To provide a selected overview of the literature on psychosocial treatments for bipolar disorder

Selective literature review

Randomised controlled trials of psychosocial interventions in bipolar disorder fall largely into five categories, namely: psychoeducation, integrated treatments, family based therapy, cognitive behavioural therapy and interpersonal social rhythm therapy. Most studies have shown some benefit in terms of relapse prevention, but have tended to be effective for either the depressed or the manic pole, and not both. Broader outcome parameters such as quality of life have not been reported consistently. The mechanisms whereby treatments might exert their effects have not been clearly delineated. Many studies have excluded patients with bipolar II and other variants, and those with psychiatric and substance use comorbidities, reducing their generalisability.

Whilst psychosocial treatments show promise in the area of bipolar disorder, more work is required to delineate the effective elements of such interventions, and to ensure generalisability to individuals with bipolar II and other forms of bipolar disorder, as well as those with psychiatric and substance use comorbidities. Other forms of delivery, such as via the internet, deserve further exploration.

To evaluate the effect of N-acetylcysteine (NAC) on substance use in a double-blind, placebo-controlled trial of NAC in bipolar disorder. It is hypothesised that NAC will be superior to placebo for reducing scores on the Clinical Global Impressions scale for Substance Use (CGI-SU).

Participants were randomised to a 6-months of treatment with 2 g/day NAC (n = 38) or placebo (n = 37). Substance use was assessed at baseline using a Habits instrument. Change in substance use was assessed at regular study visits using the CGI-SU.

Among the 75 participants 78.7% drank alcohol (any frequency), 45.3% smoked tobacco and 92% consumed caffeine. Other substances were used by fewer than six participants. Caffeine use was significantly lower for NAC-treated participants compared to placebo at week 2 of treatment but not at other study visits.

NAC appeared to have little effect on the participants who were using substances. A larger study on a substance-using population will be necessary to determine if NAC may be a useful treatment for substance use.

Impairment in emotion perception represents a fundamental feature of schizophrenia with important consequences in social functioning. A fundamental unresolved issue is the relationship between emotion perception and face perception. The aim of the present study was to examine whether facial identity recognition (Identity Discrimination) is a factor predicting facial emotion recognition in the context of the other factors, known as contributing to emotion perception, such as cognitive functions and symptoms.

We enrolled 58 stable schizophrenic out-patients and 47 healthy subjects. Facial identity recognition and emotion perception were assessed with the Comprehensive Affect Testing System. Different multiple regression models with backward elimination were performed in order to discover the relation of each significant variable with emotion perception.

In a regression including the six significant variables (age, positive symptomatology, Identity Discrimination, attentive functions, verbal memory-learning, executive functions) versus emotion processing, only attentive functions (standardised β = 0.264, p = 0.038) and Identity Discrimination (standardised β = 0.279, p = 0.029) reached a significant level. Two partial regressions were performed including five variables, one excluding attentive functions and the other excluding Identity Discrimination. When we excluded attentive functions, the only significant variable was Identity Discrimination (standardised β = 0.278, p = 0.032). When we excluded Identity Discrimination, both verbal memory-learning (standardised β = 0.261, p = 0.042) and executive functions (standardised β = 0.253, p = 0.048) were significant.

Our results emphasised the role of face perception and attentional abilities on affect perception in schizophrenia. We additionally found a role of verbal memory-learning and executive functions on emotion perception. The relationship between those above-mentioned variables and emotion processing could have implications for cognitive rehabilitation.

Recent cross-sectional studies suggest that brain changes in schizophrenia are progressive during the course of the disorder. However, it remains unknown whether this is a global process or whether some brain areas are affected to a greater degree. The aim of this study was to examine the longitudinal brain changes in patients with chronic older schizophrenia by magnetic resonance imaging (MRI).

Three-dimensional (3D) T1-weighted and diffusion tensor (DT) MRI were performed twice on each of 16 chronic older schizophrenia patients (mean age = 58.1 ± 6.7 years ) with an interval of 1 year between imaging sessions. To clarify the longitudinal morphological and white matter changes, volume data and normalised diffusion tensor imaging (DTI) metrics were compared between the first and follow-up studies using a paired t-test.

Focal cortical volume loss was observed in the left prefrontal lobe and anterior cingulate on volumetric study. In addition, DTI metrics changed significantly at the bilateral posterior superior temporal lobes, left insula, genu of the corpus callosum and anterior cingulate.

There are ongoing changes in the brains of schizophrenic patients during the course of the illness. Discrepancies between volume data and DTI metrics may indicate that the pattern of progressive brain changes varies according to brain region.