Monday April 06th, 2009

Psychoeducation is Beneficial in the Long Term in Bipolar Disorder

Dr. Eduard Vieta and Dr. Francesc Colom, second and first authors, respectively

A 6-month psychoeducational strategy achieves beneficial effects that last more than 5 years. Patients who took part in the psychoeducation sessions suffered 66% fewer episodes of mania and 75% fewer episodes of depression. This represents preventing a year of symptoms over 5 years. The cost-benefit analysis shows that the use of health care resources is far lower in these groups than in those that do not carry out the initial follow-up. Hospital Clínic de Barcelona is a pioneer both in the application of this treatment and in training professionals qualified to carry it out.

Bipolar disorder is one of the 10 main causes of disability worldwide, according to the World Health Organization. The disease is marked by sudden swings of mood, thought and behavior. Although effective pharmaceutical treatments exist, they only treat the symptoms, whereas the functional recovery of the patient requires a different type of intervention. Hence the use of psychoeducation is proposed as a prophylactic therapy that helps to prevent relapses in patients with bipolar disorder. With this strategy, patients learn the importance of taking medication and how to identify the symptoms of a relapse. Two articles published in the British Journal of Psychiatry and the Journal of Clinical Psychiatry show the clear benefits of this therapy in the long term. The studies were carried out by the Research Group on Bipolar Disorders, directed by Dr. Eduard Vieta at IDIBAPS-Hospital Clínic de Barcelona and in them, Dr. Francesc Colom appears as second and first author, respectively.

On the one hand, patients avoid a year of symptoms over 5 years of follow-up, thus reducing the number and length of stays in hospital. On the other hand, though the initial health care expenditure is higher, over time, psychoeducation is a less expensive and more effective therapy than conventional measures. These two studies are the continuation of research carried out by the same group in 2003 in which the researchers showed the benefits of psychoeducation for patients with the disease over a period of 2 years. Extending the follow-up period for a further 3 years makes this the first clinical trial to show the long-term efficacy of the therapy.

The study included 120 patients, divided in 2 groups: one group received weekly psychoeducation for the 21 weeks of the initial follow-up, together with standard psychiatric treatment; the other group attended the weekly meetings for the same period but did not receive special instructions from the therapist. The purpose of this was to control for the variability introduced by a possible support effect of the meetings themselves. After 21 weeks, patients continued to receive the usual pharmacological treatment without psychological intervention.

The results after 5 years confirmed those observed after the 2-year follow-up, in which the number of bipolar episodes was far lower for patients who received psychoeducation. Patients who took part in the psychoeducational sessions suffered 66% fewer episodes of mania and 75% fewer episodes of depression. Patients in the control group, however, suffered 35% and 56% fewer episodes of mania and depression, respectively. Patients in the psychoeducation group spent 8% of the 5 years in manic or depressive episodes, whereas patients in the control group spent 30% in these episodes, i.e., patients who received psychoeducation had fewer and shorter episodes.

Besides the clear benefits for patients, this type of intervention also has advantages in terms of health care costs. Although in the short term, during the psychoeducation phase, patients use more health care resources without additional advantages with respect to the control group, in the post-intervention period (to 5 years), it has been shown that the therapy is more effective and less expensive. Thus, although the cost of the follow-up visits is high for the treated patients, the general expense is compensated by the minimal use of subsequent emergency visits. Hospital costs in patients receiving psychoeducation represent 15% of the total, whereas for the control group, they represent 40%.

Thus, psychoeducation offers patients with bipolar disorder the ability to control their disease by means of a 6-month training period. Now, the objective is to implement and standardize the use of this therapy by training health care personnel (psychiatrists, psychologists and nurses) from the different health care and mental health centers.

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