Psychosocial Management of Bipolar Dysfunction: Methodology of Performing a Systematic Review

This report is deliberately divided in to subsections to discuss the matter completely and systematically.


In this posting the writer details how a researcher really should carry out a systematic evaluation of bipolar problem. This will support long term reviewers to carry out their opinions according to the most scientific benchmarks of the working day.

Review Approaches

In contrast to a narrative assessment, the writer offers a summary of randomized managed trials on the specific and concentrated scientific problem of the evaluation, applying explicit approaches to lookup, critically appraise, and synthesized the literature systematically. He provides together a variety of separately done research, regardless of their results, and synthesis their results.

The reviewer is well informed of the desired rigor in the preparing of a systematic critique and conducts a formal course of action for this purpose. This features a detailed and systematic search for main reports on the concentrated concern, adopted by collection of scientific tests utilizing crystal clear and reproducible eligibility conditions, vital high quality appraisal of most important reports, and finally synthesis of results according to predetermined and explicit approaches.

Aims and targets

The author endeavors to look at the effectiveness of several forms of adjunct psychosocial interventions in administration of bipolar affective dysfunction, employing an explicit a priori methodology in accordance to a common overview protocol.

A protocol was made to minimize bias, by having all important methodological conclusions plainly and systematically, just before going to the literature. The protocol aimed to established out the jobs and obvious and explicit techniques to be adopted in this systematic overview and to make sure that effects are reproducible.

Concentrated concern: Are different techniques of adjunct psychosocial management for people today with bipolar ailment handy, successful and top-quality to typical professional medical cure solo, in relapse avoidance, useful improvement, and reduction of severity and period of bipolar episodes?

Definition of psychosocial administration for the intent of conducting a systematic assessment: Psychosocial administration is an umbrella time period made use of to deal with several varieties of psychological therapies applied in the administration of bipolar dysfunction. This features cognitive remedy, spouse and children concentrated therapy, interpersonal and social rhythm treatment, psycho-schooling, and relapse avoidance. The author features experiments exactly where some of the subsequent things had been considered:

1) Schooling about the sickness: All forms of scientific tests provided should have offered typical education to the topics of the review intervention arm, in purchase to enhance the individual’s recognition and understanding of bipolar ailment.

2) Checking and self regulation: Monitoring, vigilance, identification and management of acute signs and relapse avoidance should have been element of
the agenda for the intervention arm. Individual’s potential to acknowledge and handle the relapse prodromes or the internal and exterior stressors that may possibly increase their vulnerability to potential relapse need to have been discussed.

3) Improvement of adherence to pharmacotherapy: Between the bundled scientific studies, forming a therapeutic alliance with the psychiatrist and importance of adherence to pharmacotherapy ought to have been talked about to the therapy team. Administration of side effects, and execs and downsides of health care remedy and hazards of abrupt therapy withdrawal need to have been mentioned.

4) Cognitive procedures in bipolar dysfunction need to have been mentioned with the intervention arm of incorporated research. This may well include education on tactics to observe, analyze and adjust dysfunctional habits and conduct affiliated with undesirable temper outcomes.

5) Reports provided really should have described the written content and duration of the psychological treatment for the intervention arm, and have a abide by up interval of at the very least two a long time.

6) A least whole of 6 periods really should have been shipped to the review participants incorporated in every single review.

The above described factors are viewed as to be integral sections of psychosocial management of bipolar ailment. Distinct therapy regimes, could give extra excess weight and emphasis on one or the other, but it is deemed vital for some of the earlier mentioned components to be launched, no subject how briefly by means of the training course of therapy supplied.

Eligibility requirements with rationales

Style of scientific tests

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

Rationale: The reviewers only involves RCTs, for the purpose that randomized trials are the gold standard of evaluation of success, they make certain random allocation to intervention and manage arms of the scientific tests, assist reduce assortment bias, and ensure the similarity in traits and therapies of both of those groups in the prolonged operate, except for the intervention less than examine.


1) In all bundled research, all clients experienced a analysis of bipolar condition I or bipolar dysfunction II, according to specific diagnostic conditions, identified by structured clinical interviews.

Rationale: To prevent bias resulting from unique definitions amongst reports the creator restricts the overview to research employing DSM IV standards as the reference standard for mental ailments.

2) Scientific tests really should had not exclusively recruited people who had been struggling from acute mania or individuals who had been hospitalized in acute wards at the issue of recruitment. Experiments ought to have not recruited clients with only depressive or manic episodes.

However, the scientific studies may include individuals attending day centers. Scientific tests with patients with fast cycling or combined affective episodes can not be incorporated.

Rationale: Reviewers must consider to incorporate studies where the recruited individuals, present with very similar scientific photograph and have to have related kind of support and procedure. The teams that fall underneath exclusion criteria mentioned earlier mentioned have diverse demands, severity of sickness and compliance to the intervention furnished.

3) Studies may possibly include things like clients with mild stages of despair (defined as a Beck melancholy stock 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.

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