Section 4: Nonpharmacologic Treatment Approaches

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Section 4 Nonpharmacologic Treatment Approaches
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Goals of Psychotherapy

• Establish and maintain a therapeutic alliance
• Provide education about the disease and its
  treatment
• Promote regular patterns of activity and sleep
• Identify cognitive distortions linked with
  depression
• Identify sources of interpersonal discord (eg,
  expressed emotion) and promote healthy responses
  to stress
• Detect early warning signs of mood episodes
• Minimize the negative impact of the illness
• Promote the regular use of medications

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Enhancement of Adherence and Improving Illness
Outcome in Bipolar Disorder

• Patients with bipolar disorder are often poorly
  adherent to their medical regimens
• While psychotherapy for bipolar disorder is known
  to generally improve illness outcome, it has been
  reported that interventions that focus on
  treatment adherence may yield positive results in
  this specific area

Cochran SD. J Consult Clin Psychol.
198452873-878. Colom F. Bipolar Disord.
20024(suppl 1)102.
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Psychosocial Treatment Options

• Brief technique-driven interventions 6 to 12
  individual sessions
• Cognitive therapy
• Interpersonal social rhythm therapy (IPSRT)
• Family or couples therapy
• Group psychoeducation

Scott J, et al. Psychiatr Clin North Am.
200528371-384.
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Evidence-Based Therapies

• Impact on relapse and rehospitalization rates
• Group psychoeducation
• 25 hospitalized vs 35 in unstructured group1
• Cognitive behavioral therapy (CBT)
• 1 year relapse 44 vs 75 usual care2
• 2-year follow-up found no reduction in relapse
  rates after first 6 months 3
• Family focused treatment (FFT)
• 2 year relapse 28 with FFT vs 60 with
  individual support4
• Perceived criticism may be an indicator 5

1. Colom F, et al. Arch Gen Psychiatry.
200360402-407. 2. Lam DH, et al. Arch Gen
Psychiatry. 200360145-152. 3. Lam DH, et al. Am
J Psychiatry. 2005162324-329. 4. Rea MM, et al.
J Consult Clin Psychol. 200371482-492. 5.
Miklowitz DJ, et al. Psychiatry Res.
2005136101-111.
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Interpersonal Social Rhythm Therapy Focus

• IPSRT focuses on
• The link between mood and life events
• The importance of maintaining regular daily
  rhythms
• The identification and management of potential
  precipitants of rhythm dysregulation with
  attention to interpersonal triggers
• The identification and management of affective
  symptoms

Frank E, et al. Biol Psychiatry. 200048593-604.
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Benefits of Psychotherapy Interventions

• Adjustment to Dx and Rx
• Enhanced adherence
• Improved self-esteem
• Reduced risky behaviors
• Modification of destabilizing biopsychosocial
  factors
• Management of stressors
• Learning coping strategies
• Early recognition
• Modification attitudes/beliefs

Scott J, Gutierrez MJ. Bipolar Disord.
20046498-503.
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Psychotherapy Reduces Relapse Rate
0.1
1
10
1
Logarithmic scale of odds ratio
Favors therapy
Significant reduction in relapse rate (40)
compared to standard treatment alone.
Scott J, et al. Intl J Neuropsychopharmacol.
200710123-129.