***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: Introduction Changes in biological rhythm are among the various characteristics of bipolar disorder , and have long been associated with the functional impairment of the disease . There are only a few viable options of psychosocial interventions that deal with this specific topic ; one of them is psychoeducation , a model that , although it has been used by practitioners for some time , only recently have studies shown its efficacy in clinical practice . Aim To assess if patients undergoing psychosocial intervention in addition to a pharmacological treatment have better regulation of their biological rhythm than those only using medication . Method This study is a r and omized clinical trial that compares a st and ard medication intervention to an intervention combined with drugs and psychoeducation . The evaluation of the biological rhythm was made using the Biological Rhythm Interview of Assessment in Neuropsychiatry , an 18-item scale divided in four areas ( sleep , activity , social rhythm , and eating pattern ) . The combined intervention consisted of medication and a short-term psychoeducation model summarized in a protocol of six individual sessions of 1 hour each . Results The sample consisted of 61 patients with bipolar II disorder , but during the study , there were 14 losses to follow-up . Therefore , the final sample consisted of 45 individuals ( 26 for st and ard intervention and 19 for combined ) . The results showed that , in this sample and time period evaluated , the combined treatment of medication and psychoeducation had no statistically significant impact on the regulation of biological rhythm when compared to st and ard pharmacological treatment . Conclusion Although the changes in biological rhythm were not statistically significant during the time period evaluated in this study , it is noteworthy that the trajectory of the score showed a trend towards improvement , which may indicate a positive impact on treatment , though it may take a longer time than expected 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 Bipolar disorder ( BD ) can have an impact on psychosocial functioning and quality of life ( QoL ) . Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders ; however , few studies have investigated the results of group cognitive behavior therapy ( G-CBT ) for BD . Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients , comparing this intervention plus pharmacotherapy to treatment as usual ( TAU ; only pharmacotherapy ) .  Forty-one patients with BD I and II participated in this study and were r and omly allocated to each group ( G-CBT : N = 27 ; TAU : N = 14 ) . Thirty-seven participants completed the treatment ( women : N = 66.67 % ; mean age = 41.5 years ) .  QoL and mood symptoms were assessed in all participants . Scores changed significantly by the end of treatment in favor of the G-CBT group . The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale . At the end of treatment , the G-CBT group exhibited lower scores for mania ( not statistically significant ) and depression ( statistically significant ) as well as a reduction in the frequency and duration of mood episodes ( P < 0.01 ) . The group variable was significant for the reduction of depression scores over time . This clinical change may explain the improvement in six of the eight subscales of QoL ( P < 0.05 ) . The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales . These results were not observed in the TAU control group BACKGROUND Preliminary research findings have shown that mindfulness-based cognitive therapy improves anxiety and depressive symptoms in bipolar disorder . In this study , we further investigated the effects of MBCT in bipolar disorder , in a controlled fMRI study . METHOD Twenty three patients with bipolar disorder underwent neuropsychological testing and functional MRI .  Sixteen of these patients were tested before and after an eight-week MBCT intervention , and seven were wait listed for training and tested at the same intervals . The results were compared with 10 healthy controls . RESULTS Prior to MBCT , bipolar patients reported significantly higher levels of anxiety and symptoms of stress , scored significantly lower on a test of working memory , and showed significant BOLD signal decrease in the medial PFC during a mindfulness task , compared to healthy controls . Following MBCT , there were significant improvements in the bipolar treatment group , in measures of mindfulness , anxiety and emotion regulation , and in tests of working memory , spatial memory and verbal fluency compared to the bipolar wait list group . BOLD signal increases were noted in the medial PFC and posterior parietal lobe , in a repeat mindfulness task . A region of interest analysis revealed strong correlation between signal changes in medial PFC and increases in mindfulness . LIMITATIONS The small control group is a limitation in the study . CONCLUSION These data suggest that MBCT improves mindfulness and emotion regulation and reduces anxiety in bipolar disorder , corresponding to increased activations in the medial PFC , a region associated with cognitive flexibility and previously proposed as a key area of pathophysiology in the disorder INTRODUCTION Bipolar disorder is one of ten most debilitating diseases in the world , leading to a lessened quality of life amongst its sufferers . This r and omised control trial demonstrates the effectiveness of psycho-education intervention along with a patient support system in the management of this disorder . METHODOLOGY In this trial , 108 patients , divided equally into two groups , were r and omly assigned to receive either pharmacotherapy alone ( control group ) or psycho-education along with pharmacotherapy treatment ( intervention group ) for a two year period . Each individual patient in the " intervention " group received eight , fifty-minute sessions of psychological education , followed by monthly telephone follow-up care and psychological support in the subsequent 18 months . Each group was evaluated , once every 6 months for a period of 18 months , in the areas of " quality of life " , " symptoms of relapse " , " pharmacotherapy compliance " and " number of hospital admission for recurrence of bipolar disorder " . RESULT The result of this study indicates that patients in the " intervention " group had a statistically significant enhancement in medication compliance ( P = 0.008 ) . Regarding every aspect of life quality , this group was at a better position than the " control " group ( P = 0.000 ) . As to relapse and hospital admission , the " intervention " group reported much lower cases compared with