Abstract
BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive-behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
Highlights
Few trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional metaanalyses provided limited comparisons between therapies
Psychosocial therapies are recommended as an adjunctive treatment to medications in many guidelines,[9,10,11] to reduce relapse to acute depression or mania, potentially through improved medication adherence, identification of early warning signs, self-management and family communication.[12]. These psychosocial therapies have been evaluated through randomised controlled trials (RCTs) and meta-analyses with mixed results
Previous systematic reviews and meta-analyses were based on small numbers of studies,[13,14] were limited to particular interventions (e.g. cognitive–behavioural therapy (CBT) only),[15] did not cover key peripheral indicators of recovery and did not adjust for study characteristics such as the control groups.[16]
Summary
Few trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional metaanalyses provided limited comparisons between therapies. Aims To combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA). Method Systematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF). Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores
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