Psychosocial interventions as an adjunct to pharmacotherapy in bipolar disorder.
OBJECTIVE
To summarize the evidence and make treatment recommendations regarding the use of psychosocial interventions as an adjunct to pharmacotherapy for bipolar disorder.


METHODS
We reviewed published outcome studies since 1975 identified in MEDLINE and PsychLIT searches.


RESULTS
Available studies are initial and of highly variable methodological rigour. Evidence is most robust for the efficacy of psychoeducation and family therapy, and these received the highest level of recommendation as interventions. Group therapy, cognitive-behavioural therapy, and behavioural family management therapy are supported by weaker evidence and received a lower-level treatment recommendation. Availability of only a single interpersonal and social rhythms therapy trial limited the confidence of the recommendation for this intervention.


CONCLUSIONS
Controlled trials are needed to replicate early outcome studies and guide treatment recommendations. Accumulated evidence of favourable psychosocial intervention outcomes supports, with variable confidence, their use as adjuncts to pharmacotherapy in the treatment of bipolar disorder.
Parikh
S V
SV
Department of Psychiatry, University of Toronto, Ontario. parikhs@cs.clarke-inst.on.ca
Kusumakar
V
V
Haslam
D R
DR
Matte
R
R
Sharma
V
V
Yatham
L N
LN
D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D010348:Patient Care Team; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*
D011619:Psychotropic Drugs