Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review
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Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission : A systematic review. / Seeberg, Michael; Nielsen, I. B.; Jorgensen, C. K.; Eskestad, N. D.; Miskowiak, K. W.
In: Journal of Affective Disorders, Vol. 279, 15.01.2021, p. 31-45.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission
T2 - A systematic review
AU - Seeberg, Michael
AU - Nielsen, I. B.
AU - Jorgensen, C. K.
AU - Eskestad, N. D.
AU - Miskowiak, K. W.
PY - 2021/1/15
Y1 - 2021/1/15
N2 - Background: Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field.Methods: Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients.Results: We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side effects that may have impeded blinding.Limitations: We did not conduct a quantitative meta-analysis.Conclusions: There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.
AB - Background: Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field.Methods: Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients.Results: We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side effects that may have impeded blinding.Limitations: We did not conduct a quantitative meta-analysis.Conclusions: There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.
KW - Bipolar disorder
KW - Treatment efficacy
KW - Anxiety
KW - Remission
KW - Psychological intervention
KW - Pharmacological intervention
KW - QUALITY-OF-LIFE
KW - TREATMENT ENHANCEMENT PROGRAM
KW - TERM BENZODIAZEPINE USE
KW - COMORBID ANXIETY
KW - COGNITIVE THERAPY
KW - TASK-FORCE
KW - TRANSDIAGNOSTIC TREATMENT
KW - INTERNATIONAL SOCIETY
KW - SPECTRUM DISORDERS
KW - MOOD DISORDERS
U2 - 10.1016/j.jad.2020.09.119
DO - 10.1016/j.jad.2020.09.119
M3 - Review
C2 - 33038698
VL - 279
SP - 31
EP - 45
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -
ID: 256074140