Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement.
BACKGROUND
Several previous studies have established that low treatment adherence is common among bipolar patients and may explain high rates of recurrence. On the other hand, some patients keep relapsing even when they strictly follow their prescribed somatic treatments. Psychological interventions such as psychoeducation may foster early recognition of prodromal symptoms and minimize the risk of relapse. To date, studies assessing the usefulness of psychoeducation in fully compliant patients are lacking.


METHODS
This was a single-blind, randomized, prospective clinical trial on the efficacy of group psychoeducation in remitted fully compliant DSM-IV bipolar I patients (N = 25) who were compared with a group with similar characteristics (N = 25) who did not receive psychoeducation. All patients received naturalistic pharmacologic treatment. Recruitment began in 1997 and follow-up was completed in January 2002. The follow-up phase comprised 2 years during which all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly on several outcome measures.


RESULTS
At the end of the 2-year follow-up, 23 subjects (92%) in the control group fulfilled criteria for recurrence versus 15 patients (60%) in the psychoeducation group (p < .01). The number of total recurrences and the number of depressive episodes were significantly lower in psychoeducated patients.


CONCLUSIONS
Although the present study has the limitation of small sample size, psychoeducation showed its efficacy in preventing relapses in bipolar I patients who were adherent to drug treatment. The action of psychoeducation seems to go beyond compliance enhancement and may support a tripod model composed by lifestyle regularity and healthy habits, early detection of prodromal signs followed by prompt drug intervention, and finally treatment compliance.
Colom
Francesc
F
Bipolar Disorders Program, IDIBAPS-Hospital Clinic Barcelona, Barcelona Stanley Research Center, Barcelona, Spain.
Vieta
Eduard
E
Reinares
María
M
Martínez-Arán
Anabel
A
Torrent
Carla
C
Goikolea
José Manuel
JM
Gastó
Cristòbal
C
D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage*; D001364:Awareness; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D011446:Prospective Studies; D011615:Psychotherapy, Group; D012307:Risk Factors; D055502:Secondary Prevention; D016037:Single-Blind Method; D016896:Treatment Outcome
D018692:Antimanic Agents