the " control " group at a significance level of P = 0.000 . CONCLUSION AND DISCUSSION This research has demonstrated that in the psycho-education intervention group , there was a more significant improvement in all areas of quality of life , number of relapses , and hospitalization due to recurrence of bipolar disorder and medication compliance than it was evident in the control groups Abstract Background Despite the use of maintenance medication , recurrence rates in bipolar affective disorder ( BPAD ) are high . To date , there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan . Aim The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme ( CaPE ) in Pakistan . Methods Thirty-four euthymic bipolar I and II out patients were r and omized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual ( Intervention ) or Treatment As Usual ( TAU ) ( Control ) . Outcomes were assessed using the Young Mania Rating Scale ( YMRS ) , Beck Depression Inventory ( BDI ) , EuroQoL ( EQ-5D ) , Bipolar Knowledge and Attitudes and Question naire ( BKAQ ) , and a self-reported measure of medication adherence ( Morisky Medication Adherence Scale-4 items , MMAS-4 ) . Effect sizes were derived from baseline adjusted st and ardized regression coefficients . Results Retention in the study was good , 80 % of patients in the TAU follow-up assessment and 100 % of patients in the CaPE group attended all 12 sessions . Patient satisfaction was higher in the CaPE group relative to control ( ES = 1.41 ) . Further , there were large effect sizes shown for CaPE versus TAU  for medication adherence ( MMAS-4 : ES = 0.81 ) , knowledge and attitudes towards bipolar ( BKAQ : ES = 0.68 ) , mania ( YMRS : ES = 1.18 ) , depression ( BDI : ES = 1.17 ) and quality of life measures ( EQ-5D : ES ⇒ 0.88 ) . Conclusions Culturally adapted psychoeducation intervention is acceptable and feasible , and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU . Larger scale studies are needed to confirm our findings . Trial registration . Clinical trials.gov identifier There are scarce follow-up studies evaluating the role of psychoeducation in the treatment of bipolar disorder , especially in a young sample , with a recent diagnosis and that probably received a few previous interventions . This was a r and omized clinical trial with young adults aged 18 - 29 years , who had been diagnosed with bipolar disorder through the Structured Clinical Interview for DSM ( SCID ) . The evaluation of quality of life was carried out using the Medical Outcomes Survey 36-Item Short-Form Health Survey ( MOS SF-36 ) . All participants were r and omized into two groups : combined intervention ( psychoeducation plus medication ) and treatment-as-usual ( medication ) . The sample consisted of 61 patients divided in two groups ( 29 usual treatment ; 32 combined intervention ) . The quality of life domains did not reveal statistically significant differences when comparing baseline , post-intervention and 6-month follow-up evaluations , which indicates that there is no difference between combined intervention and usual intervention regarding quality of life improvement . Both groups presented improvements in quality of life domains , except General Health and Bodily Pain , at post-intervention . Moreover , this improvement persisted at 6-month follow-up , except for the Role Physical Health domain , which remained reduced . Combined Psychoeducation plus pharmacological intervention is so effective in improving quality of life perception as it is pharmacological only intervention Introduction : Medication nonadherence is highly prevalent in patients with bipolar disorders and often results in worsening disease prognosis . The purpose of this study was to investigate the effect of group psychoeducation on medication adherence in female patients with bipolar mood disorder type I. Methods : This r and omized controlled trial was conducted on 76 patients with bipolar mood disorder admitted in female psychiatric wards of Razi teaching hospital , Tabriz , Iran . The participants were selected by convenience sampling method and were r and omly assigned to experimental and control groups . Patients in experimental group received 10 continuous 90 minutes sessions of psychoeducation , two times a week . Medication adherence was measured using the medicine check list and medication adherence rating scale ( MARS ) before and after intervention . Data analysis was performed with SPSS ver.13 . Results : There was no significant difference between two groups regarding medication adherence before the intervention . After the study intervention , the mean scores of medication adherence check list and medication adherence rating scale in the experimental group were significantly higher than the control group . Conclusion : Since group psychoeducation was effective in improving patients ' medication adherence , it could be recommended for psychiatric nurses to apply this intervention in the clinical setting BACKGROUND Limited information is available on the outcome of bipolar disorder in developing countries . OBJECTIVE To describe the symptomatic and functional outcome of bipolar disorder . METHODS The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia . In addition , key informants were used to identify individuals with probable major mental illnesses . SCAN interviews were completed at the second stage to confirm the diagnosis . A total of 315 cases of bipolar disorder were identified , of which 264 ( 69 recent-onset and 195 prevalent cases ) were prospect ively followed for a mean of 2.5 ( range 1 - 4 ) years by baseline and annual clinical assessment s using symptom rating scales . Functional dimensions of the SF-36 scale were used to describe functional outcome . R and om coefficient analyses were used to evaluate potential correlates of outcome . RESULTS The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up , although the improvement was less marked for depression . Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome . Between 35 % and 47 % of the recent-onset cases had functional role restrictions , while 42 - 52 % of long-st and ing cases had such restrictions during the follow-up years . Similarly , social and physical functioning 
    Output:
    
Psychoeducation improved treatment adherence , knowledge of and attitudes towards bipolar disorder and quality of life , and led to decreased relapse rates and hospital admissions .
Family psychoeducation prevented relapse , decreased hospital admissions and improved medication adherence .
CBT reduced both depressive and manic symptoms .
MBCT reduced emotional dysregulation .
Conclusions Adjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries .