*American Journal of Psychiatry* (vol. 164, #9) (July 2007)
includes a study: “Intensive Psychosocial Intervention Enhances
Functioning in Patients With Bipolar Depression: Results From a 9-Month
Randomized Controlled Trial.”

The article is by David J. Miklowitz, Ph.D., Michael W. Otto, Ph.D.,
Ellen Frank, Ph.D., Noreen A. Reilly-Harrington, Ph.D., Jane N. Kogan,
Ph.D., Gary S. Sachs, M.D., Michael E. Thase, M.D., Joseph R. Calabrese,
M.D., Lauren B. Marangell, M.D., Michael J. Ostacher, M.D., Jayendra
Patel, M.D., Marshall R. Thomas, M.D., Mako Araga, M.S., Jodi M.
Gonzalez, Ph.D., & Stephen R. Wisniewski, Ph.D.

Here’s how the article begins:

[begin excerpt]

Bipolar disorder is the sixth leading cause of disability worldwide (1).
Although the severity of mood episodes is the major determinant of
patients’ ability to work or have relationships, many patients
experience functional impairments, even during euthymic periods (2-5).
For example, across a 12-month follow-up of hospitalized patients with
mania, 48% recovered clinically, but only 24% recovered functionally (6).

Randomized controlled trials have established the efficacy of manual-
based, disorder-specific psychosocial treatments in conjunction with
pharmacotherapy in preventing recurrences of bipolar illness over 1-2
years (7). Surprisingly, few of these studies report on functional
outcomes (but see references 8 and 9). Thus, it is unclear whether the
symptomatic benefits associated with psychosocial interventions
translate into improvements in functioning, and if so, what the time
course of such improvements might be.

This study compared the effectiveness of three forms of intensive
psychotherapy (30 sessions over 9 months) with a brief psychoeducational
treatment (three sessions over 6 weeks) in combination with
pharmacotherapy in enhancing functioning following a bipolar depressive
episode. Participants were treated within the randomized acute
depression pathway of the multisite Systematic Treatment Enhancement
Program for Bipolar Disorder (STEP-BD [10]). Previously, we reported
that the three intensive psychosocial treatments in STEP-BD–cognitive
behavior therapy (CBT), family-focused therapy, and interpersonal and
social rhythm therapy–were superior to brief psychoeducation in
hastening recovery from depression and increasing the number of months
well during a 1-year period (11). In the present study, we undertook a
particularly conservative approach to examining the effects of
psychotherapy on functional outcomes (relationships, satisfaction with
activities, work/role functioning, and recreation) by examining whether
intensive psychotherapy affects functioning above and beyond its effects
on depression.

[end excerpt]

Here’s an excerpt from the Discussion section: “We compared three
intensive (30-session) psychosocial treatments for bipolar depression
(CBT, family-focused therapy, and interpersonal and social rhythm
therapy) in combination with pharmacotherapy to three sessions of
psychoeducation and pharmacotherapy over a 9-month period. The primary
finding is that when compared with collaborative care, intensive
psychosocial intervention significantly improved patients’ relationship
functioning and satisfaction with life beyond the level of improvements
expected from changes in depressed mood. The psychosocial interventions
had no independent effects on work/role functioning or recreation scores.”

Here’s another excerpt from the Discussion section: “This study, in
combination with our prior report from STEP-BD, suggests that intensive
psychosocial treatment is more effective than brief psychoeducation in
stabilizing depressive symptoms and enhancing functioning following a
bipolar depressive episode. These results are consistent with the
broader literature indicating that combining psychosocial interventions
with pharmacotherapy is more effective than pharmacotherapy alone for a
variety of outcome domains relevant to bipolar disorder
(7).
Nonetheless, the study also points to the limitations of our existing
treatment methods. Many of the patients in this study showed highly
variable functioning scores in one or more domains and little overall
improvement in functioning over 9 months, despite aggressively delivered
psychosocial and pharmacological treatment regimens. Functioning scores
during the treatment period were highly related to concurrent levels of
depression in all analyses, and for most domains, baseline functioning
scores accounted for a significant proportion of the outcome variance
during treatment.”

The author note states that reprint requests may be sent to Dr.
Miklowitz, Department of Psychology, University of Colorado, Muenzinger
Building, Boulder, CO 80309-0345; < m i k l o w @ p s y c h . c o l o r a d o . e d u>.

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