Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Table 3 Studies of adjunctive psychotherapy in rapid-cycling bipolar disorder

Ref.	Type of study	Sample	Intervention	Results
Levy and Remick[51], 1986	Observational study	8 women with RCBD	Supportive psychotherapy with patients and family regarding treatment response and adherence	Complete remission in 5 patients and partial remission in 3 patients for 7–40 mo with combined psychotherapy and medications
Spurkland and Vandvik[150], 1989	Case report	13-yr-old girl with RCBD	Family therapy to reduce conflicts and improve adherence	Family therapy combined with medications led to lasting remission
Benjamin and Zohar[58], 1992	Case report	45-yr-old man with treatment-resistant RCBD	Supportive psychotherapy	Psychotherapy provided relief from the rapid-cycling pattern for 3 mo
Satterfield[151], 1999	Case report	33-yr-old man with medication-resistant RCBD	Pharmacotherapy and concomitant CBT	Significant reductions in the severity of manic, depressive, and anxiety symptoms with adjunctive CBT
Reilly-Harrington et al[152], 2007	Uncontrolled trial	10 patients with RCBD	CBT included psychoeducation, cognitive restructuring, and teaching illness-management skills	CBT over 5 mo led to significant improvements in depressive symptoms for 2 mo after the treatment in 6 patients who completed the trial
Lenz et al[153], 2016	Controlled trial	16 patients with RCBD; 14 wk of adjunctive psychotherapy and 12-mo follow-up	CPT vs BT. CPT included psychoeducation and CBT; BT consisted of reading and discussing a book on bipolar disorder	Significant effects of both treatments - reductions in illness severity, reductions in the number of all episodes with CPT and depressive episodes with BT, reductions in the number and duration of hospitalizations, reductions in disability, and improvement in medication adherence and illness concepts. CPT was better than BT

BT: Bibliotherapy; CBT: Cognitive behavioural therapy; CPT: Cognitive psychoeducational therapy; RCBD: Rapid-cycling bipolar disorder.