***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 Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results . We developed a new treatment , treatment adherence therapy ( TAT ) , whose intervention modules are tailored to the reasons for an individual 's non-adherence . AIMS To examine the effectiveness of TAT with regard to service engagement and medication adherence in out- patients with psychotic disorders who engage poorly . METHOD R and omised controlled study of TAT v. treatment as usual ( TAU )  in 109 out- patients . Most outcome measurements were performed by masked assessors . We used intention-to-treat multivariate analyses ( Dutch Trial Registry : NTR1159 ) . RESULTS Treatment adherence therapy v. TAU significantly benefited service engagement ( Cohen 's d = 0.48 ) and medication adherence ( Cohen 's d = 0.43 ) . Results remained significant at 6-month follow-up for medication adherence . Near-significant effects were also found regarding involuntary readmissions ( 1.9 % v. 11.8 % , P = 0.053 ) . Symptoms and quality of life did not improve . CONCLUSIONS Treatment adherence therapy helps improve engagement and adherence , and may prevent involuntary admission BACKGROUND To our knowledge , this is the first prospect i ve natural history study of weekly symptomatic status of patients with bipolar I disorder ( BP-I ) during long-term follow-up . METHODS Analyses are based on ongoing prospect i ve follow-up of 146 patients with Research Diagnostic Criteria BP-I , who entered the National Institute of Mental Health ( Bethesda , Md ) Collaborative Depression Study from 1978 through 1981 .  Weekly affective symptom status ratings were analyzed by polarity and severity , ranging from asymptomatic , to subthreshold levels , to full-blown major depression and mania . Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined . Finally , 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. RESULTS Patients with BP-I were symptomatically ill 47.3 % of weeks throughout a mean of 12.8 years of follow-up . Depressive symptoms ( 31.9 % of total follow-up weeks ) predominated over manic/hypomanic symptoms ( 8.9 % of weeks ) or cycling/mixed symptoms ( 5.9 % of weeks ) . Subsyndromal , minor depressive , and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms ( 29.9 % vs 11.2 % of weeks , respectively ) . Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year . Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up , as did comorbid drug-use disorder . CONCLUSIONS The longitudinal weekly symptomatic course of BP-I is chronic . Overall , the symptomatic structure is primarily depressive rather than manic , and subsyndromal and minor affective symptoms predominate . Symptom severity levels fluctuate , often within the same patient over time . Bipolar I disorder is expressed as a dimensional illness featuring the full range ( spectrum ) of affective symptom severity and polarity 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 In a r and omized , controlled trial , the authors studied an adjunctive , individual psychotherapy , interpersonal and social rhythm therapy ( IPSRT ) for bipolar disorder . After stabilizing participants with episode appropriate pharmacotherapy and either IPSRT or intensive clinical management ( CM ) , participants were reassigned to IPSRT or CM in conjunction with pharmacotherapy for 2 years of preventative treatment . Early results ( n = 82 ) suggest that altering participants ' treatment assignment at entry to the preventative phase is related to risk of recurrence . Participants remaining in the same treatment for both acute and preventative phases had lower rates of recurrence ( < 20 % vs. > 40 % ) and levels of symptomatology over the subsequent 52 weeks than those reassigned to the alternate modality . This finding , consistent with the authors ' philosophy that bipolar patients benefit from stable routines , suggests that disruptions in the psychosocial treatment plan contribute to worse outcomes BACKGROUND The efficacy of adjunctive psychosocial interventions such as cognitive behaviour therapy ( CBT ) for bipolar disorder ( BD ) has been demonstrated in several uncontrolled and controlled studies . However , these studies compared CBT to either a waiting list control group , brief psycho-education or treatment as usual ( TAU ) . Our primary aim was to determine whether CBT is superior to supportive therapy ( ST ) of equal intensity and frequency in preventing relapse and improving outcome at post-treatment . A secondary aim was to look at predictors of survival time . METHOD We conducted a r and omized controlled trial ( RCT ) at the Department of Psychology , University of Tübingen , Germany ( n=76 patients with BD ) . Both CBT and ST consisted of 20 sessions over 9 months . Patients were followed up for a further 24 months . RESULTS Although changes over time were observed in some variables , they were not differentially associated with CBT or ST . CBT showed a non-significant trend for preventing any affective , specifically depressive episode during the time of therapy . Kaplan-Meier survival analyses revealed that 64.5 % of patients experienced a relapse during the 33 months . The number of prior episodes , the number of therapy sessions and