Psychosocial Interventions for Elderly People with Bipolar Disorder: Systematic Review with Meta-Analysis
DOI:
https://doi.org/10.1590/1982-4327e3426Keywords:
bipolar disorder, psychosocial intervention, aging, cognitive behavioral therapy, randomized controlled trialAbstract
Bipolar Affective Disorder is a chronic mental disorder that can have profound consequences for elderly people. The objective of this study was to analyse the evidence of the effectiveness of psychosocial and Cognitive-Behavioral Therapy-based interventions for bipolar disorder. To this end, a systematic review with meta-analysis was conducted based on randomized controlled trial, published between 2012 and 2022, that included elderly people in their samples. The search, carried out in the PubMed, SciELO, CENTRAL, and PePSIC databases, resulted in 1069 articles, 15 of which were included in this research. The recommendations of PRISMA and JBI were used. It was found that psychoeducation and, especially, interventions in Cognitive-Behavioral Therapy can improve symptoms of this disorder. Through meta-analysis, an effect in favour of Cognitive-Behavioral Therapy was observed for reducing mania, but not for depression. However, more studies are needed, as none conducted exclusively with elderly people were found.
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References
American Psychiatric Association. (2014). Manual diagnóstico e estatístico de transtornos mentais: DSM-5 - TR [Diagnostic and statistical manual of mental disorders: DSM-5 - TR] (5a ed.). Artmed.
Arenas, D. L., Bittencourt, A. M. L., Tavares, L. N., Calixto, L. H. M., Smaniotto, L. A. M., Motta, L. S., & Shansis, F. M. (2019). Transtorno bipolar no idoso [Bipolar disorder in the elderly]. In A. Cataldo, Neto, A. M. L. Bittencourt, & R. A. Marquetto (Orgs.), Manual de psiquiatria geriátrica. [Manual of geriatric psychiatry]. (pp. 131-158). Edipucrs. https://editora.pucrs.br/livro/1369/
Arnold, I., Dehning, J., Grunze, A., & Hausmann, A. (2021). Old age bipolar disorder-epidemiology, aetiology and treatment. Medicina, 57(6), 587. https://doi.org/10.3390/medicina57060587
» https://doi.org/10.3390/medicina57060587
Aromataris, E., & Munn, Z. (2020). JBI manual for evidence synthesis. JBI. https://doi.org/10.46658/JBIMES-24-01
Balduzzi, S., Rücker, G., & Schwarzer, G. (2019). How to perform a meta-analysis with R: A practical tutorial. Evidence-Based Mental Health, 22(4), 153–160. https://doi.org/10.1136/ebmental-2019-300117
Beunders, A. J. M., Orhan, M., & Dols, A. (2023). Older age bipolar disorder. Current Opinion in Psychiatry, 36(5), 397–404. https://doi.org/10.1097/YCO.0000000000000883
Bowden C. L. (2011). Pharmacological treatments for bipolar disorder: Present recommendations and future prospects. In H. Manji, & C. Zarate, Jr. (eds.), Behavioral neurobiology of bipolar disorder and its treatment (pp. 263–283). Springer.
Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. Public Library of Science One, 12(5), 1-19. https://doi.org/10.1371/journal.pone.0176849
Depp, C. A., Ceglowski, J., Wang, V. C., Yaghouti, F., Mausbach, B. T., Thompson, W. K., & Granholm, E. L. (2015). Augmenting psychoeducation with a mobile intervention for bipolar disorder: A randomized controlled trial. Journal of Affective Disorders, 174, 23-30. https://doi.org/10.1016/j.jad.2014.10.053
Ellard, K. K., Bernstein, E. E., Hearing, C., Baek, J. H., Sylvia, L. G., Nierenberg, A. A., Barlow, D. H., & Deckersbach, T. (2017). Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial. Journal of Affective Disorders, 219, 209-221. https://doi.org/10.1016/j.jad.2017.05.011
Galvão, M. C. B., & Ricarte, I. L. M. (2019). Revisão sistemática da literatura: Conceituação, produção e publicação [Systematic literature review: Concept, production and publication]. Logeion: Filosofia Da Informação, 6(1), 57–73. https://doi.org/10.21728/logeion.2019v6n1.p57-73
Gurgel, W. S., & Souza, F. G. M. (2016). Profilaxia/manutenção no transtorno bipolar [Prophylaxis/maintenance in bipolar disorder]. In F. Kapczinski, & J. Quevedo (Orgs.), Transtorno bipolar: Teoria e clínica [Bipolar disorder: Theory and clinic] (2a ed., pp. 236-259). Artmed.
Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration. https://training.cochrane.org/handbook
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
Isasi, A. G., Echeburúa, E., Limiñana, J. M., & González-Pinto, A. (2014). Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial. European Psychiatry: The Journal of the Association of European Psychiatrists, 29(3), 134–141. https://doi.org/10.1016/j.eurpsy.2012.11.002
Jensen, S. B., Dalum, H. S., Korsbek, L., Hjorthøj, C., Mikkelsen, J. H., Thomsen, K., Kistrup, K., Olander, M., Lindschou, J., Mueser, K. T., Nordentoft, M., & Eplov, L. F. (2019). Illness management and recovery: One-year follow-up of a randomized controlled trial in Danish community mental health centers: Long-term effects on clinical and personal recovery. BioMed Central Psychiatry, 19(1), 65. https://doi.org/10.1186/s12888-019-2048-0
Jones, S. H., Smith, G., Mulligan, L. D., Lobban, F., Law, H., Dunn, G., Welford, M., Kelly, J., Mulligan, J., & Morrison, A. P. (2015). Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial. The British Journal of Psychiatry, 206(1), 58–66. https://doi.org/10.1192/bjp.bp.113.141259
Lauder, S., Chester, A., Castle, D., Dodd, S., Gliddon, E., Berk, L., Chamberlain, J., Klein, B., Gilbert, M., Austin, D. W., & Berk, M. (2015). A randomized head to head trial of MoodSwings.net.au: An internet based self-help program for bipolar disorder. Journal of Affective Disorders, 171, 13-21. https://doi.org/10.1016/j.jad.2014.08.008
Lee, J. Y., & Harvey, A. G. (2015). Memory for therapy in bipolar disorder and comorbid insomnia. Journal of Consulting and Clinical Psychology, 83(1), 92–102. https://doi.org/10.1037/a0037911
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & PRISMA-P Group (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews Journal, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1
Moore, D. J., Poquette, A., Casaletto, K. B., Gouaux, B., Montoya, J. L., Posada, C., Rooney, A. S., Badiee, J., Deutsch, R., Letendre, S. L., Depp, C. A., Grant, I., Atkinson, J. H., & The HIV Neurobehavioral Research Program (HNRP) Group (2015). Individualized texting for adherence building (iTAB): Improving antiretroviral dose timing among HIV-infected persons with co-occurring bipolar disorder. AIDS and Behavior, 19(3), 459–471. https://doi.org/10.1007/s10461-014-0971-0
Moreno, D. H., David, D. P., Bio, D. S., & Moreno, R. A. (2015). Transtorno bipolar: O que é necessário saber? [Bipolar disorder: What do you need to know?] In R. A. Moreno, D. H. Moreno, D. S. Bio, & D. P. David (Orgs.), Aprendendo a viver com o transtorno bipolar: Manual educativo. (pp. 517-925). Artmed.
Morriss, R., Lobban, F., Riste, L., Davies, L., Holland, F., Long, R., Lykomitrou, G., Peters, S., Roberts, C., Robinson, H., Jones, S., & NIHR PARADES Psychoeducation Study Group (2016). Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): A pragmatic, multicentre, observer-blind, randomised controlled superiority trial. The Lancet. Psychiatry, 3(11), 1029–1038. https://doi.org/10.1016/S2215-0366(16)30302-9
Murray, G., Thomas, N., Michalak, E. E., Jones, S. H., Lapsley, S., Bowe, S. J., Foley, F., Fletcher, K., Perich, T., Johnson, S. L., Cotton, S., Berk, L., Mihalopoulos, C., Kyrios, M., & Berk, M. (2021). Mindfulness-based online intervention to improve quality of life in late-stage bipolar disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(10), 830–844. https://doi.org/10.1037/ccp0000684
Oliveira, R. L., & Savoia, M. G. (2016). Terapia Cognitivo-Comportamental para bipolares idosos [Cognitive-Behavioral Therapy for bipolar seniors]. In E. R. Freitas, A. J. G. Barbosa, & C. B. Neufeld (Orgs.). Terapias Cognitivos-Comportamentais com idosos [Cognitive-Behavioral Therapies with the older people] (pp. 231-255). Sinopsys.
