Intervention Review

Interventions for helping people recognise early signs of recurrence in bipolar disorder

  1. Richard Morriss1,*,
  2. Mohammad Amir Faizal2,
  3. Ashley P Jones3,
  4. Paula R Williamson4,
  5. Catherine A Bolton5,
  6. James P McCarthy6

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 29 OCT 2006

DOI: 10.1002/14651858.CD004854.pub2


How to Cite

Morriss R, Faizal MA, Jones AP, Williamson PR, Bolton CA, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004854. DOI: 10.1002/14651858.CD004854.pub2.

Author Information

  1. 1

    University of Nottingham , Psychiatry, Nottingham, UK

  2. 2

    Mersey Care NHS Trust, Psychiatry, Liverpool, UK

  3. 3

    University of Liverpool, Institute of Child Health, Liverpool, Merseyside, UK

  4. 4

    University of Liverpool, Centre for Medical Statistics and Health Evaluation, Liverpool, Merseyside, UK

  5. 5

    Royal Bolton Hospital Trust, Child and Adolescent Mental Health Service, Bolton, Lancashire, UK

  6. 6

    Merseycare NHS Trust, Ferndale Unit, Liverpool, UK

*Richard Morriss, Psychiatry, University of Nottingham , A Floor, South Block, Nottingham, NG7 2UH, UK. richard.morriss@nottingham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

Search methods

Relevant studies identified by searching Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References - searched on 20/10/2005), supplemented with hand searching the journal Bipolar Disorders, searching the UK National Research Register, checking reference lists of included studies and contacting authors.

Selection criteria

Only randomised controlled trials (RCTs) were included. Participants were adults with a diagnosis of bipolar disorder based on standardised psychiatric criteria.

Data collection and analysis

Two reviewers independently rated trials for inclusion. Data were extracted from included trials by reviewers using a data extraction sheet. Authors of all the included studies were contacted for any additional information required. Time to recurrence data was summarised as log hazard ratios, dichotomous data as relative risk and continuous data as weighted mean difference, using random effects models to calculate effect size only when there was heterogeneity in the data.

Main results

Eleven RCTs were identified, but only six provided primary outcome data. All six RCTs were of high quality. Time to first recurrence of any type (RE, hazards ratio 0.57, 95% CI 0.39 to 0.82), time to manic/hypomanic episode, time to depressive episode, and percentage of people hospitalised and functioning favoured the intervention group. Neither depressive nor hypomanic symptoms differed between intervention and control groups.

Authors' conclusions

This review shows a beneficial effect of EWS in time to recurrence, percentage of people hospitalised and functioning in people with bipolar disorder. However, the absence of data on the primary outcome measure in so many included studies is a source of concern and a potential source of bias. Mental health services should consider routinely providing EWS interventions to adults with bipolar disorder, as they appear to reduce hospitalisation and therefore may be cost-effective.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for helping people recognise early signs of recurrence in bipolar disorder

Bipolar disorder (BPD), or manic-depressive psychosis, is a common and severe mental illness, with a lifetime prevalence of 1-2%. BPD is characterised by two types of recurrence, mania and depression. High rates of recurrence and associated adverse consequences occur in spite of a range of effective treatments. Early warning signs (EWS) interventions, targeted at improving the recognition and self-management of manic and depressive symptoms, are intended to train people with recurrent bipolar affective disorder to recognise early warning signs of recurrence and to avert adverse outcomes. This review demonstrated that these interventions, in addition to treatment as usual (TAU), including medication and regular appointments with health professionals, have benefits on time to recurrence and hospitalisation. Compared with TAU only, EWS interventions also resulted in improved functioning at eighteen months, although these data were sparse and the findings should be interpreted with caution. EWS interventions did not appear to have any effect on depressive or manic symptoms, although again, these findings were based on small numbers of potentially selected patients in remission. It should be noted that EWS was used along with other psychological interventions, and it is not entirely clear what proportion of the beneficial effect was due to the EWS intervention alone.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

如何介入去協助病人辨識雙極性情感性疾病復發的早期徵兆

雙極性情感性疾病的復發率是很高的,即使在有效的情緒穩定劑控制下。那些教育病人辨識並處理早期鬱期或躁期預警症狀和跡象(EWS)的自我協助(self help)治療和心理治療是十分受歡迎的。此介入的主要目的在於早期介入,預防復發,因而延後下次復發的時間以及避免住院。

目標

比較EWS加上常態治療(TAU)和TAU(包含以及不包含心理治療)在躁期、鬱期、所有雙極性(主要測量結果)發作的時間,住院,功能,憂鬱症狀和狂躁症狀的治療效果。

搜尋策略

相關的試驗都是從搜尋Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers(CCDANCTRStudies and CCDANCTRReferences  searched on 20/10/2005),和人工搜尋 journal Bipolar Disorders, the UK National Research Register而來,並確認所有納入試驗的相關清單和作者。

選擇標準

只有隨機對照試驗被納入。納入個案都是根據標準精神科診斷準則,診斷為雙極性情感性疾患的成年人。

資料收集與分析

兩位評論者獨立地評價納入的試驗。評論者以data extraction sheet從納入試驗來摘錄資料。所有納入研究的作者被聯繫以提供任何額外的資訊。復發時間的資料被摘要為log hazard ratios,歧異性資料為relative risk而連續性資料為weighted mean difference,當資料存在異質性時使用random effects models來計算effect size。

主要結論

11個RCTs被找出來,但只有六個提供了初步結果的資料。所有六個RCTs都是高品質的。任何形式第一次復發的時間(RE, hazards ratio 0.57, 95% CI 0.39 to 0.82),躁期/輕躁期發作的時間,鬱期發作的時間,病人住院的比例以及功能方面都偏好接受介入這個族群。憂鬱症狀和輕躁症狀在接受介入和對照組並無不同。

作者結論

這篇回顧呈現了EWS對於雙極性疾病的病人,在復發的時間、住院的比例和功能方面是有益處的。然而,這麼多納入的研究缺乏初步結果測量的資料,可能是遭受關心的來源以及是可能偏差的來源。心理健康服務應該考慮對成人雙極性疾病患者提供常規的EWS介入,因為它們似乎能減少住院,因此可能比較符合成本效益。

翻譯人

本摘要由彰化基督教醫院謝明翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

介入可以幫助人們分辨雙極性疾病復發的早期跡象。雙極性疾病(BPD)或是躁鬱精神病是一個非常嚴重的精神疾病,終生盛行率1∼2 %。BPD的特徵是躁期和鬱期兩種形式的反覆發作。即使在有效的治療範圍下,高復發率以及相關不良的影響仍會發生。早期預警跡象(EWS)的介入,目的在改善狂躁和憂鬱症狀的辨識以及自我處理,並想要訓練復發的雙極性情感性患者去辨識復發的早期預警跡象和避開不良的結果。這篇回顧顯示,在常態的治療方式(TAU)如藥物或是和專業人員的規則預約之外,這些介入對於復發的時間和住院是有幫助的。只和TAU比較,EWS介入也產生18個月的功能改善,雖然這些資料很稀少而且其發現需要小心地解讀。EWS介入對憂鬱或狂躁症狀似乎沒有效果,但再一次,這些發現是根據少數可能被選到的緩解病人。應該注意的是,EWS和其他心理介入一起使用,使得不完全清楚有助益效果的那個部分是因為單獨EWS介入的關係。