Psychoeducation efficacy and symptomatic and functional recovery in severe bipolar disorder

Abstract

Background: Despite increasing recognition of the effectiveness of psychoeducation in the treatment of mood disorders, some factors related to severity of illness can negatively influence intervention results. Objective: To evaluate the efficacy of psychoeducation in the symptomatic and functional recovery, and quality of life improvement, of severe bipolar disorder (BD) patients. Methods: The sample comprised 55 patients with BD I and II in remission (Young Mania Rating Scale ≤6, and Hamilton Depression Rating Scale ≤7). Eighty percent of the patient sample had severe BD (6 or more mood episodes). Outpatients were randomly assigned to receive 16 sessions of psychoeducation (experimental group - EG) or 16 sessions of placebo without psychoeducation (control group - CG). Groups were evaluated at study baseline, midpoint, endpoint, and at 6 and 12 month follow ups. Results: No significant differences between the groups was found for the variables evaluated (mood symptoms, functioning and quality of life), except for overall clinical improvement, subjectively perceived by EG subjects. Both groups showed a trend towards improved clinical global impression and quality of life (environmental). No reduction in mood symptoms or improvement in psychosocial functioning was observed. Psychosocial treatment compliance was positively correlated with global functioning, social adjustment, sociability, and global clinical impression. These factors emerged as predictors of poor adherence. Limitations: The main limitations of the study were small sample size and disease severity. Conclusion: psychoeducation seems to be ineffective to improve symptoms (mood episodes) or functioning but led to an improvement of clinical global impression scores and quality of life (environment domain). Specific psychoeducation programs need to be developed for severe bipolar patients.