***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders . AIMS To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy ( CBT ) . METHOD We undertook a multicentre , pragmatic , r and omised controlled treatment trial ( n=253 ) . Patients were assessed every 8 weeks for 18 months . RESULTS More than half of the patients had a recurrence by 18 months , with no significant differences between groups ( hazard ratio=1.05 ; 95 % CI 0.74 - 1.50 ) . Post hoc analysis demonstrated a significant interaction ( P=0.04 ) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes , but less effective in those with more episodes . CONCLUSIONS People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT . However , such cases form the minority of those receiving mental healthcare BACKGROUND The efficacy and effectiveness of cognitive therapy ( CT ) is well established for unipolar disorders , but little is known about its utility in bipolar disorders . This study aim ed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population . METHOD Subjects referred by general adult psychiatrists were assessed by and independent rater and then r and omly allocated to immediate CT ( N = 21 ) or 6-month waiting-list control , which was then followed by CT ( N = 21 ) . Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT , after a 6-month course of CT and a further 6-months later . Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected . RESULTS At 6-month follow-up , subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory , the Internal State Scale , and the Global Assessment of Functioning than those in the waiting-list control group . In the 29 patients who eventually received CT  , relapse rates in the 1 8 months after commencing CT showed a 60 % reduction in comparison with the 18 months prior to commencing CT . Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable . CONCLUSION Although the results of this study are encouraging , the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise . The therapy may prove to be particularly useful in the treatment of bipolar depression Recently hospitalized bipolar , manic patients ( N = 53 ) were r and omly assigned to a 9-month , manual-based , family-focused psychoeducational therapy ( n = 28 ) or to an individually focused patient treatment ( n = 25 ) . All patients received concurrent treatment with mood-stabilizing medications . Structured follow-up assessment s were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up . Compared with patients in individual therapy , those in family-focused treatment were less likely to be rehospitalized during the 2-year study period . Patients in family treatment also experienced fewer mood disorder relapses over the 2 years , although they did not differ from patients in individual treatment in their likelihood of a first relapse . Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder Abstract Objective : To determine the efficacy of teaching patients with bipolar disorder ( manic-depressive psychosis ) to identify early symptoms of relapse and seek prompt treatment from health services . Design : Single blind r and omised controlled trial with matching on four baseline variables using a minimisation algorithm . Setting : Mental health services in four NHS trusts ( one teaching , three non-teaching ) . Subjects : 69 patients with bipolar disorder who had had a relapse in the previous 12 months . Interventions : Seven to 12individual treatment sessions from a research psychologist plus routine care or routine care alone . Main outcome measures : Time to first manic or depressive relapse , number of manic or depressive relapses , and social functioning examined by st and ardised interviews every six months for 18 months . Results : 25th centile time to first manic relapse in experimental group was 65weeks compared with 17weeks in the control group . Event curves of time to first manic relapse significantly differed between experimental and control groups ( log rank 7.04 , df=1 , P=0.008 ) , with significant reductions in the number of manic relapses over 18months ( median difference 30 % ( 95 % confidence interval 8 % to 52 % ) , P=0.013 ) . The experimental treatment had no effect on time to first relapse or number of relapses with depression , but it significantly improved overall social functioning ( mean difference 2.0(0.7to 3.2 ) , P=0.003 ) and employment ( mean difference 0.7(0.1to 1.3 ) , P=0.030 ) by 18months . Conclusion : Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse , social functioning , and employment BACKGROUND Despite the availability of efficacious medications and psychotherapies , care of bipolar disorder in everyday practice is often deficient . This trial evaluated the effectiveness of a multi-component care management program in a population -based sample of people with bipolar disorder . METHOD Four hundred and forty-one patients treated for bipolar disorder during the prior year were r and omly assigned to continued usual care or usual care plus a systematic care management program including : initial assessment and care planning , monthly telephone monitoring including brief symptom assessment and medication monitoring , feedback to and coordination with the mental health treatment team , and a structured group psychoeducational program -- all provided by a nurse care manager . Blinded quarterly assessment s generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation . RESULTS Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period ( Z= 2.44 , p=0.015 ) and approximately one-third less time in hypomanic or manic episode ( 2.59 weeks v. 1.69 weeks ) . Mean depression ratings across the entire follow-up period did not differ significantly between the two groups , but the intervention group showed a greater decline in depression ratings over time ( Z statistic for group-by-time interaction = 1.98 , p = 0.048 ) . CONCLUSIONS A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months . Preliminary results suggest a growing effect on depression over time , but longer follow-up will be needed BACKGROUND The authors ' goal was to pilot test a newly developed manual-based group psychotherapy , called Integrated Group Therapy ( IGT ) , for patients with bipolar disorder and substance dependence . METHOD In this open trial , patients with DSM-IV bipolar disorder and substance dependence ( N = 45 ) were recruited in sequential blocks to receive either group therapy ( N = 21 ) or 6 