Psychosocial Management of Bipolar Disorder: Methodology of Undertaking a Systematic Review

Psychosocial Management of Bipolar Disorder: Methodology of Undertaking a Systematic Review

This post is intentionally divided in to subsections to focus on the subject matter extensively and systematically.


In this posting the creator particulars how a researcher should carry out a systematic review of bipolar condition. This will enable long term reviewers to carry out their opinions according to the most scientific benchmarks of the working day.

Evaluation Techniques

In distinction to a narrative overview, the writer supplies a summary of randomized controlled trials on the specific and targeted medical question of the evaluate, employing explicit solutions to lookup, critically appraise, and synthesized the literature systematically. He delivers collectively a quantity of independently done research, no matter of their results, and synthesis their final results.

The reviewer is nicely aware of the desired rigor in the planning of a systematic assessment and conducts a official procedure for this purpose. This involves a comprehensive and systematic research for major experiments on the targeted concern, followed by range of studies making use of obvious and reproducible eligibility standards, important high quality appraisal of major research, and finally synthesis of outcomes in accordance to predetermined and specific approaches.

Aims and goals

The writer endeavors to analyze the effectiveness of several varieties of adjunct psychosocial interventions in administration of bipolar affective problem, making use of an express a priori methodology in accordance to a common overview protocol.

A protocol was created to limit bias, by getting all important methodological conclusions obviously and systematically, right before heading to the literature. The protocol aimed to set out the duties and distinct and express procedures to be followed in this systematic evaluation and to make certain that outcomes are reproducible.

Focused question: Are various methods of adjunct psychosocial administration for men and women with bipolar disorder valuable, helpful and top-quality to standard medical treatment method solo, in relapse avoidance, functional enhancement, and reduction of severity and period of bipolar episodes?

Definition of psychosocial management for the intent of conducting a systematic overview: Psychosocial management is an umbrella expression used to go over numerous sorts of psychological therapies used in the administration of bipolar ailment. This consists of cognitive remedy, spouse and children targeted therapy, interpersonal and social rhythm therapy, psycho-training, and relapse avoidance. The author consists of research wherever some of the adhering to aspects ended up thought of:

1) Instruction about the sickness: All kinds of experiments involved really should have offered typical education and learning to the subjects of the review intervention arm, in purchase to strengthen the individual’s awareness and knowing of bipolar problem.

2) Checking and self regulation: Checking, vigilance, identification and management of acute indications and relapse avoidance must have been component of
the agenda for the intervention arm. Individual’s capacity to acknowledge and regulate the relapse prodromes or the interior and external stressors that might maximize their vulnerability to long run relapse really should have been reviewed.

3) Improvement of adherence to pharmacotherapy: Amid the involved research, forming a therapeutic alliance with the psychiatrist and great importance of adherence to pharmacotherapy really should have been discussed to the treatment team. Administration of aspect results, and professionals and drawbacks of health care therapy and hazards of abrupt treatment withdrawal should have been mentioned.

4) Cognitive processes in bipolar problem must have been discussed with the intervention arm of involved reports. This may well contain schooling on approaches to check, look at and modify dysfunctional practices and conduct related with unwanted mood outcomes.

5) Studies incorporated ought to have described the material and duration of the psychological remedy for the intervention arm, and have a stick to up period of time of at minimum two yrs.

6) A minimum total of 6 sessions need to have been shipped to the analyze members involved in every examine.

The earlier mentioned outlined factors are deemed to be integral pieces of psychosocial management of bipolar ailment. Various treatment method regimes, could give more fat and emphasis on one or the other, but it is considered vital for some of the previously mentioned factors to be launched, no make a difference how briefly by means of the training course of therapy presented.

Eligibility conditions with rationales

Form of studies

Randomized controlled trials, Nonrandomised and quasi-randomized trials should really not bundled.

Rationale: The reviewers only features RCTs, for the purpose that randomized trials are the gold standard of evaluation of success, they make sure random allocation to intervention and control arms of the studies, aid do away with selection bias, and make sure the similarity in characteristics and treatment options of the two teams in the extensive run, other than for the intervention underneath analyze.


1) In all incorporated research, all sufferers experienced a prognosis of bipolar ailment I or bipolar condition II, in accordance to express diagnostic standards, discovered by structured medical interviews.

Rationale: To keep away from bias ensuing from distinctive definitions amongst scientific tests the writer restricts the evaluation to scientific studies working with DSM IV requirements as the reference common for psychological ailments.

2) Research should had not entirely recruited sufferers who were being struggling from acute mania or sufferers who were being hospitalized in acute wards at the place of recruitment. Research should have not recruited clients with only depressive or manic episodes.

Having said that, the scientific studies might involve these attending day centers. Scientific studies with people with fast biking or mixed affective episodes can not be integrated.

Rationale: Reviewers must try to incorporate scientific studies where by the recruited sufferers, existing with similar scientific image and will need very similar kind of help and remedy. The teams that drop less than exclusion conditions mentioned higher than have distinctive demands, severity of health issues and compliance to the intervention offered.

3) Reports may possibly involve patients with mild ranges of despair (defined as a Beck depression inventory of <15) can be included.

