Psychoeducation in bipolar disorder: A systematic review

doi:10.5498/wjp.v11.i12.1407

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Systematic Reviews

World J Psychiatr. Dec 19, 2021; 11(12): 1407-1424
Published online Dec 19, 2021. doi: 10.5498/wjp.v11.i12.1407

Table 1 Newcastle–Ottawa scale evaluation for studies that assessed psychoeducation in bipolar disorder patients

Ref.	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts on the basis of the design or analysis	Assessment of outcome	Follow-up long enough for outcomes to occur	Adequacy of follow up of cohorts	Total
Zhang et al[14], 2019	1	1	1	1	2	1	1	1	9
Wiener et al[15], 2017	1	1	1	1	1	1	1	1	8
Cardoso et al[16], 2015	1	1	1	1	1	1	1	1	8
Cardoso et al[17], 2014	1	1	1	1	1	1	1	1	8
Faria et al[18], 2014	1	1	1	1	2	1	1	1	9
Kurdal et al[19], 2014	1	1	1	1	1	1	1	1	8
Javadpour et al[20], 2013	1	1	1	1	2	1	1	1	9
de Barros Pellegrinelli et al[21], 2013	1	1	1	1	2	1	1	1	9
Candini et al[22], 2013	1	1	1	1	1	1	1	1	8
Colom et al[11], 2009	1	1	1	1	2	0	1	1	8
Colom et al[23], 2003	1	1	1	1	2	1	1	2	10
Colom et al[24], 2003	1	1	1	1	2	1	1	1	9
Dalum et al[25], 2018	1	1	1	0	1	0	1	1	6
Depp et al[26], 2015	1	1	1	1	1	1	1	1	8
Lauder et al[27], 2015	1	1	1	1	1	1	1	1	8
Torrent et al[28], 2013	1	1	1	1	2	1	1	1	9
Smith et al[29], 2011	1	1	1	1	2	1	1	1	9
Sylvia et al[30], 2011	0	1	1	1	2	1	1	0	6
D'Souza et al[31], 2010	1	1	1	1	2	1	1	1	9
Castle et al[32], 2010	1	1	1	1	2	0	1	1	8
So et al[46], 2021	1	1	1	1	1	0	1	1	7
Sajatovic et al[33], 2009	1	1	1	1	2	1	1	1	9
Miklowitz et al[34], 2007	1	1	1	1	2	0	1	0	7
Miklowitz et al[35], 2007	1	1	1	1	2	1	1	1	9
González Isasi et al[36], 2014	1	1	1	1	1	1	1	1	8
Parikh et al[37], 2012	1	1	1	1	2	1	1	1	9
Zaretsky et al[38], 2008	1	1	1	1	1	1	1	1	8
Proudfoot et al[39], 2012	1	1	1	1	1	1	1	1	8
Aubry et al[40], 2012	1	1	1	1	1	0	1	0	6
Gonzalez et al[41], 2007	0	1	1	1	2	1	1	1	8
Miklowitz et al[42], 2003	1	1	1	1	1	1	1	1	8
Petzold et al[45], 2019	1	1	1	1	1	1	1	1	8
Pakpour et al[43], 2017	1	1	1	1	1	1	1	1	8
Morris et al[7], 2016	1	1	1	1	1	1	1	1	8
Kessing et al[44], 2014	1	1	1	1	1	1	1	1	8
Gumus et al[47], 2015	1	1	1	1	1	1	1	1	8
Eker et al[48], 2012	1	1	1	0	1	0	1	1	6
Perry et al[49], 1999	1	1	1	1	2	1	1	1	9

Table 2 Extracted data from studies that evaluated psychoeducation in patients with bipolar disorder

