Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 16143731 · doi:10.1001/archpsyc.62.9.996
What was done
In a randomized controlled trial at a university medical center, 175 acutely ill adults with bipolar I disorder were randomized across four treatment sequences combining acute and 2-year maintenance phases: acute and maintenance interpersonal and social rhythm therapy (IPSRT/IPSRT), acute and maintenance intensive clinical management (ICM/ICM), acute IPSRT then maintenance ICM (IPSRT/ICM), or acute ICM then maintenance IPSRT (ICM/IPSRT). Primary outcomes were time to stabilization in the acute phase and time to affective recurrence during the 2-year preventive maintenance phase.
What was found
There was no significant difference between treatment strategies in time to stabilization during the acute phase. After controlling for survival covariates, participants assigned to IPSRT in the acute phase had significantly longer recurrence-free survival over the maintenance phase (P = .01), regardless of maintenance assignment. Acute IPSRT produced greater regularity of social rhythms at the end of acute treatment (P < .001), and greater increase in social rhythm regularity during acute treatment was associated with reduced recurrence risk during maintenance (P = .05). Numerical effect sizes, hazard ratios, and confidence intervals were not reported in the abstract.
Why it matters
Pharmacotherapy alone often yields inadequate prophylaxis in bipolar I disorder. These findings indicate that integrating behavioral regulation of daily routines and interpersonal therapy during acute episodes provides lasting prophylactic benefit against future mood episodes.
Limits
The abstract does not provide exact recurrence rates, hazard ratios, or confidence intervals. The single-center setting, active recruitment through public presentations, and reliance on participants able to complete a multi-year protocol may limit generalizability to broader real-world clinical populations. Concomitant pharmacotherapy regimens and adherence details were not specified in the abstract.
Cited by
- supports Ellen Frank at the University of Pittsburgh developed chronotherapeutic approaches for bipolar disorder focusing on the regulation of regular daily sleep-wake and activity schedules.