King’s College London issued the following news release:

Childhood abuse associated with onset of psychosis in women

Researchers at the Institute of Psychiatry, King’s College London have
published new research which indicates that women with severe mental
illness are more likely to have been abused in childhood that the
general population.

But the same association has not been found in men.

The researchers believe their findings point to differences in the way
boys and girls respond to traumatic and upsetting experiences.

The paper which is published in the April issue of the British Journal
of Psychiatry compared two groups of adults with all the participants
were aged between 16 and 64, and lived in either south-east London or

Those in the first group had experienced psychotic symptoms, such as
hallucinations or delusions and received treatment for depression, mania
or schizophrenia. Those in the second group had no mental health
problems, and acted as a control sample. Both groups were asked whether
they experienced physical or sexual abuse during their childhood.

Women with psychosis were twice as likely to report either physical or
sexual abuse compared to healthy women. But no such association was
found in men.

The researchers suggest that one explanation for this is that girls are
more likely to ‘internalise’ difficulties than boys. In other words,
girls who are abused may distance themselves from other people, and
become overly suspicious of other people’s behaviour. This may put them
at greater risk of psychotic symptoms in the future, such as paranoid

In contrast, boys may be more likely to ‘act out’ following physical
abuse and potentially be at greater risk for antisocial behaviour.

The lead author on this paper, Helen Fisher, Researcher in Psychosis at
the Institute of Psychiatry at King’s said: “These findings do not mean
that if a child is abused they will develop psychosis; but women with
such disorders are more likely to reveal a background which included
childhood abuse.

“These findings point to the need for gender-specific interventions for
abused children to prevent later mental health and behavioural problems.”

“We also know that there are psychological, biological and genetic
factors that may contribute to this condition in women and more
attention needs to be given to understanding how adult psychosis
develops. Excitingly we have just been awarded a Wellcome Trust grant to
repeat this original study on a larger scale to enable us to investigate
the factors involved in this link between childhood abuse and psychotic

The paper entitled: “Gender differences in the association between
childhood abuse and psychosis” is published in the British Journal of
Psychiatry, 194: 319-325.

The authors were: Fisher H, Morgan C, Dazzan P, Craig TK, Morgan K,
Hutchinson G, Jones PB, Doody GA, Pariante C, McGuffin P, Murray RM,
Leff J and Fearon P (2009)

Press Release
April 02, 2007
Intensive Psychotherapy More Effective Than Brief Therapy for Treating Bipolar Depression
Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). The results are published in the April 2007 issue of the Archives of General Psychiatry.

Bipolar disorder is a debilitating illness marked by severe mood swings between depression and mania that affects 2.6 percent of Americans in any given year. “We know that medication is an important component in the treatment of bipolar illness. These new results suggest that adding specific, targeted psychotherapy to medication may help give patients a better shot at lasting recovery,” said NIH Director Dr. Elias A. Zerhouni.

“STEP-BD is helping us identify the best tools-both medications and psychosocial treatments-that patients and their clinicians can use to battle the symptoms of this illness,” said NIMH Director Thomas R. Insel, M.D.

Psychotherapy is routinely employed as a means to treat bipolar illness in conjunction with medication, but the extent to which psychotherapy is effective has been unclear. In addition, most psychotherapeutic studies have been limited to a single site and compared only one type of treatment to routine care. Thus, in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations.

With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

* family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;
* cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
* interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication study reported in the New England Journal of Medicine on March 28, 2007. The researchers compared patients’ time to recovery and their stability over one year.

Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. Discontinuation rates among the groups were similar-36 percent of those in the intensive programs discontinued and 31 percent of those in collaborative care discontinued. None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.

“Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person’s chances for recovering from depression and staying healthy over the long term,” said Dr. Miklowitz. “It should be considered a vital part of the effort to treat bipolar illness.”


Miklowitz D. et al. Psychosocial Treatments for Bipolar Depression. Archives of General Psychiatry. Apr 2007; 164.

[Press release from US National Institute of Health

Harvard Mental Health Letter (May 2006) has a useful article on “Drug treatment of bipolar disorder.”

Here’s the article

One of the most troublesome psychiatric disorders has begun to succumb, in part, to medications. Bipolar (manic-depressive) disorder is a challenge for physicians and psychiatrists because of its varied, severe, and constantly changing symptoms. But many drug treatments are available and can be adapted to the needs of individual patients.


*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.


The *American Journal of Psychiatry* has just released an article
scheduled to appear in a future print edition of the journal:
“Adjunctive Psychotherapy for Bipolar Disorder: State of the Evidence.”

David J. Miklowitz, Ph.D. is the author.

Here’s how the article starts:

[begin excerpt]

Despite significant strides in the pharmacological treatment of bipolar
disorder, most bipolar patients cannot be maintained on drug treatments
alone. Up to 50% of bipolar I patients do not recover from acute manic
episodes within 1 year, and only 25% achieve full recovery of function
(1). Rates of recurrence average 40%-60% in 1-2 years even when patients
undergo pharmacotherapy (2). Patients spend as much as 47% of their
lives in symptomatic states, especially depressive states (3).
Furthermore, only about 40% of patients are fully adherent with
medication regimens in the year following an episode (4).

The ceiling on the effectiveness of pharmacotherapy has led to
systematic investigations of the role of environmental stressors, and
the corresponding role of adjunctive psychosocial treatments in the
course of the disorder. Stressful life events and high levels of
familial expressed emotion are robust predictors of mood recurrences and
delayed episode recovery in bipolar illness (5, 6). Furthermore, 17 of
18 randomized, controlled trials (Table 1) have shown that individual,
family, group, and systematic care treatments are effective in
combination with pharmacotherapy in delaying relapses, stabilizing
episodes, and reducing episode length.

The Bipolar Workbook: Tools for Controlling Your Mood Swings – Monica Basco (2006) Guilford.

Kay Redfield Jamison’s book, “An Unquiet Mind“, is often helpful for people who are coming to terms with bipolar disorder. Written by a psychologist, (a well-know expert in the area) about her own personal experiences in dealing with her bi-polar disorder.