Ref.	BD	Sample size, N (P × C)	Age in years (P × C)	Female frequency (%) (P × C)	Intervention	Applied scales/parameters	Results
Zhang et al[14], 2019	I e II	35 × 39	34.2 × 34.6	57.1 × 46.2	SCIT	YMRS	P = 0.21
						HDRS	P = 0.11
						FAST	P < 0.001
						TMTA	P = 0.77
						SDMT	P = 0.09
						HVLT-R	P = 0.09
						SCWT	P = 0.054
Wiener et al[15], 2017	ND	32 × 29	24 × 23.81	83.3 × 76.2	PMBD	HDRS	P = 0.028
Wiener et al[15], 2017	ND	32 × 29	24 × 23.81	83.3 × 76.2	PMBD	YMRS	P = 0.879
Cardoso et al[16], 2015	ND	32 × 29	24.09 × 24.03	65.6 × 72.4	PMBD	BRIAN	P = 0.88
						HARS	P = 0.175
						YMRS	P = 0.576
						HDRS	P = 0.074
Cardodo et al[17], 2014	ND	32 × 29	24.09 × 24.03	65.6 × 72.4	PMBD	HDRS	P = 0.001
Cardodo et al[17], 2014	ND	32 × 29	24.09 × 24.03	65.6 × 72.4	PMBD	YMRS	P = 0.102
Faria et al[18], 2014	II	32 × 29	24.09 × 24.03	72.4 × 65.6	PMBD	BRIAN	P = 0.01
Faria et al[18], 2014	II	32 × 29	24.09 × 24.03	72.4 × 65.6	PMBD	Depressive symptoms	P = 0.001
Kurdal et al[19], 2014	ND	40 × 40	37.17 × 33.9	35 × 40	PMBD	BDFQ	P > 0.005
Javadpour et al[20], 2013	I e II	45 × 41	24.4/23.2	23 × 21	PMBD	WHOQOL-BREF	P < 0.001
						MARS	P = 0.008
						Hospitalizations	P < 0.001
de Barros Pellegrinelli et al[21], 2013	I e II	32 × 23	43.43 × 43.74	23 × 15	PMBD	HDRS	P = 0.820
						YMRS	P = 0.716
						SAS	P = 0.114
						GAF	P = 0.586
						CGI	P = 0.026
Candini et al[22], 2013	I e II	57 × 45	41.5 × 44.8	52.6 × 48.9	PMBD	Hospitalizations	P = 0.001
Candini et al[22], 2013	I e II	57 × 45	41.5 × 44.8	52.6 × 48.9	PMBD	Number of days of hospitalization	P = 0.001
Colom et al[11], 2009	I e II	60 × 60	34.03 × 34.26	63.3 × 63.3	PMBD	New mood episode	P = 0.002
						Hospitalizations	P = 0.023
						Number of days of hospitalization	P = 0.047
Colom et al[23], 2003	I	25 × 25	35.36 × 34.48	64 × 60	PMBD	Mood episodes in the treatment phase	P = 0.003
						Mood episodes after 2 yr	P = 0.008
						Depressive episodes	P = 0.004
						Hospitalizations	P = 0.001
Colom et al[24], 2003	I e II	60 × 60	23.25 × 22.26	63.3 × 63.3	PMBD	New mood episode	P = 0.001
						Hospitalizations	P = 0.05
						Number of days of hospitalization	P = 0.05
Dalum et al[25], 2018	ND	23 × 24	41 × 45	46 × 44	IMR	IMRS-P	P = 0.14
Dalum et al[25], 2018	ND	23 × 24	41 × 45	46 × 44	IMR	IMRS-S	P = 0.76
Depp et al[26], 2015	I e II	51 × 63	46.9 × 48.1	53.7 × 63.4	PRISM	YMRS	P = 0.004
						MADRS	P = 0.036
						IIS	P = 0.636
Lauder et al[27], 2015	I e II	71 × 59	39.87 × 41.35	73 × 76	MS–PLUS	ASRMS	P = 0.02
						MADRS	P = 0.003
						MOS-SSS	P = 0.003
						MARS	P = 0.001
						GPF	P = 0.003
Torrent et al[28], 2013	I e II	159 × 80	40.59 × 40.47	57.1 × 57.5	FR	FAST	P = 0.002
						HDRS	P > 0.05
						YMRS	P > 0.05
						Hospitalizations	P > 0.05
Smith et al[29], 2011	I e II	24 × 26	42.7 × 44.7	54.2 × 69.2	BBO	FAST	P = 0.15
						GAF	P = 0.21
						SAI	P = 0.44
						WHOQOL-BREF	P = 0.25
Sylvia et al[30], 2011	I e II	4 × 6	60 × 50.2	75 × 33	NEW TX	MADRS	P = 0.10
