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26-03-2013 | Mental health | Article

Functional remediation shows promise in bipolar disorder

Abstract

Free abstract

medwireNews: A team of Spanish researchers has shown that functional remediation, a novel group intervention, improves functional outcome in euthymic patients with bipolar disorder as compared with standard treatment.

The investigators, led by Eduard Vieta (Hospital Clinic of Barcelona, Spain), conducted a multicenter, randomized, rater-blind trial involving 239 outpatients across 10 centers with a diagnosis of bipolar I or II disorder, aged between 18 and 55 years. Participants were divided into three groups in a 1:1:1 ratio to receive functional remediation, psychoeducation, or treatment as usual.

Functional remediation was found to yield significantly better results than treatment as usual, but the intervention fell short of significance when compared with psychoeducation.

Writing in the American Journal of Psychiatry, Vieta and colleagues say: "Functional remediation showed superiority to treatment as usual in improving psychosocial functioning at study endpoint, with an effect size within the range of most pharmacotherapies and psychosocial therapies."

The functional remediation program consisted of 21 weekly 90-minute training sessions in memory, attention, problem solving and reasoning, multitasking, and organization. Patients assigned to the psychoeducation arm received the same number of sessions, but the program focused on illness awareness, treatment adherence, early detection of symptoms of relapse, and lifestyle regularity.

All patients underwent clinical, neuropsychological, and functional assessment at baseline and at 21 weeks. The primary efficacy outcome was the change in total score on the Functioning Assessment Short Test over the study period.

To minimize the interference of mild depressive or manic symptoms on neurocognitive performance and general functioning, only patients with relatively low scores on the Hamilton Depression Rating Scale (≤8) and the Young Mania Rating Scale (≤6) were included in the study.

Interestingly, when changes on the Functional Assessment Short Test were looked at in detail, patients assigned to functional remediation were found to show significant improvement in only two of the six test domains: the interpersonal domain and the occupational domain. The authors point out that "5.4% of the patients in the functional remediation group were able to get a job, compared with none in the treatment-as-usual group."

They conclude: "The functional remediation program… seemed to help on occupational aspects [of bipolar disorder], which in turn could augment economic autonomy and decrease financial dependence on others."

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Afsaneh Gray, medwireNews Reporter

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