the type of BD predicted survival time . CONCLUSIONS No differences in relapse rates between treatment conditions were observed , suggesting that certain shared characteristics ( e.g. information , systematic mood monitoring ) might explain the effects of psychosocial treatment for BD . Our results also suggest that a higher number of prior episodes , a lower number of therapy sessions and a diagnosis of bipolar II disorder are associated with a shorter time before relapse BACKGROUND Despite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically design ed to enhance personal recovery for individuals with recent-onset bipolar disorder . AIMS A pilot study to assess the feasibility and effectiveness of a new intervention , recovery-focused cognitive-behavioural therapy ( CBT ) , design ed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes . METHOD A single , blind r and omised controlled trial compared treatment as usual ( TAU ) with recovery-focused CBT plus TAU ( n = 67 ) . RESULTS Recruitment and follow-up rates within 10 % of pre-planned targets to 12-month follow-up were achieved . An average of 14.15 h ( s.d . = 4.21 ) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU , recovery-focused CBT  significantly improved personal recovery up to 12-month follow-up ( Bipolar Recovery Question naire mean score 310.87 , 95 % CI 75.00 - 546.74 ( s.e . = 120.34 ) , P = 0.010 , d = 0.62 ) and increased time to any mood relapse during up to 15 months follow-up ( χ2 = 7.64 , P<0.006 , estimated hazard ratio ( HR ) = 0.38 , 95 % CI 0.18 - 0.78 ) . Groups did not differ with respect to medication adherence . CONCLUSIONS Recovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness . Clinical - and cost-effectiveness now need to be reliably estimated in a definitive trial BACKGROUND All follow-up studies of causes of death in affective disordered patients have found they have markedly elevated suicide rates and a less reproducible increased mortality from other causes . The reported rates by gender , disorder type and treatment are more variable . METHODS Hospitalised affective disordered patients ( n=406 ) were followed prospect ively for 22 years or more . Later , mortality was assessed for 99 % of them at which time 76 % had died . RESULTS St and ardised Mortality Rates ( observed deaths/expected deaths ) for patients were elevated especially for suicide and circulatory disorders in both men and women . Women actually had higher suicide rates but that did not take into account the twofold increase in general population rates for men . Unipolar patients had significantly higher rates of suicide than bipolar Is or IIs . In all groups long term medication treatment with antidepressants alone or with a neuroleptic , or with lithium in combination with antidepressants and /or neuroleptics significantly lowered suicide rates even though the treated were more severely ill . Although at the age of onset the suicide rates were most elevated , from ages 30 to 70 the rates were remarkably constant despite the different courses of illness . LIMITATIONS The patients were identified as in patients and followed prospect ively . The treatments were uncontrolled and are not quantifiable but were documented during the follow-up . CONCLUSIONS Men and women hospitalised for affective disorders have elevated mortality rates from suicide and circulatory disorders . Unipolars have higher suicide rates than bipolar Is or IIs . Long term medication treatment lowers the suicide rates , despite the fact that it was the more severely ill who were treated OBJECTIVE Although there are some r and omized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder , no trials using contemporary method ologies have analyzed the specific effect of working with caregiver-only groups . The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients . METHOD A total of 113 medicated euthymic bipolar out patients who lived with their caregivers were r and omized into an experimental and a control group . Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills . The patients did not attend the groups . Caregivers assigned to the control group did not receive any specific intervention . Patients were assessed monthly during both the intervention and the 12 months of follow-up . The primary outcome was time to any mood recurrence . RESULTS Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence ( chi2 = 6.53 ; p = 0.011 ) and longer relapse-free intervals ( log-rank chi(2 ) = 4.04 ; p = 0.044 ) . When different types of episodes were analyzed separately , the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence ( chi2 = 5.65 ; p = 0.017 ) and the time to such an episode ( log-rank chi2 = 5.84 ; p = 0.015 ) . The differences in preventing depressive and mixed episodes were not significant . CONCLUSIONS A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences , particularly mania and hypomania , in bipolar disorder 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 
    Output:
    
Low- quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up , and family psychoeducation with reduced symptoms of depression and mania .
CONCLUSIONS There is evidence that psychological interventions are effective for people with bipolar disorder .