Organização Mundial da Saúde. (2005). Envelhecimento ativo: Um projeto de política de saúde [Active ageing: A health policy project]. Organização Pan-Americana de Saúde.
Pakpour, A. H., Modabbernia, A., Lin, C. Y., Saffari, M., Ahmadzad Asl, M., & Webb, T. L. (2017). Promoting medication adherence among patients with bipolar disorder: A multicenter randomized controlled trial of a multifaceted intervention. Psychological Medicine, 47(14), 2528–2539. https://doi.org/10.1017/S003329171700109X
Parikh, S. V., Zaretsky, A., Beaulieu, S., Yatham, L. N., Young, L. T., Patelis-Siotis, I., Macqueen, G. M., Levitt, A., Arenovich, T., Cervantes, P., Velyvis, V., Kennedy, S. H., & Streiner, D. L. (2012). A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: A Canadian Network for Mood and Anxiety treatments (CANMAT) study. The Journal of Clinical Psychiatry, 73(6), 803–810. https://doi.org/10.4088/JCP.11m07343
Pereira, S. R. M. (2017). Fisiologia do envelhecimento [Physiology of aging]. In E. V. Freitas (Ed.), Tratado de geriatria e gerontologia (4a ed., pp. 267-289). Guanabara Koogan. (Trabalho original publicado em 2016).
Sajatovic, M., Tatsuoka, C., Cassidy, K. A., Klein, P. J., Fuentes-Casiano, E., Cage, J., Aebi, M. E., Ramirez, L. F., Blixen, C., Perzynski, A. T., Bauer, M. S., Safren, S. A., & Levin, J. B. (2018). A 6-month, prospective, randomized controlled trial of customized adherence enhancement versus bipolar-specific educational control in poorly adherent individuals with bipolar disorder. The Journal of Clinical Psychiatry, 79(6), 1-10. https://doi.org/10.4088/JCP.17m12036
Shobassy, A. (2021). Elderly bipolar disorder. Current Psychiatry Reports, 23(2), 5. https://doi.org/10.1007/s11920-020-01216-6
Souza, E. M., Silva, D. P. P., & Barros, A. S. (2021). Popular education, health promotion and active aging: An integrative literature review. Ciência & Saúde Coletiva, 26(4), 1355-1368. https://doi.org/10.1590/1413-81232021264.09642019
Sylvia, L. G., Pegg, S. L., Dufour, S. C., Janos, J. A., Bernstein, E. E., Chang, W. C., Hall, N. E., Ellard, K. K., Nierenberg, A. A., & Deckersbach, T. (2019). Pilot study of a lifestyle intervention for bipolar disorder: Nutrition exercise wellness treatment (NEW Tx). Journal of Affective Disorders, 250, 278-283. https://doi.org/10.1016/j.jad.2019.03.033
Wenze, S. J., Gaudiano, B. A., Weinstock, L. M., Tezanos, K. M., & Miller, I. W. (2016). Adjunctive psychosocial intervention following hospital discharge for patients with bipolar disorder and comorbid substance use: A pilot randomized controlled trial. Psychiatry Research, 228(3), 516-525. https://doi.org/10.1016/j.psychres.2015.06.005
Zdanys, K. F., & Steffens, D. C. (2015). Sleep disturbances in the elderly. The Psychiatric Clinics of North America, 38(4), 723–741. https://doi.org/10.1016/j.psc.2015.07.010
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