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National Collaborating Centre for Mental Health (UK). Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2014 Sep. (NICE Clinical Guidelines, No. 185.)

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  • April 2018: Footnotes and cautions have been added and amended to link to the MHRA's latest advice and resources on sodium valproate. Sodium valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. November 2017: Footnotes for some recommendations were updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some research recommendations have been stood down. See these changes in the short version of the guideline.

April 2018: Footnotes and cautions have been added and amended to link to the MHRA's latest advice and resources on sodium valproate. Sodium valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. November 2017: Footnotes for some recommendations were updated with current UK marketing authorisations and MHRA advice. Links to other guidelines have also been updated. Some research recommendations have been stood down. See these changes in the short version of the guideline.

Cover of Bipolar Disorder

Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care.

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APPENDIX 25Psychological and Psychosocial Interventions – Forest Plots

Abbreviations

A

acute (mania or depression)

Ad

acute depression

CBT

cognitive behavioural therapy

CI

confidence interval

FFT

family focused therapy

GAF

Global Assessment of Functioning scale

IV

intravariance

M

maintenance

M-H

Mantel–Haenszel

PE

psychoeducation

SD

standard deviation

SE

standard error

TAU

treatment as usual

1.1. Individual Psychological Interventions Compared with Treatment as Usual (TAU)

Depression symptoms at post-treatment

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Depression symptoms at follow-up

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Manic symptoms at post-treatment

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Manic symptoms at follow-up

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Number of participants admitted to hospital at post-treatment

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Number of participants admitted to hospital at follow-up

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Mean number of participants admitted to hospital at follow-up

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Number of participants who relapsed (any type) at post-treatment

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Number of participants who relapsed (any type) at follow-up

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Mean number of participants who relapsed (any type) at follow-up

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Number of participants who relapsed (depression) at post-treatment

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Number of participants who relapsed (depression) at follow-up

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Number of participants who relapsed (mania) at post-treatment

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Number of participants who relapsed (mania) at follow-up

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Number of participants who responded (any type) at post-treatment

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Number of participants who responded (any type) at follow-up

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Number of participants who responded (50% reduction in depressive symptoms) at followup

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Number of participants who responded (50% reduction in manic symptoms) at follow-up

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Quality of life at post-treatment

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Quality of life at follow-up

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Psychosocial functioning (Global Assessment of Functioning scale; GAF) at post-treatment

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Psychosocial functioning (GAF) at follow-up

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Psychosocial functioning (social and/or work) at post-treatment

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Psychosocial functioning (social and/or work) at follow-up

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Number of participants discontinuing at post-treatment

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Number of participants discontinuing at follow-up

Image app25f26

1.2. Group Psychological Interventions Compared with Treatment as Usual (TAU)

Depression symptoms at post-treatment

Image app25f27

Depression symptoms at follow-up

Image app25f28

Manic symptoms at post-treatment

Image app25f29

Manic symptoms at follow-up

Image app25f30

Number of participants admitted to hospital at post-treatment

Image app25f31

Number of participants admitted to hospital at follow-up

Image app25f32

Number of participants who relapsed (any type) at post-treatment

Image app25f33

Number of participants who relapsed (any type) at follow-up

Image app25f34

Number of participants who relapsed (depression) at post-treatment

Image app25f35

Number of participants who relapsed (depression) at follow-up

Image app25f36

Number of participants who relapsed (mania) at post-treatment

Image app25f37

Number of participants who relapsed (mania) at follow-up

Image app25f38

Number of participants who relapsed (mixed episode) at post-treatment

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Number of participants who relapsed (mixed episode) at follow-up

Image app25f40

Quality of life at post-treatment

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Quality of life at follow-up

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Psychosocial functioning (GAF) at post-treatment

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Psychosocial functioning (GAF) at follow-up

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Psychosocial functioning (social and/or work) at post-treatment

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Number of participants discontinuing at post-treatment

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Number of participants discontinuing at follow-up

Image app25f47

1.3. Family Psychoeducation Compared with TAU

Depression symptoms at post-treatment

Image app25f48

Depression symptoms at follow-up

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Manic symptoms at post-treatment

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Manic symptoms at follow-up

Image app25f51

Number of participants admitted to hospital at post-treatment

Image app25f52

Number of participants admitted to hospital at follow-up

Image app25f53

Number of participants who relapsed (any type) at post-treatment

Image app25f54

Number of participants who relapsed (depression) at follow-up

Image app25f55

Number of participants who relapsed (mania) at follow-up

Image app25f56

Number of participants who relapsed (mixed episode) at follow-up

Image app25f57

Number of participants who responded (any type) at follow-up

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Number of participants who responded (50% reduction in manic symptoms) at follow-up

