Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T22:04:17.419Z Has data issue: false hasContentIssue false
  • English
  • Français

Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Published online by Cambridge University Press:  10 April 2014

A. Peters ,
L. G. Sylvia ,
P. V. da Silva Magalhães ,
D. J. Miklowitz ,
E. Frank ,
M. W. Otto ,
N. S. Hansen ,
D. D. Dougherty ,
M. Berk  and
A. A. Nierenberg
...Show all authors
A. Peters
Affiliation:
University of Illinois at Chicago, Chicago, IL, USA
L. G. Sylvia
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
P. V. da Silva Magalhães
Affiliation:
Universidade Federal de Rio Grande de Sul, Porte Alegre, Brazil
D. J. Miklowitz
Affiliation:
UCLA School of Medicine, Los Angeles, CA, USA
E. Frank
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
M. W. Otto
Affiliation:
Boston University, Boston, MA, USA
N. S. Hansen
Affiliation:
Massachusetts General Hospital, Boston, MA, USA
D. D. Dougherty
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
M. Berk
Affiliation:
Deakin University, Melbourne, Australia University of Melbourne, Melbourne, Australia
A. A. Nierenberg
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
T. Deckersbach*
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
*
* Address for correspondence: T. Deckersbach, Ph.D., Massachusetts General Hospital, Building 149, 13th Street, 2nd Floor, Charlestown, MA 02129, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.

Method.

Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.

Results.

Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.

Conclusions.

Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

Keywords

Bipolar disordermood episodespsychotherapystaging
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 16 , December 2014 , pp. 3455 - 3467
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altman, DG, Andersen, PK (1999). Calculating the number needed to treat for trials where the outcome is time to an event. British Medical Journal 319, 1492–1495.CrossRefGoogle Scholar
Angst, F, Stassen, HH, Clayton, PJ, Angst, J (2002). Mortality of patients with mood disorders: follow-up over 34–38 years. Journal of Affective Disorders 68, 167–181.CrossRefGoogle ScholarPubMed
Berk, M, Berk, L, Dodd, S, Cotton, S, Macneil, C, Daglas, R, Conus, P, Bechdolf, A, Moylan, S, Malhi, GS (2013). Stage managing bipolar disorder. Bipolar Disorders. Published online 20 June 2013 . doi:10.1111/bdi.12099.Google ScholarPubMed
Berk, M, Berk, L, Udina, M, Moylan, S, Stafford, L, Hallam, K, Goldstone, S, McGorry, PD (2012). Palliative models of care for later stages of mental disorder: maximizing recovery, maintaining hope, and building morale. Australian and New Zealand Journal of Psychiatry 46, 92–99.CrossRefGoogle ScholarPubMed
Berk, M, Brnabic, A, Dodd, S, Kelin, K, Tohen, M, Malhi, GS, Berk, L, Conus, P, McGorry, PD (2011). Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disorders 13, 87–98.Google Scholar
Colom, F, Reinares, M, Pacchiarotti, I, Popovic, D, Mazzarini, L, Martínez-Arán, A, Torrent, C, Rosa, A, Palomino-Otiniano, R, Franco, C, Bonnin, CM, Vieta, E (2010). Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. Acta Neuropsychiatrica 22, 50–53.Google Scholar
Cook, RJ, Sackett, DL (1995). The number needed to treat: a clinically useful measure of treatment effect. British Medical Journal 310, 452–454.Google Scholar
Deckersbach, T, Peters, AT, Sylvia, L, Urdahl, A, Magalhães, PV, Otto, MW, Frank, E, Miklowitz, DJ, Berk, M, Kinrys, G, Nierenberg, A (2014). Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD. American Journal of Psychiatry 171, 178–186.Google Scholar
Fisher, RA (1970). Statistical Methods for Research Workers. Oliver and Boyd: Edinburgh.Google Scholar
Franchini, L, Zanardi, R, Smeraldi, E, Gasperini, M (1999). Early onset of lithium prophylaxis as a predictor of good long-term outcome. European Archives of Psychiatry and Clinical Neuroscience 249, 227–230.Google Scholar
Frank, E, Kupfer, DJ, Thase, ME, Mallinger, AG, Swartz, HA, Fagiolini, AM, Grochocinski, V, Houck, P, Scott, J, Thompson, W, Monk, T (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry 62, 996–1004.Google Scholar
Frank, E, Swartz, HA, Kupfer, DJ (2000). Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological Psychiatry 48, 593–604.Google Scholar
Goldberg, JF, Ernst, CL (2002). Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. Journal of Clinical Psychiatry 63, 985–991.Google Scholar
Kessing, LV, Andersen, PK, Mortensen, PB (1998). Predictors of recurrence in affective disorder. A case register study. Journal of Affective Disorders 49, 101–108.CrossRefGoogle ScholarPubMed
Ketter, TA, Houston, JP, Adams, DH, Risser, RC, Meyers, AL, Williamson, DJ, Tohen, M (2006). Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes. Journal of Clinical Psychiatry 67, 95–101.CrossRefGoogle ScholarPubMed
Kraemer, HC (2008). Toward non-parametric and clinically meaningful moderators and mediators. Statistics in Medicine 27, 1679–1692.CrossRefGoogle ScholarPubMed
Kraemer, HC, Kupfer, DJ (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59, 990–996.CrossRefGoogle ScholarPubMed
Lam, DH, Burbeck, R, Wright, K, Pilling, S (2009). Psychological therapies in bipolar disorder: the effect of illness history on relapse prevention – a systematic review. Bipolar Disorders 11, 474–482.Google Scholar
Lam, DH, Hayward, P, Watkins, ER, Wright, K, Sham, P (2005). Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. American Journal of Psychiatry 162, 324–329.Google Scholar
Lauder, S, Chester, A, Castle, D, Dodd, S, Berk, L, Klein, B, Austin, D, Gilbert, M, Chamberlain, JA, Murray, G, White, C, Piterman, L, Berk, M (2013). Development of an online intervention for bipolar disorder. www.moodswings.net.au. Psychological Health and Medicine 18, 155–165.Google Scholar
Leboyer, M, Henry, C, Paillere-Martinot, ML, Bellivier, F (2005). Age at onset in bipolar affective disorders: a review. Bipolar Disorders 7, 111–118.CrossRefGoogle ScholarPubMed
Lewandowski, KE, Cohen, BM, Ongur, D (2011). Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder. Psychological Medicine 41, 225–241.Google Scholar