Sylvia et al[30], 2011	I e II	4 × 6	60 × 50.2	75 × 33	NEW TX	LIFE-RIFT	P = 0.014
D'Souza et al[31], 2010	I	27 × 31	40.7 × 39.5	51.85 × 51.61	SIMSEP-BD	ARS	P = 0.001
						New mood episode	P = 0.015
						Time between mood episodes	P = 0.001
Castle et al[32], 2010	I e II	42 × 42	41.6 × 42.6	79 × 26	MAPS	Mood episode	P = 0.003
						Depressive symptoms	P = 0.003
						Knowledge about illness	P > 0.05
						ESM-PA	P = 0.024
						ESM-NA	P = 0.001
So et et al[46], 2021	I e II	38 × 26	35.8 × 43.1	78.9 × 73.1	LGP	Medication adherence	P > 0.05
Sajatovic et al[33], 2009	I e II	80 × 80	41.13 × 40	73.75 × 87.5	LGP	DAI	P = 0.366
						SRTAB	P = 0.577
						GAS	P = 0.382
Miklowitz et al[34], 2007	I e II	163 × 130	40.1 × 40	ND	IPI	Remission of symptoms 1 yr	P = 0.001
Miklowitz et al[35], 2007	I e II	84 × 68	ND	59 × 59	IPI	LIFE-RIFT	P = 0.006
González Isasi et al[36], 2014	I	20 × 20	43.35 × 39.25	45 × 50	CBT	STAI-S	P = 0.062
						YMRS	P = 0.009
						BDI	P = 0.131
						IS	P = 0.001
Parikh et al[37], 2012	I e II	109 × 95	40.9 × 40.9	53.2 × 63.2	CBT	LIFE	P > 0.05
						CARS-M	P = 0.089
						HDRS	P = 0.089
Zaretsky et al[38], 2008	I e II	40 × 39	ND	ND	CBT	CARS-M	P = 0.001
Zaretsky et al[38], 2008	I e II	40 × 39	ND	ND	CBT	HDRS	P = 0.001
Proudfoot et al[39], 2012	ND	139 × 134	35.3 × 40.9	66.9 × 69.4	BEP	GADS	P > 0.05
						WSAS	P > 0.05
						SWLS	P > 0.05
						BRIEF IPQ	P = 0.001
Aubry et al[40], 2012	I e II	50 × 35	46 × 52	66 × 62.9	LGP	Hospitalizations	P = 0.001
Aubry et al[40], 2012	I e II	50 × 35	46 × 52	66 × 62.9	LGP	Number of hospitalizations	P = 0.009
Gonzalez et al[41], 2007	I e II	11 × 11	40.5 × 41.0	45.45 × 45.45	IOM	GAF	P = 0.65
						CGI-BD	P = 0.06
						Depressive symptoms	P = 0.005
Miklowitz et al[42], 2003	I	31 × 70	35.6 × 36.6	58 × 66	FFT	SADS-C	P = 0.001
						New mood episode	P = 0.001
						MTS	P = 0.001
Pakpour et al[43], 2017	I e II	134 × 136	41.8 × 41.2	55.2 × 50.7	GP	MARS	P = 0.001
						YMRS	P = 0.001
						CGI	P = 0.001
						QoL.BD	P = 0.001
Petzold et al[45], 2019	I e II	39 × 34	44.32 × 42.69	43.6 × 47.1	GP	New mood episode	P = 0.175
						YMRS	P = 0.241
						HDRS	P = 0.58
						SF-36	P = 0.359
Morriss et al[7], 2016	I e II	153 × 151	44.2 × 46·5	60 × 56	GP	Time between mood episodes	P = 0.012
						SOFAS	P > 0.05
						SAS	P > 0.05
Kessing et al[44], 2014	I	72 × 86	64.1 × 63	61.1 × 48.8	GP	Time between mood episodes	P = 0.014
Kessing et al[44], 2014	I	72 × 86	64.1 × 63	61.1 × 48.8	GP	Hospitalizations	P = 0.064
Gumus et al[47], 2015	I e II	41 × 41	38.7 × 40.05	40.5 × 56.1	GP	Number of mood episodes	P = 0.208
Eker et al[48], 2012	ND	35 × 36	34.57 × 36.54	54.3 × 52.8	GP	ANT	P < 0.005
Eker et al[48], 2012	ND	35 × 36	34.57 × 36.54	54.3 × 52.8	GP	MARS	P < 0.005
Perry et al[49], 1999	I	34 × 35	44.1 × 45	68 × 69	GP	Time between manic episodes	P = 0.008
Perry et al[49], 1999	I	34 × 35	44.1 × 45	68 × 69	GP	Time between depressive episodes	P = 0.19

