Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). A Randomized Controlled Trial of Cognitive Behavioral Group Therapy for Bipolar Disorder A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment A brief dyadic group based psychoeducation program improves relapse rates in recently remitted bipolar disorder: a pilot randomised controlled trial. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Augmenting psychoeducation with a mobile intervention for bipolar disorder: a randomized controlled trial. The impact of staging bipolar disorder on treatment outcome of family psychoeducation. Preventing recurrence of bipolar I mood episodes and hospitalizations: family psychotherapy plus pharmacotherapy versus pharmacotherapy alone. Effectiveness of individual psychoeducation on recurrence in bipolar disorder; a controlled study. Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. Long-term effectiveness and cost of a systematic care program for bipolar disorder. Disrupting the rhythm of depression using Mobile Cognitive Therapy for recurrent depression: randomized controlled trial design and protocol A history of substance abuse complicates remission from acute mania in bipolar disorder. A web-based preventive intervention program for bipolar disorder: outcome of a 12-months randomized controlled trial. Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Online psycho-education to the treatment of bipolar disorder: protocol of a randomized controlled trial
OBJECTIVE Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines . The authors looked for the features associated with risk of recurrence . METHOD The authors examined prospect i ve data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) study for up to 24 months . For those who were symptomatic at study entry but subsequently achieved recovery , time to recurrence of mania , hypomania , mixed state , or a depressive episode was examined with Cox regression . RESULTS Of 1,469 participants symptomatic at study entry , 858 ( 58.4 % ) subsequently achieved recovery . During up to 2 years of follow-up , 416 ( 48.5 % ) of these individuals experienced recurrences , with more than twice as many developing depressive episodes ( 298 , 34.7 % ) as those who developed manic , hypomanic , or mixed episodes ( 118 , 13.8 % ) . The time until 25 % of the individuals experienced a depressive episode was 21.4 weeks and until 25 % experienced a manic/hypomanic/mixed episode was 85.0 weeks . Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence . Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic , hypomanic , or mixed episode recurrence . CONCLUSIONS Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery . Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence Background : This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy ( CBGT ) to prevent recurrence of episodes in euthymic patients with bipolar disorder . Methods : A r and omized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission . An experimental CBGT manual was developed and added to treatment as usual ( TAU ) , and results were compared with TAU alone . Results : Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse ( Wilcoxon = 0.667 ; p = 0.414 ) . When considering type of relapse , there was still no difference in either depressive ( Wilcoxon = 3.328 ; p = 0.068 ) or manic episodes ( Wilcoxon = 1.498 ; p = 0.221 ) . Although occurrence of episodes also did not differ between groups ( χ2 = 0.28 ; p = 0.59 ) , median time to relapse was longer for patients treated with CBGT compared to TAU ( Mann-Whitney = –2.554 ; p = 0.011 ) . Conclusions : Time to recurrence and number of episodes were not different in the group of patients treated with CBGT . However , median time to relapse was shorter in the TAU group . Studies with larger sample s may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder . Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies . To our knowledge , this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder BACKGROUND Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients . However , there has been a lack of structured , well- design ed , blinded , controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder . METHODS One hundred twenty bipolar I and II out patients in remission ( Young Mania Rating Scale score < 6 , Hamilton Depression Rating Scale-17 score < 8) for at least 6 months prior to inclusion in the study , who were receiving st and ard pharmacologic treatment , were included in a controlled trial . Subjects were matched for age and sex and r and omized to receive , in addition to st and ard psychiatric care , 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings . Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up . RESULTS Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient , and increased the time to depressive , manic , hypomanic , and mixed recurrences . The number and length of hospitalizations per patient were also lower in patients who received psychoeducation . CONCLUSION Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder Abstract Objective : To determine the efficacy of teaching patients with bipolar disorder ( manic-depressive psychosis ) to identify early symptoms of relapse and seek prompt treatment from health services . Design : Single blind r and omised controlled trial with matching on four baseline variables using a minimisation algorithm . Setting : Mental health services in four NHS trusts ( one teaching , three non-teaching ) . Subjects : 69 patients with bipolar disorder who had had a relapse in the previous 12 months . Interventions : Seven to 12individual treatment sessions from a research psychologist plus routine care or routine care alone . Main outcome measures : Time to first manic or depressive relapse , number of manic or depressive relapses , and social functioning examined by st and ardised interviews every six months for 18 months . Results : 25th centile time to first manic relapse in experimental group was 65weeks compared with 17weeks in the control group . Event curves of time to first manic relapse significantly differed between experimental and control groups ( log rank 7.04 , df=1 , P=0.008 ) , with significant reductions in the number of manic relapses over 18months ( median difference 30 % ( 95 % confidence interval 8 % to 52 % ) , P=0.013 ) . The experimental treatment had no effect on time to first relapse or number of relapses with depression , but it significantly improved overall social functioning ( mean difference 2.0(0.7to 3.2 ) , P=0.003 ) and employment ( mean difference 0.7(0.1to 1.3 ) , P=0.030 ) by 18months . Conclusion : Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse , social functioning , and employment BACKGROUND Various adjunctive psychotherapies assist in decreasing relapse and improving outcomes for people with bipolar disorder ( BD ) .  Psychoeducation programs involving patient-only or caregiver-only groups have demonstrated some efficacy . We tested in recently remitted BD if a combined group based psychoeducation program involving patient-companion dyads decreased relapse . METHOD 58 recently remitted BD out- patients were r and omised to receive either treatment as usual ( TAU , n=31 ) or 12 x 90 minute psychoeducation sessions delivered weekly in a group program to the patient and companion ( SIMSEP , n=27 ) . After 12 weeks SIMSEP patients reverted to TAU and all patients were followed until week 60 or relapse . The primary outcome measure was relapse requiring hospital or intensive community intervention . RESULTS 45 patients completed the study . 29 patients remained well at week 60 ( SIMSEP n=17 , TAU n=12 ) , whilst 16 had relapsed ( SIMSEP n=3 , TAU n=13 ) . The SIMSEP group were less likely to relapse ( Fisher 's exact test p=0.013 ; OR=0.16 ; 95 % CI 0.04 - 0.70 ) and had an 11 week longer time to relapse compared to the TAU group ( chi-square (1)=8.48 , p<0.01 ) . At study completion SIMSEP compared to TAU patients had lower Young Mania Rating Scale scores ( Mann-Whitney U=255 , p<0.01 ) . LIMITATIONS The study was limited by a small sample size . CONCLUSION A brief group psychoeducation program with recently remitted BD patients and their companions result ed in a decreased relapse rate , longer time to relapse , decreased manic symptoms and improved medication adherence suggesting utility in the adjunctive psychotherapeutic treatment of BD OBJECTIVE Although there are some r and omized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder , no trials using contemporary method ologies have analyzed the specific effect of working with caregiver-only groups . The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients . METHOD A total of 113 medicated euthymic bipolar out patients who lived with their caregivers were r and omized into an experimental and a control group . Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills . The patients did not attend the groups . Caregivers assigned to the control group did not receive any specific intervention . Patients were assessed monthly during both the intervention and the 12 months of follow-up . The primary outcome was time to any mood recurrence . RESULTS Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence ( chi2 = 6.53 ; p = 0.011 ) and longer relapse-free intervals ( log-rank chi(2 ) = 4.04 ; p = 0.044 ) . When different types of episodes were analyzed separately , the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence ( chi2 = 5.65 ; p = 0.017 ) and the time to such an episode ( log-rank chi2 = 5.84 ; p = 0.015 ) . The differences in preventing depressive and mixed episodes were not significant . CONCLUSIONS A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences , particularly mania and hypomania , in bipolar disorder BACKGROUND Psychosocial interventions for bipolar disorder are frequently unavailable and re source intensive . Mobile technology may improve access to evidence -based interventions and may increase their efficacy . We evaluated the feasibility , acceptability and efficacy of an augmentative mobile ecological momentary intervention targeting self-management of mood symptoms . METHODS This was a r and