Psychoeducation No More Effective Than Peer Support at Reducing Time to Next Bipolar Episode

In patients with bipolar disorder, structured group psychoeducation was found to be no more clinically effective than unstructured peer support at reducing the time to the next bipolar episode. However, group psychoeducation may have specific benefits in patients who have more recently developed bipolar disorder, including time to next mania episode, interpersonal function, and patient acceptability. The findings were published in Lancet Psychiatry.

Richard Morriss, MD, from the University of Nottingham and colleagues recruited 304 participants aged 18 and older from 8 sites in England and randomized 153 participants to attend 21, 2-hour weekly sessions of structured group psychoeducation and 151 participants to attend 21, 2-hour weekly sessions of optimized unstructured peer support. The primary outcome was time from randomization to next bipolar episode (International Standard Randomised Controlled Trial registry, number ISRCTN62761948).

The researchers found that:

• Psychoeducation was the most beneficial to patients who had a low number (1 to 7) of previous bipolar episodes (χ²; HR 0.28, 95% CI 0.12-0.68; P =.034).
• At 96 weeks, 89 participants (58%) in the psychoeducation group had experienced a next bipolar episode compared with 98 participants (65%) in the peer-support group.
• There was no difference in time to next bipolar episode between the groups (hazard ratio [HR] 0.83, 95% CI 0.62-1.11; P =.217). 
• The attendance was higher at psychoeducation groups than at peer-support groups (median 14 sessions [IQR 3 to 18] vs 9 sessions [2 to 17]; P =0.026).
• One participant in the psychoeducation group and 3 participants in the peer-support group died during follow-up, but these deaths were found to be unrelated to the study.

“Group psychoeducation is a low-cost psychological intervention for bipolar disorder with a few specific clinical benefits, especially for people early in their illness course,” the authors concluded, “if the focus of care is on improving self-management, interpersonal function, and support, and preventing future mania relapse. However, the intervention does not reduce overall bipolar relapse in people with long-established bipolar disorder, nor does it improve performance aspects of function.”

Limitations

• There was a low rate of completion of self-rated symptomatic and functional outcomes
• There is a moderate reliability of assessment of mania symptoms
• There was no formal rating of blinding
• Treatment sessions were not recorded, so adherence to treatment was not known

Reference

Morriss R, Labban F, Riste L, et al. Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial. Lancet Psychiatry. 2016 Nov;3(11):1029-1038. doi:10.1016/S2215-0366(16)30302-9.