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Background

Relapse prevention for bipolar disorder increases time to relapse but is not available in routine practice.

Aims

To determine the feasibility and effectiveness of training community mental health teams (CMHTs) to deliver enhanced relapse prevention.

Method

In a cluster randomised controlled trial, CMHT workers were allocated to receive 12 h training in enhanced relapse prevention to offer to people with bipolar disorder or to continue giving treatment as usual. The primary outcome was time to relapse and the secondary outcome was functioning.

Results

Twenty-three CMHTs and 96 service users took part. Compared with treatment as usual, enhanced relapse prevention increased median time to the next bipolar episode by 8.5 weeks (hazard ratio 0.79, 95% CI 0.45–1.38). Social and occupational functioning improved with the intervention (regression coefficient 0.68, 95% CI 0.05–1.32). The clustering effect was negligible but imprecise (intracluster correlation coefficient 0.0001, 95% CI 0.0000–0.5142).

Conclusions

Training care coordinators to offer enhanced relapse prevention for bipolar disorder may be a feasible effective treatment. Large-scale cluster trials are needed.

This paper describes two cases involving the use of cognitive behavioural therapy (CBT) to treat the positive symptoms of schizophrenia. In both cases the individuals were experiencing acute psychotic symptoms during their first admission to hospital. Each case illustrates how CBT was used to tackle a particular issue pertinent to the delivery of treatment at this early stage in the development of an individual's experiences of psychotic symptoms. Case one describes therapy with a young person of 17 where developmental issues are pertinent; case two describes the use of therapy to engage a person whose symptoms have ostensibly remitted. In both cases the promotion of understanding of the origin of their experiences was vital to the conduct of therapy. The implications of these issues to conducting therapy with this client group and the methods used to overcome them are discussed with reference to the future developments of cognitive behavioural therapy for use with this client group.

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Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial

FIRST EPISODE PSYCHOSIS: TWO CASES TO ILLUSTRATE THE ROLE OF COGNITIVE BEHAVIOUR THERAPY IN MAKING SENSE OF UNUSUAL EXPERIENCES

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Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial

FIRST EPISODE PSYCHOSIS: TWO CASES TO ILLUSTRATE THE ROLE OF COGNITIVE BEHAVIOUR THERAPY IN MAKING SENSE OF UNUSUAL EXPERIENCES