Category: Bipolar Disorders
Introduction: Although treatment guidelines for bipolar disorder often recommend adjunctive psychotherapy alongside pharmacologic regimens, further research is warranted to identify which forms of psychotherapy may be better than others, particularly when offered outside of controlled settings in the community. To examine this, we analyzed the impact of community-based psychological care on treatment outcomes in a comparative effectiveness trial for bipolar disorder. We hypothesized that those in adjunctive psychological care would have greater improvement in clinical status over time compared to those without adjunctive psychological care.
Method: Participants were adult outpatients (N=482) diagnosed with bipolar disorder who participated in a multi-site, comparative effectiveness trial of lithium versus quetiapine. Mixed model regressions were conducted to examine changes in overall disorder impairment (Bipolar Inventory of Symptoms Scale; BISS) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; Q-LES-Q) and also if these changes were moderated by engagement in psychological services (assessed with the Cornell Service Index) over the duration of the 24-week study. The present study defined psychological service usage as any engagement with a psychologist for any type of psychological care
Results: Participants (n=440) with valid data on service usage at the three time points it was assessed (i.e., weeks 0, 12, and 24) were included in this analysis. Eighty-one (18.4%) participants endorsed seeing a psychologist over the course of treatment. Baseline values for the BISS (M=56.69; SD=19.14) and Q-LES-Q (M=38.57; SD=9.92) did not differ between treatment groups or between those who did and did not engage in external psychological care. We found that overall disorder severity (t=-25.23; pt=14.62; p0.05). Results did not differ between randomization groups (lithium versus quetiapine).
Discussion: These data suggest that community-based adjunctive psychological service usage did not moderate treatment outcomes in a comparative effectiveness trial of quetiapine and lithium. These data are limited as it was not possible to validate the type and quality of psychological care, as all service usage data relied on self-report. Furthermore, the generality of the definition of care allowed for analysis at a broad level but sacrificed specific analysis by type of psychological service, which should be targeted in future research.
Steven Dufour– Massachusetts General Hospital, Brighton, Massachusetts
Jacob Dinerman– Massachusetts General Hospital, Somerville, Massachusetts
Samantha Walsh– Massachusetts General Hospital
Jessica Janos– Clinical Research Coordinator, Massachusetts General Hospital, Brookline, Massachusetts
Thilo Deckersbach– Associate Professor of Psychology in the Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
Louisa Sylvia– Assistant Professor, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Andrew Nierenberg– Massachusetts General Hospital
Clinical Research Coordinator
Massachusetts General Hospital
Associate Professor of Psychology in the Department of Psychiatry
Massachusetts General Hospital
Massachusetts General Hospital, Harvard Medical School