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More on a Psychotherapy for Bipolar Disorder

The presence of medical and anxiety comorbidities altered the effectiveness of interpersonal and social rhythms therapy.

Mood-stabilizing medications constitute the cornerstone of treatment for bipolar disorder, but they rarely are curative. These investigators studied the relative efficacy of two manual-based psychotherapies. Interpersonal and social rhythms therapy (IPSRT) combines interpersonal therapy, facilitation of mourning for the person the patient would have been without illness, and careful attention to circadian cues (e.g., mealtime and bedtime). Intensive clinical management (ICM) includes education about the illness and sleep hygiene, nonspecific support, and attention to physical symptoms and adverse effects. Both acute treatment (through 4 weeks of remission) and maintenance (27 months) were studied.

The researchers randomized 175 acutely ill bipolar I or schizoaffective patients to receive one of four sequences: acute and maintenance IPSRT, acute and maintenance ICM, acute IPSRT and maintenance ICM, and acute ICM and maintenance IPSRT. All patients underwent a standardized medication regimen.

In medically healthy patients without comorbid anxiety disorders, acute IPSRT was associated with a longer time to recurrence (during the maintenance phase) that was statistically and clinically significant (effect size, 1.76). Improved social rhythms appeared to mediate this reduced recurrence risk. In patients with medical or anxiety comorbidities, acute IPSRT was associated with more rapid recurrence during the follow-up, compared with ICM. Medication adherence or type of maintenance psychotherapy did not affect recurrence risk.

Comment: IPSRT requires time-consuming attention to social rhythms, and acutely ill patients may be highly motivated; once they start the protocol, they seem to continue with it, which presumably helps to stabilize mood as well as circadian rhythms. Patients with significant medical or anxiety comorbidity may find ICM (with its attention to physical functioning) more compatible with their understanding of their condition. It remains to be seen whether maintenance IPSRT is even necessary and whether medically ill bipolar patients would benefit from combining features of the two psychotherapies.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry October 19, 2005

Citation(s):

Frank E et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005 Sep; 62:996-1004.

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