ANT: Attitudes towards neuroleptic treatment; ASRMS: Altman self-rating mania scale; ARS: Medication adherence scale; B: Baseline; BBO: Beating bipolar online; BD: Bipolar disorder; BDG: Bipolar disorder group; BDI: Beck depression inventory; BDFQ: Bipolar Disorder Functioning Questionnaire; BEP: Bipolar Education Program; BDNF: Brain-Derived Neurotrophic Factor; BRIAN: Biological Rhythm Interview of Assessment in Neuropsychiatry; BRIEF IPQ: The Brief Illness Perception Questionnaire; C: Controls; CARS-M: Clinician-Administered Rating Scale for Mania; CBT: Cognitive-behavioral therapy; CC: Collaborative care; CGI-BD: Clinical Global Impression Scale for Bipolar Disorder; DAI: Drug Attitude Inventory; EDM: Education about Disorders and Medications; ESM-PA: With in person positive affect as measured by using Experience Sampling Method; ESM-NA: Within-person negative affect as measured by using Experience Sampling Method; FAST: Functional Assessment Test; FFT: Family-focused treatment; FR: Functional remediation; GADS: The Goldberg Anxiety and Depression Scale; GAF: Global Assessment of Functioning; GAS: Global Assessment Scale; HVLT-R: Hopkins Verbal Learning Tests-Revised; GDNF: Glial cell line-derived neurotrophic factor; GPF: Global Measure of Psychosocial Functioning; GP: Group Psychoeducation; HARS: Hamilton Anxiety Rating Scale; HDRS: Hamilton Depression Rating Scale; IOM: Integrative Outpatient Model; IMR: Illness Management and Recovery program; IMRS–P: Illness Management and Recovery Scale–participants’ version; IMRS–S: Illness Management and Recovery Scale–staffs; IPI: Intensive Psychosocial Intervention; IS: Maladjustment scale; IRSRT: Interpersonal and social rhythm therapy; LGP: Life Goals Program; LIFE: Longitudinal Interval Follow-up Evaluation; LIFE-RIFT: The Range of Impaired Functioning Tool; MADRS: Montgomery–Asberg Depression Rating Scale; MOSSF-36: Medical Outcomes Survey Short-form General Health Survey; MTS: Maintenance Treatment Scale; MARS: Medication Adherence Rating Scale; MAPS: Monitoring mood and activities (M), assessing prodromes (A), preventing relapse (P) and setting Specific, Measurable, Achievable, Realistic, Time-framed (SMART) goals (S); MARS: Medication adherence rating scale; MS-PLUS: MoodSwings-Plus; MOS-SSS: Medical Outcomes Study Social Support Survey; ND: Not described; NEW TX-Program: Nutrition/weight loss, Exercise, and Wellness Treatment; NGF: Nerve growth factor; P: Patients; PMBD: Psychoeducation Manual For Bipolar Disorder; PRISM: Personalized Real-Time Intervention for Stabilizing Mood , QoL.BD: Quality of Life in Bipolar Disorder scale; SAI: Schedule for Assessment of Insight; SADS-C: Schedule for Affective Disorders and Schizophrenia, Change Version; SAS: Social Adjustment Scale; SCIT: Social cognition and Interaction Training; SCWT: Stroop Color-Word Test; SDMT: Symbol Digit Modalities Test; SIMSEP-BD: Systematic Illness Management Skills Enhancement Program Bipolar Disorder; SF-36: 36-Item Short Form Survey; SOFAS: Social and Occupational Functioning Assessment Scale; SRTAB: Self-reported treatment adherence behaviours; STAI-S: State Trait Anxiety Inventory; SWLS: The Satisfaction with Life Scale; TMTA: Trail Making Test-A; WHOQOL–BREF: World Health Organization Quality of Life, Brief version; WSAS: The Work and Social Adjustment Scale; YMRS: Young Mania Rating Scale.

