Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment

Objective To determine the efficacy of teaching patients with bipolar disor der (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. Design Single blind randomised controlled trial with matching on four basel ine variables using a minimisation algorithm. Setting Mental health services in four NHS trusts (one teaching, three non- teaching). Subjects 69 patients with bipolar disorder who had had a relapse in the pre vious 12 months. Interventions Seven to 12 individual treatment sessions from a research psy chologist plus routine care or routine care alone. Main outcome measures Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardis ed interviews every six months for 18 months. Results 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and cont rol groups (log rank 7.04, df = 1, P = 0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P = 0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression bu t it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P = 0.003) and employment (mean difference 0.7 (0.1 to 1.3), P = 0.030) by 18 months. Conclusion Teaching patients to recognise early symptoms of manic relapse a nd seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.