Group psychoeducation could be effective in treating patients in early stages of bipolar disorder

Structured group psychoeducation sessions could be more successful in treating patients in the early stages of bipolar disorder than standard peer-support offered by the NHS and the voluntary sector, research has found.

The study by academics at The Universities of Nottingham, Lancaster (Spectrum Centre) and Manchester published this week in Lancet Psychiatry, and funded by the National Institute of Health Research (NIHR), found evidence that psychoeducation - in which patients are offered information on their illness and work with family members to develop personalised coping strategies - could potentially offer an effective early intervention for people with bipolar disorder.

They have called for further research to explore whether group psychoeducation could be used preventatively to halt the further progression of the disorder.

The research was led by Professor Richard Morriss in the University's School of Medicine and Institute of Mental Health - a partnership between the University and Nottinghamshire Healthcare NHS Trust and NIHR Collaborative for Leadership in Applied Health Research and Care East Midlands.

Professor Morriss said: "NICE recommended group psychoeducation for bipolar disorder was put into practice in the NHS in England and Wales. However, the effectiveness of the intervention was questioned in the media on the basis that previous research had been low in quality. We have conducted a large high quality randomised controlled trial of group psychoeducation against a rigorous control and this shows that overall there are benefits to people with bipolar disorder overall from this cheap and easy to implement intervention in providing information, support and increasing time before they next have a mania episode, and in especially in people who first develop bipolar disorder where it may considerably reduce the number of relapses in bipolar disorder."

Bipolar disorder is a common lifelong mental health disorder which first affects people in adolescence or early adulthood. Previously known as manic depression, the condition affects patients' moods, causing them to experience episodes of feeling low and lethargic while at other times feeling very high and overactive.

In the UK, information and emotional support is offered to people with bipolar disorder through unstructured peer-support groups run through the NHS and charities such as Bipolar UK, which includes a national network of more than 130 support groups.

Between September 2009 and June 2012, the researchers recruited 304 bipolar patients to the trial, who were randomly assigned to receive either psychoeducation or peer support.

While structured group psychoeducation was found to be no more clinically effective than unstructured peer support across the whole of the group, an analysis of the results showed that psychoeducation was more popular - attendance at psychoeducation groups was higher than at peer-support groups (a median of 14 sessions versus nine sessions).

The study also showed that psychoeducation was most beneficial in participants with few previous bipolar episodes (less than eight episodes).

Two themes also emerged from qualitative study of the value of the two groups: increased knowledge in general about bipolar disorder and specifically how it affects the participant as an individual and tackling isolation and stigma by allowing patients to share similar experiences.

However, some participants blamed dropping out of treatment for their illness on a lack of structure within the peer-support groups.

In an accompanying editorial in Lancet Psychiatry, Professor Eduard Vieta, the Spanish psychiatrist and a leading scientific authority on the neurobiology and treatment of bipolar disorder, and Professor Ivette Morilla, a specialist in clinical psychology, suggest that the study's strength could lie in its finding on the importance of early intervention.

"It could be argued that this was not the primary objective of the study, but at the end of the day this is, indeed, the most pragmatic conclusion that one can take from the study results," they say.

"In patients with less than eight episodes, PEd significantly delayed time to the next episode, indicating that the intervention may be better suited for subjects at early stages of the illness.

"To conclude, group psychoeducation may work well in bipolar patients with few episodes and perhaps no substantial comorbidity. Because of its low cost, it should be implemented and delivered as part of a community-centred early intervention approach."

After demand from participants in the study and their nurses and doctors, group psychoeducation is now a funded NHS service delivered by Nottinghamshire Healthcare NHS Foundation Trust for people with bipolar disorder in Nottingham and Mansfield. Nottinghamshire Healthcare NHS Foundation Trust is now working with East Midlands Academic Health Science Network to explore the development of a collaborative project to implement group psychoeducation in partnership with NHS services across the East Midlands. Nationally the intervention has been adopted by NICE as a key recommendation and quality standard for putting into clinical practice with groups now being held in other parts of the country such as Manchester and Birmingham.