Table 3 Newcastle–Ottawa scale evaluation for studies that evaluated psychoeducation in relatives of patients with bipolar disorder

Ref.	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts on the basis of the design or analysis	Assessment of outcome	Follow-up long enough for outcomes to occur	Adequacy of follow up of cohorts	Total
Hubbard et al[50], 2016	1	1	1	1	1	1	0	1	7
Fiorillo et al[51], 2015	1	1	1	1	1	1	1	0	7
Madigan et al[52], 2012	1	1	1	1	1	1	1	1	8
Reinares et al[53], 2008	1	1	1	1	1	1	1	1	8
Solomon et al[54], 2008	1	1	1	1	1	0	1	0	6
Reinares et al[55], 2004	1	1	1	1	1	1	1	0	7
Van Gent et al[56], 1991	1	1	1	1	1	0	1	0	6
Miklowitz et al[57], 2000	1	1	1	1	1	0	1	1	7
Simoneau et al[58], 1999	1	1	1	1	1	0	1	0	6

Table 4 Extracted data from studies that evaluated psychoeducation in relatives of patients with bipolar disorder

Ref.	BD	Psychoeducation group			Group control			Applied scales/parameters	Results
Ref.	BD	Psychoeducation strategy	n (%)		Intervention strategy	n (%)		Applied scales/parameters	Results
Hubbard et al[50], 2016	ND	GCPBD	18	8 Partner; 10 Parents	WL	14	3 Partner; 8 Parents; 1 Sibling; 2 Friend	DASS- 21	P = 0.52
								BAS	P = 0.91
								KBDS	P > 0.05
								BDSS	P > 0.05
Fiorillo et al[51], 2015	BD I	PFI	85	21 Parents; 44 Partner; 10 Son; 9 Sibling; 1 Other	WI	70	23 Parents; 31 Partner; 11 Son; 3 Sibling; 2 Other	Subjective burden	P = 0.001
								Professional help	P = 0.001
								Help in emergencies	P = 0.01
Madigan et al[52], 2012	ND	MFGP; SFGP	18; 19	ND	WI	10	ND	Caregiver knowledge	P = 0.404
								IEQ	P = 0.795
								GHQ12	P = 0.723
								WHOQOL Bref	P = 0.355
								GAF	P = 0.617
Reinares et al[53], 2008	BD I e II	PFI	57	35 Parents; 20 Partner; 2 Offspring/siblings	WI	56	27 Parents; 25 Partner; 4 Offspring/siblings	Amount of daily contact between the patient and the caregiver	P = 0.757
								Manic/hypomanic recurrence time	P = 0.015
								Medication adherence	P = 0.611
Solomon et al[54], 2008	BD I	MFGP; IFT	21; 16	ND	WI	16	ND	New mood episode	P = 0.47
								Hospitalization frequency	P = 0.04
								BRMS	P = 0.44
								HAM-D	P = 0.12
Reinares et al[55], 2004	BD I e II	PFI	30	17 Parents; 12 Partner; 1 Sibiling	WI	15	6 Parents; 6 Partner; 2 Son; 1 Sibiling	HAM–D	P > 0.05
								YMRS	P > 0.05
								Subjective burden of the caregiver	P = 0.48
								FES	P = 0.22
								Knowledge about the disorder	P = 0.001
Van Gent et al[56], 1991	ND	GT	14	14 Partner	WI	12	12 Partner	IPSQ	P > 0.05
								IPP	P > 0.05
								SCL-90	P > 0.05
Miklowitz et al[57], 2000	BD I	FFT	31	ND	CMNF	70	ND	New mood episode	P = 0.042
								Depressive symptoms	P = 0.06
								Manic symptoms	P = 0.59
Simoneau et al[58], 1999	ND	FFT	22	ND	CMNF	22	ND	KPI	P > 0.05

BAS: Burden assessment scale; BD: Bipolar disorder; BDSS: Bipolar disorder self-efficacy scale; BPRS: Brief psychiatric rating scale; BRMS: Bech-Rafaelsen Mania Scale; C: Control; CMNF: Crisis management with naturalistic follow-up; DAS: Disability assessment scale; DASS-21: Depression, Anxiety, Stress Scale; FES: Family Environment Scale (Cohesion, Expressiveness e Conflict)-Relationship subscales; FFT: Program of pharmacotherapy and family-focused psychoeducational treatment; GAF: Global Assessment of Functioning; GHQ12: General Health Questionnaire 12; GCPBD: Guide for Caregivers of People with Bipolar Disorder; HAM–D: Hamilton Rating Scale for Depression–17-item; IEQ: Involvement evaluation questionnaire; IFT: Individual family therapy; IPP: Inventory of psychosocial problems; IPSQ: Interactional Problem Solving Questionnaire; KBDS: Knowledge of Bipolar Disorder Scale; KPI: Interactional coding system-assessed verbal and nonverbal communication behaviors of patients and their family; MFGP: Multifamily Group Psychoeducation; N: Total number l; ND: Not described; P: Psychoeducation; PFI: Psychoeducational family intervention; SADS-C: Schedule for Affective Disorders and Schizophrenia-Change Version; SCL-90: Symptom Checklist; SFGP: Solution Focused Group Psychotherapy; GT: Group therapy; WHOQOL Brief: World Health Organization Quality of Life, Brief version; WI: Without intervention; WL: Waiting list; YMRS: Young Mania Rating Scale.

Citation: Rabelo JL, Cruz BF, Ferreira JDR, Viana BM, Barbosa IG. Psychoeducation in bipolar disorder: A systematic review. World J Psychiatr 2021; 11(12): 1407-1424
URL: https://www.wjgnet.com/2220-3206/full/v11/i12/1407.htm
DOI: https://dx.doi.org/10.5498/wjp.v11.i12.1407