Group Psychoeducation Helpful in Bipolar Disorder

Laurie Barclay, MD

April 17, 2003

April 17, 2003 — Group psychoeducation is effective in preventing recurrence in patients with bipolar I or II disorder receiving standard medical therapy, according to the results of a study published in the April issue of the Archives of General Psychiatry. According to the editors, this study is important because of the controlled design, the long follow-up period of 24 months, and the disease severity in its subjects.

"Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients," write Francesco Colom, PhD, and colleagues from the Hospital Clinic de Barcelona in Spain. "However, there has been a lack of structured, well-designed, blinded, controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder."

This study enrolled 120 bipolar I and II outpatients in remission for at least six months, with Young Mania Rating Scale score less than 6 and Hamilton Depression Rating Scale–17 score less than 8. After matching for age and sex, subjects were randomized to receive 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings, in addition to standard psychiatric care. Group psychoeducation focused on early detection of prodromal symptoms, enhancement of treatment compliance, and induction of lifestyle regularity.

Compared with the nonstructured group, the psychoeducation group had significantly fewer relapsed patients and recurrences per patient, and increased time to depressive, manic, hypomanic, and mixed recurrences. During treatment, 36 patients (60%) in the control group had recurrence of mania, hypomania, mixed episode, or depression compared with 23 patients (38%) in the psychoeducation group (P < .05). At two-year follow-up, 55 subjects (92%) in the control group met criteria for recurrence, compared with 40 subjects (67%) in the psychoeducation group (P < .001).

Although the number of patients who needed hospitalization was comparable in both groups, the number of hospitalizations per patient and the number of days of hospitalization were significantly lower in the psychoeducated group.

"Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder," the authors write. "The effectiveness of psychoeducation appears to be patent very early, as shown by the lower number of recurrences during treatment, but its effect lasts for a long time.... Psychoeducation may not be enough to help some patients avoid hospitalization but may facilitate early detection of an episode and thereby decrease the severity of the episode."

Arch Gen Psychiatry. 2003;60:402-407

Reviewed by Gary D. Vogin, MD

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