omized single-blind controlled trial with 82 consumers diagnosed with bipolar disorder who completed a four-session psychoeducational intervention and were assigned to 10 weeks of either : 1 ) mobile device delivered interactive intervention linking patient-reported mood states with personalized self-management strategies , or 2 ) paper- and -pencil mood monitoring . Participants were assessed at baseline , 6 weeks ( mid-point ) , 12 weeks ( post-treatment ) , and 24 weeks ( follow up ) with clinician-rated depression and mania scales and self-reported functioning . RESULTS Retention at 12 weeks was 93 % and both conditions were associated with high satisfaction . Compared to the paper- and -pencil condition , participants in the augmented mobile intervention condition showed significantly greater reductions in depressive symptoms at 6 and 12 weeks ( Cohen׳s d for both were d=0.48 ) . However , these effects were not maintained at 24-weeks follow up . Conditions did not differ significantly in the impact on manic symptoms or functional impairment . LIMITATIONS This was not a definitive trial and was not powered to detect moderators and mediators . CONCLUSIONS Automated mobile-phone intervention is feasible , acceptable , and may enhance the impact of brief psychoeducation on depressive symptoms in bipolar disorder . However , sustainment of gains from symptom self-management  mobile interventions , once stopped , may be limited BACKGROUND Psychological interventions on top of pharmacological treatment can improve the outcome of bipolar disorder . However , there is a paucity of data on the aspects that may influence the effectiveness of psychological approaches to bipolar disorders . The staging models suggest a progression from prodromal to more severe and treatment-resistant presentations . The aim of this study was to assess whether a staging model in bipolar disorder was related to patients ' response to psychoeducation delivered to caregivers . METHODS Post-hoc analysis from a 15-month r and omized controlled trial showing the efficacy of group psychoeducation for caregivers in the prophylaxis of recurrences . The sample was composed of 113 medicated euthymic bipolar out patients who lived with their caregivers . For the purpose of this study the patients were subdivided into two groups according to staging . The prophylactic efficacy of  caregiver psychoeducation  was studied based on staging . RESULTS Patients on Stage I benefited from  caregiver psychoeducation  by having longer time to recurrence ( Log-rank chi-square : 6.26 ; p=0.012 ) . No significant benefits from  caregiver psychoeducation  were found in patients on advanced stages . LIMITATIONS The present post-hoc analysis was not properly powered to compare each one of the four stages with each other , instead staging was divided into Stage I and advanced stages ( II , III or IV ) . CONCLUSIONS Psychoeducation for caregivers of bipolar patients on Stage I may improve long-term outcome in terms of time to recurrence . This study highlights the need to introduce psychological interventions early in the course of the illness as some treatments may be more useful in patients at earlier stages of bipolar disorder OBJECTIVES This study compared the efficacy of three treatment conditions in preventing recurrence of  bipolar I mood episodes  and hospitalization for such episodes : individual family therapy plus pharmacotherapy , multifamily group therapy plus pharmacotherapy , and pharmacotherapy alone . METHODS Patients with bipolar I disorder were enrolled if they met criteria for an active mood episode and were living with or in regular contact with relatives or significant others . Subjects were r and omly assigned to individual family therapy plus pharmacotherapy , multifamily group therapy plus pharmacotherapy , or pharmacotherapy alone , which were provided on an outpatient basis . Individual family therapy involved one therapist meeting with a single patient and the patient 's family members , with the content of each session and number of sessions determined by the therapist and family . Multifamily group psychotherapy involved two therapists meeting together for six sessions with multiple patients and their respective family members , with the content of each session preset . All subjects were prescribed a mood stabilizer , and other medications were used as needed . Subjects were assessed monthly for up to 28 months . Following recovery from the index mood episode , subjects were assessed for recurrence of a mood episode and for hospitalization for such episodes . RESULTS Of a total of 92 subjects that were enrolled in the study , 53 ( 58 % ) recovered from their intake mood episode . The analyses in this report focus upon these 53 subjects , 42 ( 79 % ) of whom entered the study during an episode of mania . Of the 53 subjects who recovered from their intake mood episode , the proportion of subjects within each treatment group who suffered a recurrence by month 28 did not differ significantly between the three treatment conditions . However , only 5 % of the