Collaborative Care for Bipolar Disorder: Part II. Impact on Clinical Outcome, Function, and Costs

Background.The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.Method.Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.Results.Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.Conclusions.Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

Download Full-text

Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2014.07.013 ◽

2014 ◽

Vol 36 (6) ◽

pp. 575-580 ◽

Cited By ~ 6

Author(s):

Joseph M. Cerimele ◽

Abigail C. Halperin ◽

Clarence Spigner ◽

Anna Ratzliff ◽

Wayne J. Katon

Keyword(s):

Primary Care ◽

Bipolar Disorder ◽

Qualitative Study ◽

Collaborative Care

Download Full-text

Overview of Late-Life Depression

10.1093/med:psych/9780195382242.003.0005 ◽

2015 ◽

Author(s):

Mark D. Miller

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Personality Disorders ◽

Collaborative Care ◽

Late Life ◽

Medical Conditions ◽

Late Life Depression ◽

Alcohol Treatments

Chapter 4 outlines late-life depression. It explores the causes of depression (including medical conditions, medication, and alcohol), treatments for depression, and other diagnoses (bipolar disorder, co-occuring anxiety, and personality disorders), depression and cognitive impairment, and collaborative care.

Download Full-text

Psychosocial Treatment for Bipolar Disorder

CNS Spectrums ◽

10.1017/s1092852900027784 ◽

2010 ◽

Vol 15 (S3) ◽

pp. 14-16

Author(s):

Noreen Reilly-Harrington

Keyword(s):

Bipolar Disorder ◽

Collaborative Care ◽

Medication Compliance ◽

Behavioral Therapy ◽

Mood Stabilizer ◽

Psychosocial Treatment ◽

Psychoeducational Intervention ◽

Type I ◽

Bipolar Type ◽

Social Rhythm

Medication is the mainstay of treatment for bipolar disorder. However, no medication will be effective if patients do not take it, and the rates of medication compliance in bipolar disorder are very low. Johnson and McFarland found that the modal length of compliance with a mood stabilizer was only 2 months. Keck and colleagues found that 50% to 66% of patients with bipolar disorder exhibit poor compliance within the first 12 months of treatment. In addition, even with adequate medication compliance, high rates of relapse persist.Adjunctive psychosocial treatments can help reduce relapse and provide patients as well as their families with tools to manage bipolar disorder more effectively. Several forms of intensive psychotherapy have shown promise for the treatment of bipolar disorder. In the Systematic Treatment Enhancement Program for Bipolar Disorder, Miklowitz and colleagues compared three forms of intensive interventions: cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy, and family-focused treatment. These were compared to a brief, 3-session psychoeducational intervention known as collaborative care. A total of 293 depressed patients with bipolar type I or type II disorder were treated with protocol pharmacotherapy and were randomly assigned to either one of the three intensive interventions or the brief psychoeducational intervention.The three intensive interventions provided up to 30 sessions of treatment over a 9-month period. The collaborative care intervention consisted of three sessions administered over a 6-week period. The authors found that patients who received one of the intensive interventions had a median time to recovery 110 days earlier than patients who had received the collaborative care conditions. Patients who received one of the three intensive psychotherapies also had significantly higher year-end recovery rates, and are more than 1 to 1.5 times more likely to be clinically well during any study month. No statistically significant differences were found between the 3 intensive treatments.

Download Full-text

Collaborative care for patients with bipolar disorder: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.152520 ◽

2015 ◽

Vol 206 (5) ◽

pp. 393-400 ◽

Cited By ~ 13

Author(s):

Trijntje Y. G. van der Voort ◽

Berno van Meijel ◽

Peter J. J. Goossens ◽

Adriaan W. Hoogendoorn ◽

Stasja Draisma ◽

...

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Depressive Symptoms ◽

Medication Adherence ◽

The Netherlands ◽

Collaborative Care ◽

Controlled Trial ◽

Response To Treatment ◽

Care Programme ◽

Relevant Effect

BackgroundA substantial number of people with bipolar disorder show a suboptimal response to treatment.AimsTo study the effectiveness of a collaborative care programme on symptoms and medication adherence in patients with bipolar disorder, compared with care as usual.MethodA two-armed, cluster randomised clinical trial was carried out in 16 out-patient mental health clinics in The Netherlands, in which 138 patients were randomised. Patient outcomes included duration and severity of symptoms and medication adherence, and were measured at baseline, 6 months and 12 months. Collaborative care comprised contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes. Mental health nurses functioned as care managers in this programme. The trial was registered with The Netherlands Trial Registry (NTR2600).ResultsCollaborative care had a significant and clinically relevant effect on number of months with depressive symptoms, both at 6 months (z =–2.6, P = 0.01, d = 0.5) and at 12 months (z =–3.1, P = 0.002, d = 0.7), as well as on severity of depressive symptoms at 12 months (z =–2.9, P = 0.004, d = 0.4). There was no effect on symptoms of mania or on treatment adherence.ConclusionsWhen compared with treatment as usual, collaborative care substantially reduced the time participants with bipolar disorder experienced depressive symptoms. Also, depressive symptom severity decreased significantly. As persistent depressive symptoms are difficult to treat and contribute to both disability and impaired quality of life in bipolar disorder, collaborative care may be an important form of treatment for people with this disorder.

Download Full-text