Adjunctive Interpersonal and Social Rhythm Therapy Aids Bipolar Patients

Marie T. Crowe, PhD

The 2020 American Psychiatric Association (APA) Annual Meeting was cancelled this year, with plans made to convert the world-leading psychiatry conference into a two-part virtual session and educational platform for attendees.

In lieu of regular on-site coverage, HCPLive® will be running a series of interviews, insights, and reporting on topics that frequently headline the APA meeting—featuring familiar experts.

Adjunctive interpersonal and social rhythm therapy (IPSRT) could lower the readmission rate of bipolar disorder patients.

A team, led by Marie Crowe, PhD, Otago Medical School, compared relapse rates at 18 months among patients with bipolar disorder who received either IPSRT or treatment as usual consisting of general practices medical are following discharge from a publicly funded mental health service in New Zealand.

The investigators examined 88 patients with either bipolar I or II disorder who were discharged during the previous 3 months.

Each patient was randomly assigned to either 18 months of IPSRT or to treatment as usual.

The investigators sough primary outcome measures of the Life Interval Follow-Up Evaluation (LIFE) completed at weeks 26, 52, and 78 of treatment and secondary measures of scores on the Social Adjustment Scale (SAS) and the Quality of Life-Bipolar Disorder Scale (QoL-BD) and readmission to mental health services.

In the intention-to-treat analysis, there were no significant differences observed in rates of mood episodes between the 2 groups (OR, 0.93; 95% CI, 0.37-2.17; P = 0.86). There was also a statistically significant different between the intervention and treatment-as-usual group in SAS scores (effect size = 0.5). but not on the QoL-BD.

There was also a significantly lower readmission rate in the intervention group.

“This pragmatic clinical effectiveness trial found that a combination of IPSRT and medication management over 18 months did not significantly improve mood relapse but did improve patient functioning,” the authors wrote.

Family involvement in psychotherapy sessions delayed onset of bipolar disorder in high-risk children and adolescents.

David Miklowitz, PhD, director of the Max Gray Child and Adolescent Mood Disorders Program of the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, and colleagues studied 127 children and teenagers to determine which of 2 types of treatment was more effective at delaying new and recurring bipolar symptoms.

Nearly 80% of the adolescents in a family-focused treatment recovered from their initial symptoms during the study period, while 65% in the educational group recovered.

The study is an important step in decreasing the severity of bipolar disorder early on for children, co-author Christopher Schneck, MD, an associate professor of psychiatry at the University of Colorado Anschutz Medical Campus, said in a statement.

The team of investigators from UCLA, the University of Colorado, and Stanford University, included 127 youths aged 9—17 years old with symptomatic mood disorder and a family history of bipolar disorder. Participants had a prior week Young Mania Rating Scale > 11 or a two-week Children’s Depression Rating Scale, Revised score > 29, which indicated at least moderate current mood symptoms.

Among the participants, 70.9% met the eight-week mood recovery criteria during follow-up, 18.1% did not, and 11% withdrew at baseline. For those in the family-focused treatment, 47 of the 61 participants (77%) recovered in a median of 24 weeks (95% CI, 17—33 weeks; P = .93) compared with 43 of 66 (65.2%) in the enhanced care group in 23 weeks (95% CI, 17—29 weeks; P = .93) (HR for FFT vs EC, 1.02; 95% CI, .67—1.54; P = .93).

High-risk participants in the family-focused treatment group had longer time between recovery and the next mood episode (HR, .55; 95% CI, .48—.92; P = .02). That group also had long intervals from randomization to the next mood episode (HR, .59; 95% CI, .35—.97; P = .03). Family-focused treatment was also associated with longer lapses in time before the next depressive episodes (HR, .53; 95% CI, .31—.88; P = .01).

The study, “Clinical Effectiveness Trial of Adjunctive Interpersonal and Social Rhythm Therapy for Patients With Bipolar Disorder,” was published online in The American Journal of Psychotherapy.