[Psychotherapeutic and psychosocial approaches in bipolar disorder: a systematic literature review].
OBJECTIVE
Aim of this systematic review was critical presentation of psychosocial approaches in bipolar disorders with regard to their fundamentals and impact on the clinical course and outcome of the illness.


METHODS
PubMed, Medline, PsycINFO and Turkish databases between 1980 and 2009 were searched by using keywords "bipolar disorder" and "psychotherapy", "psychosocial approaches", "psychological intervention". Randomized controlled trials, reviews and meta analysis were included.


RESULTS
Fifty studies met the inclusion criteria where four types of interventions -psychoeducation, family focused, cognitive behavioral and interpersonal psychosocial rhythm therapy-were studied. Twenty two of 24 original research papers were randomized controlled trials, 23 were reviews and 3 were meta analysis. In almost all studies psychotherapeutic approach was applied as adjunctive to pharmacotherapy. Group psychoeducation was more effective in preventing manic relapses, whereas cognitive behavioral and family focused therapies showed efficacy in preventing depressive episodes. Additional benefits on such secondary outcomes as medication compliance, number and duration of hospitalizations, time to recurrence were reported. Effects on functionality and quality of life were assessed rarely, but reported to be beneficial. Cultural adaptation studies are scarce and needs exploration.


CONCLUSIONS
Psychosocial interventions adjunctive to pharmacotherapy in bipolar disorder seem to be effective in relapse prevention. Stage of illness where the therapy is initiated and the targeted episode for prevention varies between interventions. Future studies are needed to strengthen the place of psychosocial interventions in treatment guidelines and would contribute to narrow the gap between effectiveness of pharmacotherapy and functional improvement.
Istanbul U, Istanbul Medical School Psychiatry Department, Mood Disorders Unit, Capa Istanbul, Turkey. drsibelcakir@yahoo.com
Sibel
S
Cakir
Ayşegül
A
Ozerdem
D001714:Bipolar Disorder / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010353:Patient Education as Topic; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence