Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:647386 |
| Date | January 2014 |
| Creators | Bond, Kirsten |
| Publisher | University of Manchester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://www.research.manchester.ac.uk/portal/en/theses/a-brief-psychoeducation-intervention-for-patients-with-bipolar-disorder-effect-on-attitudes-and-beliefs-and-their-relationship-to-clinical-outcomes(a2b7f420-b1f8-443d-a8ba-970e81bae01f).html |
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