monthly assessment s , but no experimental treatment ( N = 24 ) . RESULTS When compared with patients who did not receive group therapy , patients who received IGT had significantly better outcomes on the Addiction Severity Index drug composite score ( p < .03 ) , percentage of months abstinent ( p < .01 ) , and likelihood of achieving 2 ( p < .002 ) or 3 ( p < .004 ) consecutive abstinent months . CONCLUSION IGT is a promising treatment for patients with bipolar disorder and substance dependence , who have traditionally had poor outcomes . It is unclear , however , how much of the improvement among the group therapy patients is attributable to the specific content of the treatment . A study comparing this treatment with another active psychotherapy treatment is warranted CONTEXT Psychosocial interventions have been shown to enhance  pharmacotherapy outcomes in bipolar disorder . OBJECTIVE To examine the benefits of 4 disorder-specific psychotherapies in conjunction with pharmacotherapy on time to recovery and the likelihood of remaining well after an episode of bipolar depression . DESIGN R and omized controlled trial . SETTING Fifteen clinics affiliated with the Systematic Treatment Enhancement Program for Bipolar Disorder . Patients A total of 293 referred out patients with bipolar I or II disorder and depression treated with protocol pharmacotherapy were r and omly assigned to intensive psychotherapy ( n = 163 ) or collaborative care ( n = 130 ) , a brief psychoeducational intervention . INTERVENTIONS Intensive psychotherapy was given weekly and biweekly for up to 30 sessions in 9 months according to protocol s for family-focused therapy , interpersonal and social rhythm therapy , and cognitive behavior therapy . Collaborative care consisted of 3 sessions in 6 weeks . MAIN OUTCOME MEASURES Outcome assessment s were performed by psychiatrists at each pharmacotherapy visit . Primary outcomes included time to recovery and the proportion of patients classified as well during each of 12 study months . RESULTS All analyses were by intention to treat . Rates of attrition did not differ across the intensive psychotherapy ( 35.6 % ) and collaborative care ( 30.8 % ) conditions . Patients receiving intensive psychotherapy had significantly higher year-end recovery rates ( 64.4 % vs 51.5 % ) and shorter times to recovery than patients in collaborative care ( hazard ratio , 1.47 ; 95 % confidence interval , 1.08 - 2.00 ; P = .01 ) . Patients in intensive psychotherapy were 1.58 times ( 95 % confidence interval , 1.17 - 2.13 ) more likely to be clinical ly well during any study month than those in collaborative care ( P = .003 ) . No statistically significant differences were observed in the outcomes of the 3 intensive psychotherapies . CONCLUSIONS Intensive psychosocial treatment as an adjunct to pharmacotherapy was more beneficial than brief treatment in enhancing stabilization from bipolar depression . Future studies should compare the cost-effectiveness of models of psychotherapy for bipolar disorder . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00012558 OBJECTIVE In a previous r and omized controlled study , the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year . This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months . METHOD Patients with DSM-IV bipolar I disorder ( N=103 ) suffering from frequent relapses were r and omly assigned into a cognitive therapy plus medication group or a control condition of medication only . Independent raters , who were blind to patient group status , assessed patients at 6-month intervals . RESULTS Over 30 months , the cognitive therapy group had significantly better outcome in terms of time to relapse . However , the effect of relapse prevention was mainly in the first year . The cognitive therapy group also spent 110 fewer days ( 95 % CI=32 to 189 ) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days ( 95 % CI=3 to 105 ) in bipolar episodes out of a total of 450 for the last 18 months . Multivariate analyses of variance showed that over the last 18 months , the cognitive therapy group exhibited significantly better mood ratings , social functioning , coping with bipolar prodromes , and dysfunctional goal attainment cognition . CONCLUSIONS Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled . However , the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period . Further studies should explore the effect of booster sessions or maintenance therapy BACKGROUND Several previous studies have established that low treatment adherence is common among bipolar patients and may explain high rates of recurrence . On the other h and , some patients keep relapsing even when they strictly follow their prescribed somatic treatments . Psychological interventions such as psychoeducation may foster early recognition of prodromal symptoms and minimize the risk of relapse . To date , studies assessing the usefulness of psychoeducation in fully compliant patients are lacking . METHOD This was a single-blind , r and omized , prospect i ve clinical trial on the efficacy of group psychoeducation in remitted fully compliant DSM-IV bipolar I patients ( N = 25 ) who were compared with a group with similar characteristics ( N = 25 ) who did not receive psychoeducation .  All patients received naturalistic pharmacologic treatment . Recruitment began in 1997 and follow-up was completed in January 2002 . The follow-up phase comprised 2 years during which all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly on several outcome measures . RESULTS At the end of the 2-year follow-up , 23 subjects ( 92 % ) in the control group fulfilled criteria for recurrence versus 15 patients ( 60 % ) in the psychoeducation group ( p < .01 ) . The number of total recurrences and the number of depressive episodes were significantly lower in psychoeducated patients . CONCLUSION Although the present study has the limitation of small sample size , psychoeducation showed its efficacy in preventing 
    Output:
    
RESULTS Cognitive-behavioural therapy or group psychoeducation may be effective for relapse prevention in stable individuals .
Family therapy was no more or less effective than individual psychosocial therapy or crisis management .
There is no evidence that care management or integrated group therapy is effective in the prevention of relapse .
CONCLUSIONS Cognitive-behavioural therapy , group psychoeducation and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments