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Am Fam Physician. 2003;68(5):960-962

During the natural course of bipolar affective disorder, relapses and recurrences are frequent. Pharmacotherapy is used currently to prevent relapses and recurrences, but a significant number of patients are not protected by these medications. Few trials examine the impact that psychotherapy may have on these events. Some recent studies have shown that through psychotherapy, patients with bipolar affective disorder can recognize prodromes to their relapses. These prodromes may precede full bipolar syndrome by weeks, so early detection and intervention may keep these symptoms mild. Cognitive therapy can be used to teach patients skills to cope with bipolar affective disorder and provide better control of their symptoms. Lam and colleagues conducted a randomized controlled trial to study the effect of cognitive therapy on preventing relapses and promoting social function in patients with bipolar affective disorder.

Adult patients were assigned to receive or not receive cognitive therapy for bipolar affective disorder. Participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for bipolar 1 disorder and experienced frequent relapses despite the use of mood stabilizers. Patients with high residual symptoms or those who were in an acute episode were excluded from the study.

Patients who met the inclusion criteria were assigned randomly to the cognitive therapy (51 patients) or control group (52 patients). Those in the control group received minimal psychiatric care, including the use of mood stabilizers at a recommended level and regular psychiatric follow-up as outpatients. Patients assigned to cognitive therapy received the same minimal psychiatric care plus cognitive therapy. The cognitive therapy consisted of 12 to 18 individual sessions within the first six months and two booster sessions in the second six months and was designed to prevent relapse. All participants were assessed using multiple standardized questionnaires every six months during the study.

Patients in the cognitive therapy group had significantly fewer bipolar episodes, days in bipolar episodes, and number of admissions for these episodes compared with the control group. The cognitive therapy group also had fewer mood symptoms and functioned at a higher social level than patients in the control group. In addition, patients receiving cognitive therapy coped better with manic prodromes and had less fluctuation of their manic symptoms.

The authors conclude that cognitive therapy specifically designed to prevent relapse in patients with bipolar affective disorder successfully reduces symptoms and improves social functioning. Cognitive therapy also has beneficial effects when used in conjunction with pharmacotherapy; this is particularly true in patients with frequent relapses of bipolar symptoms.

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