subjects receiving adjunctive multifamily group therapy required hospitalization , compared to 31 % of the subjects receiving adjunctive individual family therapy and 38 % of those receiving pharmacotherapy alone , a significant difference . Time to recurrence and time to hospitalization did not differ significantly between the three treatment groups . CONCLUSION For patients with bipolar I disorder , adjunctive multifamily group therapy may confer significant advantages in preventing hospitalization for a mood episode This research was conducted as an controlled experimental study which aim ed to determine the effectiveness of individual psychoeducation program on recurrence rate during 1year follow up period . The study included eighty-two patients who had been diagnosed with bipolar disorder . There were no hospitalizations in intervention group , while 7.3 % of control patients experienced hospitalizations ; recurrence rates were 18.9 % in the intervention group patients and 34.1 % in the control group patients , but statistical significant difference between the groups was not found . Four sessions of individual psychoeducation may have some positive effects but seem to be ineffective for preventing recurrences in patients with bipolar disorder during one year prospect i ve follow up OBJECTIVE To determine if the repeated occurrence of manic episodes in bipolar I disorder ( BD-I ) patients is associated with reduced cognitive performance , which could in turn imply a worsening in the disorder 's evolution . METHOD Cognitive performance in euthymic patients was assessed using  attention , memory , and executive function tests  on 24 BD-I patients who had experienced only 1 manic episode , on 27 BD-I patients with 2 manic episodes , on 47 BD-I patients with 3 or more manic episodes , and on 66 healthy control subjects . RESULTS In BD-I patients , number of manic episodes was positively associated with poorer performance on neurocognitive tests , an association that was not accounted for by depression , disease chronicity , onset , or medication . Significant differences in attention and executive function were found between patients and controls and in those patients who had had just 1 manic episode compared to those who had 3 or more . CONCLUSION The number of manic episodes predicted poor cognitive performance , suggesting that the recurrence of mania may have a long-term neuropsychological impact . Prospect i ve follow-up studies need to be completed to explore this effect further as better treatment adherence may have a protective effect on neurocognitive function CONTEXT Despite the availability of efficacious treatments , the long-term course of bipolar disorder is often unfavorable . OBJECTIVE To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder . DESIGN R and omized controlled trial with allocation concealment and blinded outcome assessment . SETTING Mental health clinics of a group-model prepaid health plan . PATIENTS Of 785 patients in treatment for bipolar disorder who were invited to participate , 509 attended an evaluation appointment , 450 were found eligible to participate , and 441 enrolled in the trial . INTERVENTIONS Participants were r and omly assigned to a multicomponent intervention program or to continued care as usual . Three nurse care managers provided a 2-year systematic intervention program , including the following : a structured group psychoeducational program , monthly telephone monitoring of mood symptoms and medication adherence , feedback to treating mental health providers , facilitation of appropriate follow-up care , and as-needed outreach and crisis intervention . MAIN OUTCOME MEASURES In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination . Health plan administrative records were used to assess the use and cost of mental health services . RESULTS Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms ( z = 2.09 , P = .04 ) and the time with significant mania symptoms ( 19.2 vs 24.7 weeks ; F(1 ) = 6.0 , P = .01 ) . There was no significant intervention effect on mean level of depressive symptoms ( z = 0.19 , P = .85 ) or time with significant depressive symptoms ( 47.6 vs 50.7 weeks ; F(1 ) = 0.56 , P = .45 ) . Benefits of the intervention were found only in a subgroup of 343 persons with clinical ly significant mood symptoms  at the baseline assessment . The incremental cost ( adjusted ) of the intervention was 1251 dollars ( 95 % confidence interval , 55 - 2446 dollars ) , including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services . CONCLUSIONS Population -based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder , and cost increases are modest considering the clinical gains . The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression Background Major depressive disorder ( MDD ) is projected to rank second on a list of 15 major diseases in terms of burden in 2030 . The major contribution of MDD to disability and health care costs is largely due to its highly recurrent nature . Accordingly , efforts to reduce the disabling effects of this chronic condition should shift to preventing recurrence , especially in patients at high risk of recurrence . Given its high prevalence and the fact that interventions are necessary during the remitted phase , new approaches are needed to prevent relapse in depression . Methods / design The best established effective and available psychological intervention is cognitive therapy . However , it is costly and not available for most patients . Therefore , we will compare the effectiveness and cost-effectiveness of self-management supported by online CT accompanied by SMS based tele-monitoring of depressive symptomatology , i.e. Mobile Cognitive Therapy ( M-CT ) versus treatment as us usual ( TAU ) .  