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Meta-Analysis
. 2007 Jan 24;2007(1):CD004854.
doi: 10.1002/14651858.CD004854.pub2.

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

R K Morriss  1 , M A Faizal, A P Jones, P R Williamson, C Bolton, J P McCarthy
Affiliations
Meta-Analysis

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

R K Morriss et al. Cochrane Database Syst Rev. .

Abstract

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 strategy: 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.

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Conflict of interest statement

One author (RM) is the co‐author for two studies that were included in the review.

Figures

1.1
1.1. Analysis
Comparison 1 Treatment as usual (TAU) versus TAU and additional early warning sign recognition, Outcome 1 Time to first recurrence of any type.
1.2
1.2. Analysis
Comparison 1 Treatment as usual (TAU) versus TAU and additional early warning sign recognition, Outcome 2 Time to manic/hypomanic episode.
1.3
1.3. Analysis
Comparison 1 Treatment as usual (TAU) versus TAU and additional early warning sign recognition, Outcome 3 Time to depressive episode.
1.4
1.4. Analysis
Comparison 1 Treatment as usual (TAU) versus TAU and additional early warning sign recognition, Outcome 4 Percentage of people hospitalised.
1.5
1.5. Analysis
Comparison 1 Treatment as usual (TAU) versus TAU and additional early warning sign recognition, Outcome 5 Measure of functioning.
2.1
2.1. Analysis
Comparison 2 Heterogeneity, Outcome 1 EWS intervention vs psychological control group for time to first recurrence of any type.
2.2
2.2. Analysis
Comparison 2 Heterogeneity, Outcome 2 EWS intervention vs psychological control group for time to manic/hypomanic episode.
2.3
2.3. Analysis
Comparison 2 Heterogeneity, Outcome 3 EWS intervention vs psychological control group for time to depressive episode.
2.4
2.4. Analysis
Comparison 2 Heterogeneity, Outcome 4 Time to first recurrence of any type for TAU Vs enhanced TAU.
2.5
2.5. Analysis
Comparison 2 Heterogeneity, Outcome 5 Time to first recurrence of any type for Intervention delivered in groups vs individually.
2.6
2.6. Analysis
Comparison 2 Heterogeneity, Outcome 6 Inclusion one month after episode vs recruitment during episode.
2.7
2.7. Analysis
Comparison 2 Heterogeneity, Outcome 7 Time to first recurrence of any type for simple VS complex intervention for EWS.
2.8
2.8. Analysis
Comparison 2 Heterogeneity, Outcome 8 Time to manic/hypomanic episode for simple Vs complex intervention for EWS.
2.9
2.9. Analysis
Comparison 2 Heterogeneity, Outcome 9 Time to depressive episode for simple Vs complex intervention for EWS.
2.10
2.10. Analysis
Comparison 2 Heterogeneity, Outcome 10 Time to first recurrence in studies where EWS as primary focus Vs EWS as secondary focus.
2.11
2.11. Analysis
Comparison 2 Heterogeneity, Outcome 11 Time to manic episode in studies where EWS as primary focus Vs EWS as secondary focus.
2.12
2.12. Analysis
Comparison 2 Heterogeneity, Outcome 12 Time to depressive episode in studies where EWS as primary focus Vs EWS as secondary focus.
See this image and copyright information in PMC

Comment in

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