Macneil, CA, Hasty, M, Cotton, S, Berk, M, Hallam, K, Kader, L, McGorry, P, Conus, P (2012). Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study. Early Intervention Psychiatry 6, 380–388.CrossRefGoogle ScholarPubMed
Magalhães, PV, Dodd, S, Nierenberg, AA, Berk, M (2012 a). Cumulative morbidity and prognostic staging of illness in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Australian and New Zealand Journal of Psychiatry 46, 1058–1067.Google Scholar
Magalhães, PV, Kapczinski, F, Nierenberg, AA, Deckersbach, T, Weisinger, D, Dodd, S, Berk, M (2012 b). Illness burden and medical comorbidity in the Systematic Treatment Enhancement Program for Bipolar Disorder. Acta Psychiatrica Scandinavica 125, 303–308.Google Scholar
McMurrich, S, Sylvia, LG, Dupuy, JM, Peckham, AD, Peters, AT, Deckersbach, T, Perlis, RH (2012). Course, outcomes, and psychosocial interventions for first-episode mania. Bipolar Disorders 14, 797–808.CrossRefGoogle ScholarPubMed
Miklowitz, DJ (2008). Adjunctive psychotherapy for bipolar disorder: state of the evidence. American Journal of Psychiatry 165, 1408–1419.Google Scholar
Miklowitz, DJ, Otto, MW (2007). Psychosocial interventions for bipolar disorder: a review of literature and introduction of the systematic treatment enhancement program. Psychopharmacological Bulletin 40, 116–131.Google ScholarPubMed
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Kogan, JN, Sachs, GS, Thase, ME, Calabrese, JR, Marangell, LB, Ostacher, MJ, Patel, J, Thomas, MR, Araga, M, Gonzalez, JM, Wisniewski, SR (2007 a). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. American Journal of Psychiatry 164, 1340–1347.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Wisniewski, SR, Kogan, JN, Nierenberg, AA, Calabrese, JR, Marangell, LB, Gyulai, L, Araga, M, Gonzalez, JM, Shirley, ER, Thase, ME, Sachs, GS (2007 b). Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Archives of General Psychiatry 64, 419–426.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Simoneau, TL, George, EL, Richards, JA, Kalbag, A, Sachs-Ericsson, N, Suddath, R (2000). Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biological Psychiatry 48, 582–592.CrossRefGoogle ScholarPubMed
Newcombe, RG (1998). Interval estimation for the difference between independent proportions: comparison of eleven methods. Statistics in Medicine 17, 873–890.Google Scholar
Nickerson, RS (2000). Null hypothesis significance testing: a review of an old and continuing controversy. Psychological Methods 5, 241–301.Google Scholar
Perich, T, Manicavasagar, V, Mitchell, PB, Ball, JR, Hadzi-Pavlovic, D (2013). A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder. Acta Psychiatrica Scandinavica 127, 333–343.CrossRefGoogle ScholarPubMed
Pincus, T, Miles, C, Froud, R, Underwood, M, Carnes, D, Taylor, SJ (2011). Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials: a consensus study. BMC Medical Research Methodology 11, 14.Google Scholar
Rosa, AR, González-Ortega, I, González-Pinto, A, Echeburúa, E, Comes, M, Martinez-Àran, A, Ugarte, A, Fernández, M, Vieta, E (2012). One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatrica Scandinavica 125, 335–341.Google Scholar
Roy-Byrne, P, Post, RM, Uhde, TW, Porcu, T, Davis, D (1985). The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica Supplement 317, 1–34.CrossRefGoogle ScholarPubMed
Sachs, GS, Guille, C, McMurrich, SL (2002). A clinical monitoring form for mood disorders. Bipolar Disorders 4, 323–327.Google Scholar
Sachs, GS, Thase, ME, Otto, MW, Bauer, M, Miklowitz, D, Wisniewski, SR, Lavori, P, Lebowitz, B, Rudorfer, M, Frank, E, Nierenberg, AA, Fava, M, Bowden, C, Ketter, T, Marangell, L, Calabrese, J, Kupfer, D, Rosenbaum, JF (2003). Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry 53, 1028–1042.Google Scholar
Scott, J, Paykel, E, Morriss, R, Bentall, R, Kinderman, P, Johnson, T, Abbott, R, Hayhurst, H (2006). Cognitive–behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. British Journal of Psychiatry 188, 313–320.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–57.Google Scholar
Van Dijk, S, Jeffrey, J, Katz, MR (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders 145, 386–393.CrossRefGoogle Scholar
Vitiello, B, Riddle, MA, Yenokyan, G, Axelson, DA, Wagner, KD, Joshi, P, Walkup, JT, Luby, J, Birmaher, B, Ryan, ND, Emslie, G, Robb, A, Tillman, R (2012). Treatment moderators and predictors of outcome in the Treatment of Early Age Mania (TEAM) study. Journal of the American Academy of Child and Adolescent Psychiatry 51, 867–878.Google Scholar
Zis, AP, Grof, P, Webster, M, Goodwin, FK (1980). Prediction of relapse in recurrent affective disorder. Psychopharmacological Bulletin 16, 47–49.Google Scholar