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Exposure to obstetric complications and subsequent development of bipolar disorder: systematic review
- Authors:
- SCOTT Jan, et al
- Journal article citation:
- British Journal of Psychiatry, 189(1), July 2006, pp.3-11.
- Publisher:
- Cambridge University Press
Research has suggested an association between obstetric complications and bipolar disorder. However, no quantitative evaluation has been made of the pooled data from existing studies. The aim was to systematically review studies comparing exposure to obstetric complications in cases of bipolar disorder v. non-psychiatric controls, and in cases of bipolar disorder v. cases of other mental disorders. Publications were identified by computer searches of seven databases, by hand searches of reference lists and from raw data received from researchers. Forty-six studies were identified, of which 22 met the inclusion criteria. The pooled odds ratio for exposure to obstetric complications and subsequent development of bipolar disorder was 1.01 compared with healthy controls, 1.13 compared with cases of unipolar disorder and 0.61 compared with those who developed schizophrenia. There is no robust evidence that exposure to obstetric complications increases the risk of developing bipolar disorder. However, the range of events regarded as obstetric complications and methodological inadequacies make definitive conclusions difficult.
Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial
- Authors:
- SCOTT Jan, et al
- Journal article citation:
- British Journal of Psychiatry, 188(4), April 2006, pp.313-320.
- Publisher:
- Cambridge University Press
Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. The aims to compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT). The authors undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months. More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.