Preventing Recurrent Mood Episodes
Psychotherapy and psychoeducational approaches, long-term psychopharmacology, and combination therapy all play a role in preventing recurrent mood episodes.
Psychotherapeutic and Psychoeducational Approaches Are Critical
A number of studies presented at the 4th Biennial Conference of the International Society for Bipolar Disorders in Sao Paulo, Brazil in March indicated that cognitive-behavioral therapy (CBT) and individual and group psychoeducational approaches enhance both short- and long-term outcomes for patients with bipolar illness. These studies add to an already substantial literature that shows that focused psychotherapies (such as cognitive/behavioral, interpersonal, and social rhythms therapies) and psychoeducation are superior to treatment as usual.
These therapies can provide a variety of approaches to stress management and reduction, and can enhance family and interpersonal communication. Another way these focused psychotherapeutic approaches help patients is by demonstrating the benefits of effective long-term preventive treatment and encouraging its consistent use.
Without consistent prophylactic treatment, patients are at high risk for recurrences and their subsequent psychosocial and neurobiological consequences. Greater number of prior episodes is associated with an increased risk of psychosocial dysfunction, treatment resistance, cognitive dysfunction, medical comorbidities, and even dementia in old age.
After the jump: preventive psychopharmacology and combination therapy. Read more
Persistence of Mild Depression Is Risk Factor for Relapse into Full-Blown Episodes
In naturalistically treated bipolar patients, depression is three times more prevalent than manic symptoms (according to studies by Judd et al., Kupka et al., and Ezquiaga et al.). The occurrence of even residual depression or subsyndromal symptoms can be highly impairing, and is a predictor of increased likelihood for subsequent relapse, according to a poster presented by Gitlin et al. at the American Psychiatric Association meeting in San Francisco in May 2009.
These new data support that of a large number of other investigators who have made similar observations, all indicating the importance of attempting to achieve full remission as a major goal of clinical therapeutics in order to decrease likelihood of relapse. Gitlin’s study further indicated that impairment of quality of life in bipolar patients was closely related to the degree of their subsyndromal symptomatology.
