MedWire News: The addition of psychotherapy to treatment as usual (TAU) may help reduce symptoms of depression and overall symptom severity in young people who have experienced a first episode of psychotic mania, say researchers.
"A number of important studies have emerged in the last decade that indicate the potential benefit of psychological interventions on a number of aspects of bipolar disorder including symptomatology, medication adherence, relapse rates, and social and occupational functioning," observe Craig Macneil (Orygen Research Centre, Melbourne, Victoria, Australia) and team.
But they add that "there has been a significant lack of psychotherapy research involving young people, and people early in the course of bipolar disorder."
To address this, the researchers studied 40 young people, aged 15-25 years, who had experienced a first episode of psychotic mania. Of these, 20 received TAU, consisting of standard case management and pharmacotherapy, plus a manualized psychological intervention (psychotherapy group) and 20 received TAU alone (controls).
The team explains that the eight-module psychological intervention was developed specifically to account for challenges experienced by young people early in the course of bipolar disorder, and focused on developmental factors that could impact on engagement, adaptation to the disorder, treatment adherence, and functioning.
All of the participants were assessed at baseline and at 18-month follow-up using the Montgomery Asberg Depression Rating Scale (MADRS), the 21-item Hamilton Depression Rating Scale (HAMD-21), the Young Mania Rating Scale (YMRS), and the symptom severity subscale of the Clinical Global Impression scale (CGI-S). They were also assessed at both time points using the Global Assessment of Functioning (GAF), and the Social and Occupational Functioning Assessment Scale (SOFAS).
The researchers found that patients in the psychotherapy group and controls experienced a significant reduction in mean YMRS scores between baseline and follow-up, from 34.2 to 6.0, and from 35.2 to 6.9, respectively, with no significant difference between the groups.
However, patients in the psychotherapy group experienced significantly greater reductions in mean depression scores and overall symptom severity than controls. Specifically, among patients in the psychotherapy group, MADRS scores fell from 12.4 to 4.2, HAMD scores from 9.8 to 2.3, and CGI-S scores from 5.3 to 1.6. In controls, these scores fell from 10.1 to 7.7, from 7.0 to 6.3, and from 5.5 to 2.7, respectively.
Patients in the psychotherapy group also experienced greater improvements in functioning than controls, with GAF scores increasing from 33.8 to 70.8 versus 33.5 to 56.8, respectively, and SOFAS scores increasing from 39.3 to 72.0 versus 36.8 to 56.9, respectively.
Macneil and team conclude in Early Intervention in Psychiatry: "This study suggests that a manualized psychological intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional outcome following a first episode of psychotic mania."
They add: "These findings are promising, given that many people with bipolar disorder and schizoaffective disorder experience significant levels of subsyndromal symptoms long after syndromal recovery, and struggle to achieve functional recovery through the initial years of their disorders."
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
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