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Bipolar Affective Disorder is one of the most long-term recurrent mental health disorders. Despite the efforts in pharmacological management of bipolar disorder, relapse and residual symptoms remain a major factor in the development of illness chronicity, and long term social and occupational disability. For individuals themselves relapse is critical in the development of secondary psychological morbidity. On the basis of a review of the current literature on psychological treatments and the influence of psychological and psychosocial factors on the onset, course and outcome in bipolar disorder an integrated psychological intervention model for this clinical group is presented. This treatment approach will combine effective cognitive behavioural therapy elements and interpersonal psychotherapy components. The efficacy and effectiveness of this intervention is investigated through a clinical randomised controlled trial. The trial is comparing three conditions in an exploratory partially randomised design; a waiting list condition of treatment as usual (TAU), consisting of clinical management and psychiatric follow up, and the experimental groups of cognitive interpersonal intervention in a group and individual treatment format. Participants were randomised into the TAU or treatment group; in the treatment group participants' were offered a choice of group or individual therapy. Participants randomised to TAU were offered treatment after a six months waiting period. Those participants in the treatment group were assessed at the start of treatment, at mid-treatment, end of treatment, and at a six months and 18 months follow up using a variety of clinician rated and self rated assessments of clinical symptoms as well as relevant psychological and psychosocial factors. Clinical service data relating to service use and hospital admissions were collected for the entire group for pre and post intervention periods. Overall out of 258 referrals, 212 individuals were assessed for the study and 193 individuals started treatment, 174 participants completed the minimum number of treatment sessions, 134 were available for follow-up assessments at 6 months post treatment and 108 were available for follow-up at 18 months post treatment. The direct comparison of treatment and control group showed a large positive treatment effect of cognitive interpersonal therapy on the primary outcome, quality of life. Similarly medium to large treatment effects were shown for the secondary outcomes, indicators of bipolar symptoms, emotional distress and indicators of relapse and recurrence. Participants who completed treatment showed significant improvement in quality of life, psychiatric symptoms, and emotional distress'. Further, their relapse rates and hospital admissions as well as their use of emergency psychiatric services were significantly reduced. The analysis of psychological and psychosocial predictors established clear differential effects of psychological factors on therapeutic change and outcome in relation to depression and symptoms of mania respectively, demonstrating that the change in cognitive, interpersonal and psychosocial variables through the intervention is predictive of outcome indicators at end of treatment and follow up. The results of these analyses aid the development of a cognitive interpersonal model of bipolar affective disorder and support the development of an integrated psychological treatment aimed at this complex and chronic clinical group. |
