Abstract
BackgroundDespite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan.AimThe purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan.MethodsThirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients.ResultsRetention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88).ConclusionsCulturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings.Trial registration. Clinicaltrials.gov identifier NCT02210390
Highlights
Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high
Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with Treatment As Usual (TAU)
In the culturally adapted bipolar psychoeducation programme (CaPE) group, 22.2% or participants had over three previous hospital admissions compared to 37.5% of the TAU group (Table 2)
Summary
Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. Despite the use of maintenance drug treatment, recurrence rates of bipolar disorder are high; a recent meta-analysis of long-term naturalistic studies reported a mean risk of at least one Husain et al Int J Bipolar Disord (2017) 5:3 new syndromal BD episode of 55.2% (26.3%/year) with clinically determined treatments (Vázquez et al 2015). A recent meta-analysis suggests that pharmacotherapy plus psychological intervention may significantly reduce recurrence rates and hospital admissions (Oud et al 2016)
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