4.2 Treatment of Bipolar Disorder

Question 1

Waar gaat artikel Frank over?

Frank et al. (2005)

Answer 1

Compare interpersonal and social rhythm therapy (IPSRT) and Intensive clinical management (ICM)
- Zeitgeber hypothesis

Question 2

Interpersonal and social rhythm therapy (IPSRT)

Frank et al. (2005)

Answer 2

Used as acute and maintenance treatment

Based on Zeitgeber hypothesis

Question 3

Zeitgeber hypothesis

Frank et al. (2005)

Answer 3

Unstable daily routines will lead to instability in circadian rhythm.

When this happens to sensitive people it will lead to affective episodes

Question 4

Results

Frank et al. (2005)

Answer 4

1. No difference between treatment in time to remission
2. After 2 years, overall return rate better in IPSRT
3. IPSRT pat’s in acute phase had sig fewer mood episodes
4. IPRST pat’s higher regularity of social rhythms
5. Good physical healt= better long-term with IPSRT
6. Pat’s with medical or anxiety benefited more form ICM
7. Married pat’s had sig better long-term outcomes

Question 5

Discussion

Frank et al. (2005)

Answer 5

• Findings are in line with Zeitgeber hypothesis
• Pat’s most motivated after acute episode
• IPSRT during acute treatment = best results
• Pat’s with medical symptoms –> ICM (this treatment is somatic focused)

Question 6

Waar gaat artikel Lam over?

Lam et al. (2003)

Answer 6

Studied CT in addition to pharmacotherapy in preventing BD episodes

Question 7

Results

Relapse rates

Lam et al. (2003)

Answer 7

Out of all pat’s= 53% relapse (during 12 months)

Control group = 50% relapse (first 6 months)
Control group= 75% (second 6 months)

CT group= 28.3% (first 6 months)
CT groupt= 43.8% (second 6 months)

Question 8

Results

Experiencing symptoms + hostpitalization

Lam et al. (2003)

Answer 8

CT group, sig fewer pat’s experienced:
- Depressive
- Manic
- Mixed episodes

Sig fewer were hostpitalized (15% vs 30%)

Question 9

Results

CT had fewer days in:

Lam et al. (2003)

Answer 9

1. Hospital for bipolar episodes and for depression
2. In bipolar episodes and also in depression or mania

Question 10

Results

Over time:

Lam et al. (2003)

Answer 10

• BDI (depression) scores of CT became lower, while control group became higher
• BHS (hopelessness) score in CT also lower at month 4
• ISS (internal state) scores also lower in CT at 3, 5, 11 months

Question 11

Results

Mood fluctuations

Lam et al. (2003)

Answer 11

Control group more mood fluctuations than CT

Question 12

Results

Medication compliance

Lam et al. (2003)

Answer 12

After 6 months, CT had better medication compliance than control (88.4% vs 66.7%)

Question 13

Results

Coping

Lam et al. (2003)

Answer 13

CT group better at coping with depressive symptoms (6 months) and better coping with mania (12 months)

Question 14

Waar gaat atikel Kessing over?

Kessing et al. (2018)

Answer 14

Long-term studies:
- effectiveness lithium compared to other mood stabilizers in maintenance therapy

Question 15

Discussion

Kessing et al. (2018)

Answer 15

• Lithium monotherapy better than monotherapy with other mood stabilizers.
• Only a few combinations were better than lithium mono: with olanzepine or quetiapine.

So: lithium reduces risk of suicide, and may also prevent onset of dementia.