title: The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder.
abstract: OBJECTIVE
  Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder. The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years.
  
  
  METHODS
  Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment.
  
  
  RESULTS
  The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes.
  
  
  CONCLUSIONS
  In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.
authors.affiliation: Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA. franke@upmc.edu
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Isabella
authors.initials: I
authors.lastname: Soreca
authors.forename: Holly A
authors.initials: HA
authors.lastname: Swartz
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Fagiolini
authors.forename: Alan G
authors.initials: AG
authors.lastname: Mallinger
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Grochocinski
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000293:Adolescent; D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology*; D003710:Demography; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group; D012919:Social Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome