Am Fam Physician. 2004 Jun 1;69(11):2668.
Multiple medications are available to stabilize acute symptoms of bipolar I disorder. Unfortunately, even when these medication regimens are maximized, patients still are at substantial risk for symptom recurrence. In a significant number of patients with bipolar I disorder, symptoms recur within two years, and approximately one half of patients have significant inter-episode symptoms. In addition, patients with bipolar disorder who receive mood stabilizers often have significantly impaired work, family, and social relationships after their acute symptoms have resolved. This information led the National Institute of Mental Health to recommend that research in bipolar disorder concentrate on developing adjuvant psychosocial interventions. The primary objective for this adjuvant therapy is to prevent relapses, reduce interepisode symptoms, and encourage consistency with medication use. One such adjuvant treatment that has shown promise is family therapy. Miklowitz and colleagues evaluated a family-focused therapy program for patients with bipolar disorder to determine its impact on the period of remission, mood symptoms, and medication compliance.
This randomized controlled study involved patients with a diagnosis of bipolar disorder, including manic, mixed, or depressed episodes, within the past three months. These diagnoses were established using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 3d ed., rev. Study participants were living with or had regular contact with a care-giving family member. Patients were randomized to receive family-focused therapy along with pharmacotherapy, or crisis management intervention and pharmacotherapy. The family-focused therapy, which consisted of 21 sessions over nine months, included psychoeducation, communication training, and problem-solving–skills training involving all family members. The crisis management intervention consisted of two one-hour, home-based sessions within the first two months, followed by availability to receive crisis intervention on an as-needed basis. Main outcome measures included time to relapse, depressive and manic symptoms, and medication adherence. Outcome assessments were performed every three to six months for two years.
There were 101 patients who met inclusion criteria for the study. The family-focused therapy and crisis management groups had similar rates of study completion. Patients enrolled in the family-focused therapy group had significantly fewer relapses and longer survival intervals compared with patients in the crisis management group. In addition, the family-focused therapy group had a greater reduction in mood disorders. With regard to medication compliance, the two groups were similar at the start of the study but, over time, patients in the family-focused therapy group had significantly better rates of compliance.
The authors conclude that combining family psychoeducation with pharmacotherapy in the treatment of bipolar disorder after an acute episode reduces relapse rates and improves symptoms and medication compliance. They add that psychosocial interventions are no substitute for pharmacotherapy but may augment therapy with mood stabilizers.
Miklowitz DJ, et al. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. September 2003;60:904–12.
Copyright © 2004 by the American Academy of Family Physicians.
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