Problem-Solving Skills Improve Bipolar Disorder Outcomes

Bipolar disorder is stubbornly resistant to treatment. Even bipolar patients who take medication as directed and attend all appointments and support groups often have suboptimal treatment responses.

Concerned about persistent depressive symptoms and their affect on quality of life, researchers recently designed a collaborative care intervention that added problem-solving patient education to usual care. Their results, published ahead of print in the British Journal of Psychiatry, show that collaborative care can decrease the duration and magnitude of depressive symptoms in bipolar patients.

In this cluster randomized, controlled trial, 138 patients treated in 16 outpatient mental health clinics received usual treatment either alone or supplemented with a collaborative care program—a relatively intense intervention. The researchers monitored medication adherence and symptom duration and severity at baseline, 6 months, and 12 months.

In this study, collaborative care was structured to improve self-management skills systematically. Patients could even invite a family member or friend to attend sessions with them.

The team contracted with bipolar patients in the collaborative care arm to identify their most significant problems and come to agreement that they would focus on resolving them. They were provided psychoeducation, problem-solving treatment, systematic relapse prevention, and outcomes monitoring. Overall, 6 brief sessions helped patients improve their practical problem-solving skills directed at everyday conundrums.

Patients in the collaborative care arm had significantly and clinically measureable improvements in depressive symptoms at 6 months and 12 months. Symptom duration and magnitude both improved, as well.

Medication adherence remained steady in both groups, however, with no improvement noted.

The collaborative care model incorporated patients, informal caregivers, and health care providers into its design—a factor considered innovative. Compared with usual treatment, collaborative care substantially reduced the time participants with bipolar disorder reported depressive symptoms.

Any intervention that significantly improves difficult, disabling depressive symptoms could improve quality of life for patients with bipolar disorder.