The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a multi-centered effectiveness research program with the stated goal of determining best-practice treatment options for all phases of bipolar disorder; mania, depression, remission, and recurrence prevention. STEP-BD sought to determine which treatments, or combinations of treatments were most effective for treating “real world" patients with bipolar disorder in community settings. It included patients with diverse psychiatric and medical co-occurring illnesses who are commonly excluded from standard narrowly focused clinical efficacy trials. Pharmacotherapy interventions were chosen from lithium, valproate, bupropion, paroxetine, lamotrigine, risperidone, inositol, and tranylcypromine. Psychotherapy interventions studied were Cognitive Behavioral Therapy, Family-Focused Therapy, and Interpersonal and Social Rhythm Therapy Pharmacotherapy is first-line treatment for acute bipolar disorder episodes. While symptom remission is a necessary but not sufficient treatment goal, in the STEP-BD cohort even optimal “best practice” pharmacotherapy did not consistently and reliably achieve and maintain remission. Approximately half the participants who were symptomatic at study entry failed to achieve complete recovery. Of those patients who did achieve total symptom remission almost half experienced recurrences within the two-year follow-up period (Am J Psychiatry 2006; 163:217–224). In response to the fact that pharmacotherapy alone was inadequate for symptom relief, and of limited efficacy in resolving many of the disabilities that “cause clinically significant distress or impairment in social, occupational or other important areas of functioning”, intensive, targeted psychotherapies were developed to treat patients with bipolar disorder and their families. These therapies significantly improve symptomatic as well as functional outcomes. Patients taking medications to treat bipolar disorder were more likely to get well faster and stay well if they received intensive psychotherapy (Arch Gen Psychiatry 2007; 64:419–427). Combining family psychotherapy with pharmacotherapy enhanced post episode symptomatic adjustment and medication adherence (Arch Gen Psychiatry. 2003; 60:904-912). Intensive psychosocial treatment as an adjunct to pharmacotherapy enhanced relationship functioning and life satisfaction, and promoted stabilization from bipolar depression (Am J Psychiatry 2007; 164:1340–1347). The family-focused treatment approach for bipolar disorder is an intensive time-limited evidence-based psychotherapy designed to treat the broader milieu within which the patient is functioning. Family-Focused Therapy (FFT) is directed at teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. STEP-BD research confirmed the efficacy of Family Focused Therapy, when used as an adjunct to pharmacotherapy, to reduce time to recovery, delay relapse/recurrence, reduce relapse rates, improve patient functioning, reduce inter-episode symptoms, improve medication compliance, and increase total time in recovery for adults and teenagers with bipolar disorder over the course of 1 to 2 years.
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