How effective is a psychological intervention program for patients with refractory bipolar disorder? A randomized controlled trial.
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.
Isasi
Ana González
AG
Psychiatry Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain. anagonis@hotmail.com
Echeburúa
Enrique
E
Limiñana
José María
JM
González-Pinto
Ana
A
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
D014150:Antipsychotic Agents