The impact of a simple individual psycho-education program on quality of life, rate of relapse and medication adherence in bipolar disorder patients

https://doi.org/10.1016/j.ajp.2012.12.005Get rights and content

Abstract

Introduction

Bipolar disorder is one of ten most debilitating diseases in the world, leading to a lessened quality of life amongst its sufferers. This randomised control trial demonstrates the effectiveness of psycho-education intervention along with a patient support system in the management of this disorder.

Methodology

In this trial, 108 patients, divided equally into two groups, were randomly assigned to receive either pharmacotherapy alone (control group) or psycho-education along with pharmacotherapy treatment (intervention group) for a two year period. Each individual patient in the “intervention” group received eight, fifty-minute sessions of psychological education, followed by monthly telephone follow-up care and psychological support in the subsequent 18 months. Each group was evaluated, once every 6 months for a period of 18 months, in the areas of “quality of life”, “symptoms of relapse”, “pharmacotherapy compliance” and “number of hospital admission for recurrence of bipolar disorder”.

Result

The result of this study indicates that patients in the “intervention” group had a statistically significant enhancement in medication compliance (P = 0.008). Regarding every aspect of life quality, this group was at a better position than the “control” group (P = 0.000). As to relapse and hospital admission, the “intervention” group reported much lower cases compared with the “control” group at a significance level of P = 0.000.

Conclusion and discussion

This research has demonstrated that in the psycho-education intervention group, there was a more significant improvement in all areas of quality of life, number of relapses, and hospitalization due to recurrence of bipolar disorder and medication compliance than it was evident in the control groups.

Highlights

► This randomized clinical trial study evaluated effectiveness of individual psycho-education intervention in management of bipolar mood disorder. ► All patients were in euthymic phase. ► Results were evaluated in areas of the relapses, hospitalization, medication adherence and quality of life. ► Decrease of relapses and hospitalization in the intervention group was observed. ► Intervention group reported a higher level in all domains of quality of life and improvement of medication compliance.

Introduction

Bipolar disorder (BpD) is a well-established and one of the oldest diagnoses of mental disorders in the field of psychiatry. This disorder is the sixth cause of disability amongst the older population of the world (Colom and Vieta, 2009). Even after putting behind the acute periods, one may still suffer the destructive consequences of bipolar disorder. Sufferers generally complain about dissatisfaction with personal and social life, employment and education related difficulties, and are susceptible to other psychological and physiological indispositions.

On the other hand, as reported by Lacro et al. (2002), it is known that the rate of individual bipolar patients routinely and consciously taking the prescribed medicines is only 35%, which is much lower than that of schizophrenics at 50–60%.

Since it is apparent that betterment of a system of pharmacotherapy assists in decreasing the frequency of relapse and in increasing the quality of life, various interventional methods have been employed to assist in potentiating the procedures of treatment. (Pharmacotherapy, in this context, is a reference to each individual patient's self-motivation to make a conscious decision to follow procedurally a prearranged treatment program, put together by the healthcare professional, i.e. adherence to taking the prescribed pharmaceutical medication on one's own accord armed with the knowledge of the disease and indicators of relapse.)

Selected review of research literature revealed that there was a positive relationship between different psychological interventions such as behavioural therapies, family reliant treatments, psychosocial education, and interpersonal therapies with adherence to medical psychotherapy (Bauer et al., 2006, Cakir et al., 2009, Colom et al., 2003, Even et al., 2007, Goodwin et al., 2003, Lincoln et al., 2007, Maczka et al., 2010, Miklowitz, 2008, Osterberg and Blaschke, 2005, Perry et al., 1999, Rouget and Aubry, 2007, Rucci et al., 2002, Simon et al., 2006, Simpson et al., 2011, Zaretsky et al., 2007), as well as reduction in the number of relapses and hospitalizations.

There are few studies in Iran on educational therapy for BpD patients (Ghadirian et al., 2009). This randomised control trial aims at evaluating the effectiveness of psychoeducational intervention along with a patient support system in management of this disorder.

Section snippets

Methods

This study was performed during the remission phase of patients with BpDs after being discharged from the hospital. The study was done in hospitals affiliated with Shiraz University of Medical Sciences on BpD patients discharged from wards one, three and four of the Psychoneurology Department of Ebn Sina Hospital as well as those discharged from the Psychoneurology Department of Hafez Teaching hospital.

Results and data analysis

One hundred eight eligible patients were randomly allocated to the study. Fifty-four participants were assigned to psycho-education with pharmacotherapy and 54 to pharmacotherapy alone. Duration of this study was 18 months (June 2010–November 2011).

Discussion

The aim of the present study was to find out the effectiveness of simple individual psycho-education with pharmacotherapy compared with pharmacotherapy alone on the quality of life, adherence to psychiatric medication, and prevention of recurrence in patients with BpD. All patients were in a euthymic phase when they were allocated to the study.

Demographic distribution of age, sex, job, level of education, and marital status, in both the intervention and control groups, was similar. They also

Conclusion

Psycho-education has an important role in management of BpD. Simple individual psycho-education along with pharmacotherapy followed by long term education with a telephone contact had a positive outcome for management of the disease processes. Although study about the cost effectiveness of this type of treatment was not performed, the positive treatment outcome of the intervention group overshadowed the associated cost of treatment. One of the strengths of this study was the advantage of

Role of funding source

This study was supported by Shiraz University of Medical Science under student grant number 2871.

Conflict of interest

None declared.

Acknowledgements

The writers would like to express their utmost gratitude to the vice president of research at Shiraz University of Medical Sciences as well as the Centre for Psychiatric Research for the assistant in conducting this project.

References (31)

  • F. Colom et al.

    Psychoeducation Manual for Bipolar Disorder

    (2006)
  • F. Colom et al.

    Group psychoeducation for stabilized bipolar disorders: 5-year outcome of a randomized clinical trial

    British Journal of Psychiatry

    (2009)
  • F. Colom et al.

    Psychoeducation for bipolar disorders

  • R. D‘Souzaa et al.

    A brief dyadic group based psychoeducation program improves relapse rates in recently remitted bipolar disorder: a pilot randomized controlled trial

    Journal of Affective Disorders

    (2010)
  • C.H. Even et al.

    Characteristics of voluntary participants versus nonparticipants in a psychoeducation program for euthymic patients with bipolar disorder [abstract]

    Journal of Nervous and Mental Disease

    (2007)
  • Cited by (45)

    • A Randomized Controlled Trial of Transcultural Validation of Group-Based Psychosocial Intervention for Patients with Bipolar Disorder

      2020, Psychiatry Research
      Citation Excerpt :

      Future studies on this issue should explore Chinese patients' concerns about medication and overcome the specific barriers to medication compliance in group-based intervention. Consistent with previous studies, group-based psychosocial intervention in the current study was able to improve the physical and mental components of QoL in Chinese outpatients with BD (Castle et al., 2007; Javadpour et al., 2013; Patelis-Siotis, 2001). Improvements in depressive symptoms and achieving euthymia may contribute to improving QoL for patients with BD.

    View all citing articles on Scopus
    View full text