Remitted patients ( n = 268 ) with at least two previous depressive episodes will be recruited and r and omized over ( 1 ) M-CT in addition to TAU versus ( 2 ) TAU alone , with follow-ups at 3 , 12 , and 24 months . R and omization will be stratified for number of previous episodes and type of treatment as usual . Primary outcome is time until relapse/recurrence over 24 months using DSM-IV-TR criteria as assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders ( SCID ) . For the economic evaluation the balance between costs and health outcomes will be compared across strategies using a societal perspective . Discussion Internet-based interventions might be helpful in empowering patients to become their own disease managers in this lifelong recurrent disorder . This is , as far as we are aware of , the first study that examines the ( cost ) effectiveness of an E-mental health program using SMS monitoring of symptoms with therapist support to prevent relapse in remitted recurrently depressed patients .Trial registration Netherl and s Trial Register ( NTR ) : BACKGROUND Substance abuse frequently complicates the course of bipolar illness , promotes mixed states , and contributes to poor outcome in mania . Preliminary open trials suggest that anticonvulsant mood stabilizers may enhance remission rates and outcome for bipolar patients with substance abuse . This study compared remission patterns for mixed or pure manic episodes among bipolar in patients with or without substance abuse histories . METHOD Hospital records were retrospectively review ed for 204 DSM-III-R bipolar I in patients . Clinical features were compared for those with or without substance abuse/dependence histories predating the index manic episode . Time until remission was analyzed by Kaplan-Meier survival analysis . Naturalistic treatment outcome with lithium or anticonvulsant mood stabilizers was compared for those with or without past substance abuse . RESULTS Past substance abuse was evident in 34 % of the bipolar sample and comprised most often alcoholism ( 82 % ) , followed by cocaine ( 30 % ) , marijuana ( 29 % ) , sedative-hypnotic or amphetamine ( 21 % ) , and opiate ( 13 % ) abuse . Substance abuse was more common among men ( p < .05 ) and those with mixed rather than pure mania ( p < .05 ) . Remission during hospitalization was less likely among patients with prior substance abuse ( p < .05 ) , especially alcohol or marijuana abuse , and among mixed manic patients with past substance abuse ( p < .05 ) . Bipolar patients with substance abuse histories who received divalproex or carbamazepine  remitted during hospitalization more often than did those who received lithium as the sole mood stabilizer ( p < .05 ) . CONCLUSION These findings support previous reports suggesting that bipolar patients with past substance abuse have poorer naturalistic treatment outcomes , but may show a better response to anticonvulsant mood stabilizers than lithium BACKGROUND The Internet is used to deliver information on many psychiatric disorders such as bipolar disorder . This paper reports on the results of a 12-months r and omised controlled trial , which examined the efficacy of an Internet-based preventive program for bipolar disorder , adjunctive to usual pharmacological management . METHODS Participants were recruited by completing an online screening question naire accessed through the Black Dog Institute and Sentiens websites based in Australia . The treatment was predominantly psycho-educational with cognitive behavioral therapy optional elements . The attention control treatment comprised directing subjects to a variety of websites focused on ' healthy living ' . Time to recurrence was determined using Kaplan-Meier survival analysis . The main outcome measures were recurrence as defined by : ( i ) depressive and /or hypomanic symptomatology and functional capacity ( using Beck Depression Inventory , Internal State Scale and Sheehan Disability Scale ) and ( ii ) hospitalization . RESULTS Two-hundred- and -thirty-three subjects were r and omized to the active or control treatment groups . There were no significant differences between the active and control treatment groups on any of the definitions of recurrence . LIMITATIONS Reliance on an online self-report tool to confirm diagnosis and hospitalization rates may have potentially allowed for inclusion of individuals with other diagnoses