Image app25f59

Quality of life at follow-up

Image app25f60

Psychosocial functioning (GAF) at follow-up (57 weeks)

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Psychosocial functioning (GAF) at follow-up (109 weeks)

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Number of participants discontinuing at post-treatment

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Number of participants discontinuing at follow-up (~52 weeks)

Image app25f64

Number of participants discontinuing at follow-up (~104 weeks)

Image app25f65

1.4. Family Psychoeducation Compared with an Active Control

Depression symptoms at post-treatment

Image app25f66

Depression symptoms at follow-up

Image app25f67

Manic symptoms at post-treatment

Image app25f68

Manic symptoms at follow-up

Image app25f69

Number of participants admitted to hospital at post-treatment

Image app25f70

Number of participants admitted to hospital at follow-up

Image app25f71

Number of participants who relapsed (any type) at post-treatment

Image app25f72

Number of participants who relapsed (any type) at follow-up (~52 weeks)

Image app25f73

Number of participants who relapsed (any type) at follow-up (~104 weeks)

Image app25f74

Number of participants who responded (any type) at follow-up

Image app25f75

Number of participants who responded (50% reduction in depressive symptoms) at followup

Image app25f76

Number of participants who responded (50% reduction in manic symptoms) at follow-up

Image app25f77

Number of participants discontinuing at post-treatment

Image app25f78

Number of participants discontinuing at follow-up

Image app25f79

1.5. Cognitive Behavioural Therapy (CBT) Compared with an Active Control

Depression symptoms at post-treatment

Image app25f80

Depression symptoms at follow-up

Image app25f81

Manic symptoms at post-treatment

Image app25f82

Number of participants who relapsed (any type) at post-treatment

Image app25f83

Number of participants who relapsed (any type) at follow-up

Image app25f84

Number of participants who relapsed (depression) at follow-up

Image app25f85

Number of participants who relapsed (mania) at follow-up

Image app25f86

Number of participants who relapsed (mixed) at follow-up

Image app25f87

Number of participants discontinuing at follow-up

Image app25f88

1.6. Interpersonal and Social Rhythm Therapy Compared with an Active Control

Depression symptoms at post-treatment

Image app25f89

Manic symptoms at post-treatment

Image app25f90

Number of participants who relapsed (any type) at post-treatment

Image app25f91

Number of participants who responded (any type) at post-treatment

Image app25f92

Number of participants who responded (50% reduction in depressive symptoms) at followup

Image app25f93

Psychosocial functioning (GAF) at post-treatment

Image app25f94

Psychosocial functioning (social and/or work) at post-treatment

Image app25f95

Number of participants discontinuing at post-treatment

Image app25f96

Number of participants discontinuing at follow-up

Image app25f97

1.7. Collaborative Care Compared with TAU

Depression symptoms at post-treatment

Image app25f98

Depression symptoms at follow-up

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Manic symptoms at post-treatment

Image app25f100

Manic symptoms at follow-up

Image app25f101

Number of participants admitted to hospital at post-treatment

Image app25f102

Number of participants who relapsed (any type) at post-treatment

Image app25f103

Number of participants who relapsed (depression) at post-treatment

Image app25f104

Number of participants who relapsed (mania) at post-treatment

Image app25f105

Quality of life at post-treatment

Image app25f106

Quality of life at follow-up

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Number of participants discontinuing at post-treatment

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Number of participants discontinuing at follow-up

Image app25f109

1.8. Integrated Group Therapy Compared with Group Drug Counselling

Depression symptoms at post-treatment

Image app25f110

Depression symptoms at follow-up

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Manic symptoms at post-treatment

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Manic symptoms at follow-up

Image app25f113

1.9. Integrated Cognitive and Interpersonal Therapy Compared with Treatment as Usual (TAU)

Depression symptoms at post-treatment

Image app25f114

Manic symptoms at post-treatment

Image app25f115

Quality of life at post-treatment

Image app25f116

Number of participants discontinuing at post-treatment

Image app25f117
© The British Psychological Society & The Royal College of Psychiatrists, 2014.

All rights reserved. No part of this guideline may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, or in any information storage or retrieval system, without permission in writing from the National Collaborating Centre for Mental Health. Enquiries in this regard should be directed to the Centre Administrator: ku.ca.hcyspcr@nimdAHMCCN

Bookshelf ID: NBK545959
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