title: How effective is a psychological intervention program for patients with refractory bipolar disorder? A randomized controlled trial.
abstract: BACKGROUND
  The aim of this research was to evaluate the short-term and long-term efficacy of a combined treatment (pharmacological + psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder.
  
  
  METHODS
  40 patients were randomly assigned to one of the following: Experimental group under combined treatment, and Control group under pharmacological treatment. We used an analysis of variance (ANOVA), including one or two factors, with repeated measures at different evaluation times: baseline, post-treatment, 6-month follow-up and 12-month follow-up.
  
  
  RESULTS
  We found significant between-group differences at all evaluation times after the treatment. The experimental group showed less hospitalizations than the control group in the 12-month evaluation (p=0.007) as well as lower rates of depression and anxiety in the 6-month valuation (p=0.015; p=0.027) and the 12-month evaluation (p=0.001; p<0.001). Significant differences in relation to mania and inadaptation emerged in the post-treatment evaluation (p=0.004; p<0.001) and were sustained throughout the study (p=0.002, p<0.001; p<0.001, p<0.001). Analysis of within-group differences in the Experimental group showed reduction of mania (p<0.001), depression (p=0.001), anxiety (p=0.003) and inadaptation (p<0.001) throughout the study; while in the Control group, it showed increased numbers of hospitalizations (p=0.016), as well as higher rates of mania (p=0.030), anxiety (p<0.001) and inadaptation (p=0.003).
  
  
  CONCLUSIONS
  Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Suggestions for future research are commented on.
authors.affiliation: Psychiatry Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain. anagonis@hotmail.com
authors.forename: Ana González
authors.initials: AG
authors.lastname: Isasi
authors.forename: Enrique
authors.initials: E
authors.lastname: Echeburúa
authors.forename: José María
authors.initials: JM
authors.lastname: Limiñana
authors.forename: Ana
authors.initials: A
authors.lastname: González-Pinto
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents