title: Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial.
abstract: OBJECTIVE
  The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological+psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder.
  
  
  METHODS
  Forty patients were randomly assigned to either an Experimental group-under combined treatment - or a Control group - under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points.
  
  
  RESULTS
  Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P=0.015). The Experimental group showed lower depression and anxiety in the 6-month (P=0.006; P=0.019), 12-month (P=0.001; P<0.001) and 5-year (P<0.001, P<0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P=0.009; P<0.001) and were sustained throughout the study (6-month: P=0.006, P<0.001; 12-month: P<0.001, P<0.001; 5-year: P=0.004, P<0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning.
  
  
  CONCLUSIONS
  A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented.
authors.affiliation: Psychiatry Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain. Electronic address: anagonis@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: González Isasi
authors.affiliation: Faculty of Psychology, University of the Basque Country, CIBERSAM, San Sebastián, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Echeburúa
authors.affiliation: Unidad de Investigación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Limiñana
authors.affiliation: CIBERSAM, Department of Psychiatry, Santiago Apóstol Hospital, EHU/UPV, Vitoria, Spain.
authors.forename: A
authors.initials: A
authors.lastname: González-Pinto
mesh_terms: D000328:Adult; D001007:Anxiety / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011613:Psychotherapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cognitive-behavioral model; Combined therapy; Long-term follow-up; Pharmacological treatment; Psychoeducation; Refractory bipolar disorder