Psychoeducation Efficacy in Bipolar Disorders: Beyond Compliance Enhancement
J Clin Psychiatry 2003;64(9):1101-1105
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Several previous studies have
established that low treatment adherence is common among bipolar
patients and may explain high rates of recurrence. On the other
hand, some patients keep relapsing even when they strictly follow
their prescribed somatic treatments. Psychological interventions
such as psychoeducation may foster early recognition of prodromal
symptoms and minimize the risk of relapse. To date, studies
assessing the usefulness of psychoeducation in fully compliant
patients are lacking.
Method: This was a single-blind,
randomized, prospective clinical trial on the efficacy of group
psychoeducation in remitted fully compliant DSM-IV bipolar I
patients (N = 25) who were compared with a group with similar
characteristics (N = 25) who did not receive psychoeducation. All
patients received naturalistic pharmacologic treatment.
Recruitment began in 1997 and follow-up was completed in January
2002. The follow-up phase comprised 2 years during which all
patients continued receiving naturalistic treatment without
psychological intervention and were assessed monthly on several
Results: At the end of the 2-year
follow-up, 23 subjects (92%) in the control group fulfilled
criteria for recurrence versus 15 patients (60%) in the
psychoeducation group (p < .01). The number of total
recurrences and the number of depressive episodes were
significantly lower in psychoeducated patients.
Conclusion: Although the present study has the
limitation of small sample size, psychoeducation showed its
efficacy in preventing relapses in bipolar I patients who were
adherent to drug treatment. The action of psychoeducation seems
to go beyond compliance enhancement and may support a tripod
model composed by lifestyle regularity and healthy habits, early
detection of prodromal signs followed by prompt drug
intervention, and finally treatment compliance.