The impact of staging bipolar disorder on treatment outcome of family psychoeducation

BACKGROUND: Psychological interventions on top of pharmacological treatment can improve the outcome of bipolar disorder. However, there is a paucity of data on the aspects that may influence the effectiveness of psychological approaches to bipolar disorders. The staging models suggest a progression from prodromal to more severe and treatment-resistant presentations. The aim of this study was to assess whether a staging model in bipolar disorder was related to patients' response to psychoeducation delivered to caregivers. METHODS: Post-hoc analysis from a 15-month randomized controlled trial showing the efficacy of group psychoeducation for caregivers in the prophylaxis of recurrences. The sample was composed of 113 medicated euthymic bipolar outpatients who lived with their caregivers. For the purpose of this study the patients were subdivided into two groups according to staging. The prophylactic efficacy of caregiver psychoeducation was studied based on staging. RESULTS: Patients on Stage I benefited from caregiver psychoeducation by having longer time to recurrence (Log-rank chi-square: 6.26; p=0.012). No significant benefits from caregiver psychoeducation were found in patients on advanced stages. LIMITATIONS: The present post-hoc analysis was not properly powered to compare each one of the four stages with each other, instead staging was divided into Stage I and advanced stages (II, III or IV). CONCLUSIONS: Psychoeducation for caregivers of bipolar patients on Stage I may improve long-term outcome in terms of time to recurrence. This study highlights the need to introduce psychological interventions early in the course of the illness as some treatments may be more useful in patients at earlier stages of bipolar disorder.