A multi-center naturalistic study of a newly designed 12-sessions group psychoeducation program for patients with bipolar disorder and their caregivers

Background: Psychoeducation (PE) for bipolar disorder (BD) has a first-line recommendation for the maintenance treatment phase of BD. Formats vary greatly in the number of sessions, whether offered individually or in a group, and with or without caregivers attending. Due to a large variation in formats in the Netherlands, a new program was developed and implemented in 17 outpatient clinics throughout the country. The current study investigated the feasibility of a newly developed 12-sessions PE group program for patients with BD and their caregivers in routine outpatient practice and additionally explored its effectiveness. Methods: Participants in the study were 108 patients diagnosed with BD, 88 caregivers and 35 course leaders. Feasibility and acceptance of the program were investigated by measures of attendance, and evaluative questionnaires after session 12. Preliminary treatment effects were investigated by pre- and post-measures on mood symptoms, attitudes towards BD and its treatment, levels of self-management, and levels of expressed emotion. Results: There was a high degree of satisfaction with the current program as reported by patients, caregivers, and course leaders. The average attendance was high and 83% of the patients and 75% of the caregivers completed the program. Analyses of treatment effects suggest positive effects on depressive symptoms and self-management in patients, and lower EE as experienced by caregivers. Conclusions: This compact 12-sessions psychoeducation group program showed good feasibility and was well accepted by patients, caregivers, and course leaders. Preliminary effects on measures of self-management, expressed emotions, and depressive symptoms were promising. After its introduction it has been widely implemented in mental health institutions throughout the Netherlands

A pilot study of a combined group and individual functional remediation program for patients with bipolar i disorder

Background Bipolar disorder has been associated with a decrease in cognitive functioning affecting the functional outcome of patients independent of mood states. However, there have only been few attempts to investigate the effects of functional remediation for patients with bipolar disorder. The current study investigates the feasibility and effectiveness of a combined group and individual functional remediation program for bipolar disorder, including both patients and their caregivers. Methods Twelve participants diagnosed with bipolar I disorder, and their caregivers, were treated with a combined group and individual functional remediation program. The feasibility of the program was evaluated by dropout rates and participants' evaluations of the program. The effectiveness of the program was explored through the assessment of functional outcome at baseline, immediately post-treatment, and follow-up three months later. Results The results indicate a high degree of satisfaction and a low dropout rate with the current program. Assessment of outcomes suggests improved functioning in the areas of autonomy and occupational functioning, evolving from baseline to follow-up. Limitations Due to a small sample size and the lack of a control group the results are preliminary. Conclusions This relatively brief intervention offers a more tailor-made approach to functional remediation and shows good feasibility, acceptability and improvement of functioning in patients with bipolar I disorder

Is the lack of association between cognitive complaints and objective cognitive functioning in patients with bipolar disorder moderated by depressive symptoms?

Objectives: To investigate the association between cognitive complaints and objective cognitive functioning in bipolar patients, with a focus on the moderating role of depressive symptoms. Methods: The association between cognitive complaints (measured by the total score and four subscales of the Cognitive Failure Questionnaire; CFQ) and objective cognitive functioning (domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory and executive functioning/working memory, and the total score) was assessed in 108 euthymic (n = 45) or mildly to moderately depressed bipolar patients (n = 63). We studied potential moderation of this association by depressive symptoms (total score of the Inventory of Depressive Symptomatology-self rating). Analyses were performed using Pearson correlations and multiple linear regression. Results: Cognitive complaints were not associated with objective cognitive functioning, except for CFQ 'memory for names' which was positively correlated with speed of information processing (r=0.257, p = 0.007). Although depressive symptoms were positively associated with cognitive complaints (total score and three subscales; p <0.01), the association between cognitive complaints and objective cognitive functioning was not moderated by depressive symptoms (p for interaction 0.054 to 0.988). Limitations: It can be argued whether the retrospective questionnaire (CFQ) is sufficiently accurate to measure the type of cognitive dysfunctions seen in bipolar patients. Conclusions: Cognitive complaints are not associated with objective cognitive functioning, irrespective of depressive symptoms. However, cognitive complaints are indicative for depressive symptoms. Clinicians should be to be alert to depressive symptoms rather than objective cognitive problems in patients expressing cognitive complaints. (C) 2011 Elsevier B.V. All rights reserved