title: Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial.
abstract: BACKGROUND
  Relapse prevention for bipolar disorder increases time to relapse but is not available in routine practice.
  
  
  OBJECTIVE
  To determine the feasibility and effectiveness of training community mental health teams (CMHTs) to deliver enhanced relapse prevention.
  
  
  METHODS
  In a cluster randomised controlled trial, CMHT workers were allocated to receive 12 h training in enhanced relapse prevention to offer to people with bipolar disorder or to continue giving treatment as usual. The primary outcome was time to relapse and the secondary outcome was functioning.
  
  
  RESULTS
  Twenty-three CMHTs and 96 service users took part. Compared with treatment as usual, enhanced relapse prevention increased median time to the next bipolar episode by 8.5 weeks (hazard ratio 0.79, 95% CI 0.45-1.38). Social and occupational functioning improved with the intervention (regression coefficient 0.68, 95% CI 0.05-1.32). The clustering effect was negligible but imprecise (intracluster correlation coefficient 0.0001, 95% CI 0.0000-0.5142).
  
  
  CONCLUSIONS
  Training care coordinators to offer enhanced relapse prevention for bipolar disorder may be a feasible effective treatment. Large-scale cluster trials are needed.
authors.affiliation: Spectrum Centre, Division of Health Research, University of Lancaster, Lancaster, UK. f.lobban@lancaster.ac.uk
authors.forename: F
authors.initials: F
authors.lastname: Lobban
authors.forename: L
authors.initials: L
authors.lastname: Taylor
authors.forename: C
authors.initials: C
authors.lastname: Chandler
authors.forename: E
authors.initials: E
authors.lastname: Tyler
authors.forename: P
authors.initials: P
authors.lastname: Kinderman
authors.forename: R
authors.initials: R
authors.lastname: Kolamunnage-Dona
authors.forename: C
authors.initials: C
authors.lastname: Gamble
authors.forename: S
authors.initials: S
authors.lastname: Peters
authors.forename: E
authors.initials: E
authors.lastname: Pontin
authors.forename: W
authors.initials: W
authors.lastname: Sellwood
authors.forename: R K
authors.initials: RK
authors.lastname: Morriss
mesh_terms: D001714:Bipolar Disorder / Q000517:prevention & control*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004496:Education, Continuing / Q000458:organization & administration*; D005240:Feasibility Studies; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D055502:Secondary Prevention; D006113:United Kingdom