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Outcome of the First Year

Dominic H. Lam, PhD; Edward R. Watkins, PhD; Peter Hayward, PhD; Jenifer Bright, MSc; Kim Wright, BA; Natalie Kerr, MSc; Gina Parr-Davis, MSc; Pak Sham, PhD

Arch Gen Psychiatry. 2003;60:145-152.

Background  Despite the use of mood stabilizers, a significant proportion of patients with bipolar affective disorder experience frequent relapses. A pilot study of cognitive therapy (CT) specifically designed to prevent relapses for bipolar affective disorder showed encouraging results when used in conjunction with mood stabilizers. This article reports the outcome of a randomized controlled study of CT to help prevent relapses and promote social functioning.

Methods  We randomized 103 patients with bipolar 1 disorder according to the DSM-IV, who experienced frequent relapses despite the prescription of commonly used mood stabilizers, into a CT group or control group. Both the control and CT groups received mood stabilizers and regular psychiatric follow-up. In addition, the CT group received an average of 14 sessions of CT during the first 6 months and 2 booster sessions in the second 6 months.

Results  During the 12-month period, the CT group had significantly fewer bipolar episodes, days in a bipolar episode, and number of admissions for this type of episode. The CT group also had significantly higher social functioning. During these 12 months, the CT group showed less mood symptoms on the monthly mood questionnaires. Furthermore, there was significantly less fluctuation in manic symptoms in the CT group. The CT group also coped better with manic prodromes at 12 months.

Conclusion  Our findings support the conclusion that CT specifically designed for relapse prevention in bipolar affective disorder is a useful tool in conjunction with mood stabilizers.

From the Departments of Psychology (Drs Lam, Watkins, and Hayward and Mss Bright, Wright, Kerr, and Parr-Davis) and Psychological Medicine (Dr Sham), Institute of Psychiatry, London, England.

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