such as borderline personality disorder . The ' attention control ' treatment may have included more ' active ' components than intended . CONCLUSIONS This is the first report examining the efficacy of a r and omized controlled web-based psychological intervention in a large sample of subjects with bipolar disorder . The potential reasons for failing to demonstrate a significant difference compared to the active control are discussed BACKGROUND The efficacy of adjunctive psychosocial interventions such as cognitive behaviour therapy ( CBT ) for bipolar disorder ( BD ) has been demonstrated in several uncontrolled and controlled studies . However , these studies compared CBT to either a waiting list control group , brief psycho-education or treatment as usual ( TAU ) . Our primary aim was to determine whether CBT is superior to supportive therapy ( ST ) of equal intensity and frequency in preventing relapse and improving outcome at post-treatment . A secondary aim was to look at predictors of survival time . METHOD We conducted a r and omized controlled trial ( RCT ) at the Department of Psychology , University of Tübingen , Germany ( n=76 patients with BD ) . Both CBT and ST consisted of 20 sessions over 9 months . Patients were followed up for a further 24 months . RESULTS Although changes over time were observed in some variables , they were not differentially associated with CBT or ST . CBT showed a non-significant trend for preventing any affective , specifically depressive episode during the time of therapy . Kaplan-Meier survival analyses revealed that 64.5 % of patients experienced a relapse during the 33 months . The number of prior episodes , the number of therapy sessions and the type of BD predicted survival time . CONCLUSIONS No differences in relapse rates between treatment conditions were observed , suggesting that certain shared characteristics ( e.g. information , systematic mood monitoring ) might explain the effects of psychosocial treatment for BD . Our results also suggest that a higher number of prior episodes , a lower number of therapy sessions and a diagnosis of bipolar II disorder are associated with a shorter time before relapse Background Bipolar disorder patients frequently present recurrent episodes and often experience subsyndromal  symptoms  ,  cognitive impairment and difficulties in functioning  , with a  low quality of life , illness relapses and recurrent hospitalization . Early diagnosis and appropriate intervention may play a role in preventing neuroprogression in this disorder . New technologies represent an opportunity to develop st and ardized psychological treatments using internet-based tools that overcome some of the limitations of face-to-face treatments , in that they are readily accessible and the timing of therapy can be tailored to user needs and availability . However , although many psychological programs are offered through the web and mobile devices for bipolar disorder , there is a lack of high quality evidence concerning their efficacy and effectiveness due to the great variability in measures and methodology used . Methods This clinical trial is a simple-blind r and omized trial within a European project to compare an internet-based intervention with treatment as usual .  Bipolar disorder patients are to be included and r and omly assigned to one of two groups : 1 ) the experimental group ( tele-care support ) and 2 ) the control group . Participants in both groups will be evaluated at baseline ( pre-treatment ) and post-treatment . Discussion This study describes the design of a clinical trial based on psychoeducation intervention that may have a significant impact on both prognosis and treatment in bipolar disorder . Specifically , bringing different services together ( service aggregation ) , it is hoped that the approach proposed will significantly increase the impact of information and communication technologies on access and adherence to treatment , quality of the service , patient safety , patient and professional satisfaction , and quality of life of patients .Trial registration NCT02924415 . Retrospectively registered 27 September
This review shows a beneficial effect of EWS in time to recurrence , percentage of people hospitalised and functioning in people with bipolar disorder .
BACKGROUND Recurrence rates for bipolar disorder are high despite effective treatments with mood stabiliser drugs .
Self-help treatments and psychological treatments that teach patients to recognise and manage early warning symptoms and signs ( EWS ) of impending manic or depressive episodes are popular with patients .
The main aim of such interventions is to intervene early and prevent bipolar episodes , thereby increasing the time to the next recurrence and preventing hospitalisation .
OBJECTIVES To compare the effectiveness of an EWS intervention plus treatment as usual ( TAU ) versus TAU ( involving and not involving a psychological therapy ) on time to manic , depressive and all bipolar episodes ( the primary outcome ) , hospitalisation , functioning , depressive and manic symptoms .