title: Enhanced relapse prevention for bipolar disorder--ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder.
abstract: BACKGROUND
  Bipolar Disorder (BD) is a common and severe form of mental illness characterised by repeated relapses of mania or depression. Pharmacotherapy is the main treatment currently offered, but this has only limited effectiveness. A recent Cochrane review has reported that adding psycho-social interventions that train people to recognise and manage the early warning signs of their relapses is effective in increasing time to recurrence, improving social functioning and in reducing hospitalisations. However, the review also highlights the difficulties in offering these interventions within standard mental health services due to the need for highly trained therapists and extensive input of time. There is a need to explore the potential for developing Early Warning Sign (EWS) interventions in ways that will enhance dissemination.
  
  
  METHODS
  This article describes a cluster-randomised trial to assess the feasibility of training care coordinators (CCs) in community mental health teams (CMHTs) to offer Enhanced Relapse Prevention (ERP) to people with Bipolar Disorder. CMHTs in the North West of England are randomised to either receive training in ERP and to offer this to their clients, or to continue to offer treatment as usual (TAU). The main aims of the study are (1) to determine the acceptability of the intervention, training and outcome measures (2) to assess the feasibility of the design as measured by rates of recruitment, retention, attendance and direct feedback from participants (3) to estimate the design effect of clustering for key outcome variables (4) to estimate the effect size of the impact of the intervention on outcome. In this paper we provide a rationale for the study design, briefly outline the ERP intervention, and describe in detail the study protocol.
  
  
  CONCLUSIONS
  This information will be useful to researchers attempting to carry out similar feasibility assessments of clinical effectiveness trials and in particular cluster randomised controlled trials.
authors.affiliation: School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. fiona.lobban@manchester.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Lobban
authors.forename: Carol
authors.initials: C
authors.lastname: Gamble
authors.forename: Peter
authors.initials: P
authors.lastname: Kinderman
authors.forename: Lee
authors.initials: L
authors.lastname: Taylor
authors.forename: Claire
authors.initials: C
authors.lastname: Chandler
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tyler
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Eleanor
authors.initials: E
authors.lastname: Pontin
authors.forename: William
authors.initials: W
authors.lastname: Sellwood
authors.forename: Richard K
authors.initials: RK
authors.lastname: Morriss
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004502:Education, Medical, Continuing; D006801:Humans; D010348:Patient Care Team; D055502:Secondary Prevention; D013222:State Medicine; D016896:Treatment Outcome