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Authors' reply

Published online by Cambridge University Press:  02 January 2018

David Castle
Affiliation:
Department of Psychiatry, University of Melbourne, and St Vincent's Health Melbourne, Fitzroy, Victoria, Australia. Email: David.Castle@svhm.org.au
Monica Gilbert
Affiliation:
Frameworks for Health, St Vincent's Health Melbourne, Fitzroy
Sue Lauder
Affiliation:
Barwon Health, Department of Clinical and Biomedical Science, University of Melbourne, Geelong
Greg Murray
Affiliation:
Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn
Carolynne White
Affiliation:
Frameworks for Health, St Vincent's Health Melbourne, Fitzroy
Michael Berk
Affiliation:
Department of Clinical and Biomedical Sciences, University of Melbourne, and Orygen Research Centre, Mental Health Research Institute, Geelong, Victoria, Australia
Lesley Berk
Affiliation:
Department of Clinical and Biomedical Sciences, University of Melbourne, and Orygen Research Centre, Mental Health Research Institute, Geelong, Victoria, Australia
Corresponding
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2010 

We are pleased that Gupta found our study Reference Castle, White, Chamberlain, Berk, Berk and Lauder1 of interest. As he says, the findings provide ‘further evidence that psychosocial treatments can supplement pharmacological treatments and improve the course and outcome of bipolar disorder’. Reference Castle, Berk, Lauder, Berk and Murray2

Regarding the three issues he raises: first, we agree that given the rigorous randomisation process the reporting of P values for baseline differences between ‘treatment’ and ‘control’ groups is not essential. However, many studies do report these P values and we have followed this convention in our article. Reporting P values also allows a ‘check’ on the randomisation. Here we posit that the idea of randomisation is to obtain ‘comparable’ comparison groups. If randomisation ‘fails’ in any particular way, this seems important to be aware of in both the conduct of the analyses and the interpretation of the results.

Second, regarding the outcomes, we were particularly interested to see whether we could deliver an intervention that addressed both poles of the illness, hence our strategy to define the primary outcomes in the way we did. With regard to the pooling of mixed and manic episodes, that is the most commonly used convention in clinical trial reporting. Reference Colom, Vieta, Sánchez-Moreno, Goikolea, Popova and Bonnin3

Lastly, the rate of relapse in itself is not as important as the difference in rates between the intervention and the control group. Relapse is the most commonly used primary outcome measure in comparable trials. Reference Tohen, Frank, Bowden, Colom, Ghaemi and Yatham4 Our definition of relapse as the primary outcome was dictated by the fact that in bipolar disorder it is relapse that matters most for clinical care rather than symptomatic differences at any single point in time. We should also point out that the lower relapse rate in the intervention group was mirrored by a reduction in emergency psychiatric contacts and hospital admissions, lending support to the clinical utility of the intervention.

Footnotes

Edited by Kiriakos Xenitidis and Colin Campbell

References

1 Castle, D, White, C, Chamberlain, J, Berk, M, Berk, L, Lauder, S, et al. Group-based psychosocial intervention for bipolar disorder: randomised controlled trial. Br J Psychiatry 2010; 196: 383–8.CrossRefGoogle ScholarPubMed
2 Castle, DJ, Berk, L, Lauder, S, Berk, M, Murray, G. Psychosocial interventions for bipolar disorder. Acta Neuropsychiatrica 2009; 21: 275–84.CrossRefGoogle Scholar
3 Colom, F, Vieta, E, Sánchez-Moreno, J, Goikolea, JM, Popova, E, Bonnin, CM, et al. Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome subanalysis. J Affect Disord 2009; 112: 30–5.CrossRefGoogle ScholarPubMed
4 Tohen, M, Frank, E, Bowden, CL, Colom, F, Ghaemi, NS, Yatham, LN, et al. The International Society for Bipolar Disorders (ISBD) task force on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2010; 12: 53.Google Scholar
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