bipolar disorder: Review of the present and insights into the future. J Affect Disord 2015; 188:1.
- Hidalgo-Mazzei D, Mateu A, Reinares M, et al. Psychoeducation in bipolar disorder with a SIMPLe smartphone application: Feasibility, acceptability and satisfaction. J Affect Disord 2016; 200:58.
- DEFINITION OF BIPOLAR DISORDER
- GROUP PSYCHOEDUCATION
- Evidence of efficacy
- General principles
- - Medical model
- - Clinical setting
- - Mechanism of action
- Administering treatment
- - Illness awareness
- - Symptoms
- - Medication options and adherence
- - Detecting prodromal signs
- - Lifestyle regularity
- - Other topics
- DETECTING EARLY WARNING SIGNS
- COGNITIVE-BEHAVIORAL THERAPY
- Cognitive-behavioral therapy for insomnia
- FAMILY THERAPY
- INTERPERSONAL AND SOCIAL RHYTHM THERAPY
- HEALTHY LIFESTYLE
- FUNCTIONAL REMEDIATION
- ELECTRONIC RESOURCES
- INFORMATION FOR PATIENTS