Top 30 Quality Measures

The treatment of mental or emotional problems using psychological techniques (e.g., cognitive behavioural therapy, or talking therapy).
Additional Domain(s) : Accessibility

There is a large literature describing psychotherapy of depression. This literature is explicitly or implicitly limited to patients with a unipolar course of illness, or at best includes some patients with bipolar disorder depression. Recommendations for the treatment of bipolar depression can only be made by extrapolating from evidence collected from depressed patients.

Psychosocial interventions include a variety of approaches such as befriending, cognitive behavioral therapy, dialectal behavioral therapy, family therapy, interpersonal therapy, patient education, psychoanalytical psychotherapy, self help groups, self management, support networks an other psychological and/or psychosocial packages.

The CBT interventions in these studies were adapted to use in patients with bipolar affective disorders by incorporating early warning signs monitoring. This involves training patients to identify possible prodromal features of manic or depressive relapse, ie the relapse signiture. Early warning signs monitoring also involves developing of at risk situations and producing and rehearsing an action plan once prodromes have been recognized by patient.

A group psycho-educational approach, over 21 sessions, had a greater success in relapse prevention compared with attendance for the same number of sessions at unstructured group meetings.

An adaptation of behavioral family therapy, with a focus on couples or families of patients with bipolar disorder has been shown to be beneficial. Members of families, who received 9 months of family focused therapy (FFT) showed significant improvement in family functioning. Follow up over two years demonstrated fewer relapses and longer survival intervals for patients who received FFT compared with those who received the crisis management intervention. FFT has a significant benefit compared with individually focused patient treatment in reducing rates of hospitalization for affective episodes.

SIGN. Bipolar Affective Disorder. May 2005. Section 4.3.6; pp: 17 Retrieved on Aug 3, 2006 from: http://www.sign.ac.uk/pdf/sign82.pdf

II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.

• Very important but not always under PHC control.
• It would be difficult to use this measure without a clear definition of what is meant by evidence-based psychosocial interventions (i.e. does this include diet & exercise counselling?)

Ratings-based Rank Relevance 8 Actionability 26 Overall Importance 8		Stakeholder Rank Academics 29 Clinicians 11 Consumers 10 Decision Makers 11 �		Special Group Rank First Nations 25 Rural Areas 16 Federal Stakeholders 11
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 2 13 59 8 34 9 30 51 9 44 47 20 37				Overall Rank        11