Rationale:This group of patients can benefit from therapies provided and be able to comply with the treatment.

4) Patients on both arms of the included studies should be on regular prophylactic medication.

Rationale: Standard prophylactic pharmacotherapy is the mainstay of treatment of bipolar disorder and it is considered unethical to interrupt medical treatment for experimental purposes. Non-compliance with the medical treatment will significantly change the clinical outcomes of either arm of the study.

5) The included studies only should have trialed adults (between 18 and 65).

Rationale: Studies should include examine the adult age group. The clinical picture, diagnosis and management of childhood bipolar disorder vary significantly from the adult conditions. Older groups commonly have co-morbid physical, mental and cognitive conditions that might introduce confounding to the results and would be very difficult to account for.

6) Studies that mainly focus on patients with other psychiatric co-morbidities or bipolar disorder secondary to organic causes should not be included.

Rationale: The clinical picture, diagnosis, management and complications vary in the above groups.

7) Only studies with patients with a history of at least 2 bipolar episodes and at least one episode within last two years should be included (not in full remission for more than 2 years).

Rationale: A minimum number of 2 episodes ensures diagnostic certainty, and helps avoid first time diagnostic errors to include other mental health conditions such as PTSD and schizophrenia. One episode should be within last 2 years, to ensure that the disease was ongoing at the time of recruitment and the patient was not in full long-term recovery or burnt out phase.

Outcome measures

The included studies should examine some of the following as their outcome measures:

1) Mean number of bipolar episodes and mean number of bipolar related hospitalisation.

2) Time to next episodes (as defined by DSM IV criteria for manic, depressive and mixed episodes).

3) Changes in global functioning and/or duration or severity of bipolar symptoms, using validation instruments.

4) Mean number of days fulfilling the DSM IV diagnosis a bipolar episode.

5) Mean number of episode free days.

6) Mean number of bipolar related days in hospital.

7) Rate of suicide in intervention and control groups.

Search strategy

As the rigour of systematic search methods is an important determinant of unbiased systematic reviews, extended systematic search methods including hand-searching, reference lists, personal communication searching of specialised databases and registries is used by the reviewer to carry out this review.

The search strategy aims at increasing sensitivity of our search, by minimising non-retrieval of the documents that were relevant to the review question and to maximise retrieval of the documents that are relevant to the review respectively.

Every effort should be made for the search to be as extensive as possible. This means that the reviewer may err on the side of retrieval of too many items and subsequently excluding those that are not relevant after direct examination of the papers.

Electronic search

The search terms used in a systematic review are constructed using the following strategy:

1) The reviewer derives major terms from the questions by identifying the population, interventions and outcomes.

2) Alternative spellings and synonyms are identified for major terms. The reviewer also includes terms identified through discussions with experts in the field and subject librarians of mental health trusts.

3) The keywords are checked in any relevant papers available to the reviewer at the outset.

4) The Boolean operator OR is used to incorporate alternative spellings and synonyms.

5) The Boolean operator AND is used to link the major terms from the population, interventions and outcomes.

6) Brackets are used for grouping of terms.

7) Each stage is double checked with a specialist librarian based at mental health library.

The following specified electronic databases have to be searched from inception with the following Mesh terms (or their equivalents in different databases):

(“bipolar disorder” OR “manic depressive psychosis” OR “bipolar depression” OR “manic depression”) Combined with the following subject headings using the Boolean connector AND (Cognitive therapy OR social rhythm therapy OR psycho-education OR family therapy OR family focused therapy OR psychosocial management OR psychosocial intervention OR psychological therapy).

The following free text searches are combined using the Boolean connectors accordingly: (“bipolar disorder*” OR “bipolar depress*” OR “manic depress*” ) AND ( Cognitive therap* OR cognitive behavio* OR social rhythm therap* OR psycho-education OR psychosocial intervention* OR psychosocial management* OR psychosocial treatment OR relapse prevention OR psychological therap* OR psychological management OR psycho-education OR family therap* OR family focus*)

1.The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) will be checked.

2. The Cochrane Central Register of Controlled Trials (CENTRAL) will be checked meticulously according to existing database.

The following additional databases are searched to check the completeness of the review:

4. PsycINFO

Reference checking

The reference lists of all identified randomised controlled trials, other relevant papers and major textbooks of bipolar disorder written in English should be checked. This process will be repeated until no further reports or papers seem relevant, and until no new studies are found that are not already identified electronically.

Hand searching

The journal Bipolar Disorder, will be hand-searched. No further studies should be found though this method which were not already identified among the electronic hits.

Personal Communications

The authors of significant papers are identified from authorship lists over the last two decades. They, and other experts in the field, are contacted and asked of their knowledge of other published or unpublished studies, relevant to this review. No further papers are identified through this process.

Inclusion and exclusion process

Studies scoped by the search strategies elaborated earlier above were checked to ensure satisfaction of both inclusion and exclusion criteria.

Abstracts of all cited studies should be obtained. Studies will be excluded at this stage only if unequivocal evidence is found in the abstracts. When this is not possible full texts of studies are obtained to take a decision regarding exclusion. Excluded studies are recorded with details of the author´s reasons for exclusion.