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Background: Although several adjunctive psychological interventions are effective in the maintenance of bipolar disorders (BD), no attempt has been made to classify them according to their ability to prevent manic versus depressive episodes. Our study aims to rank the adjunctive psychotherapies for the prophylaxis of BD by means of their polarity index (PI)., Methods: Randomized controlled trials comparing the efficacy of a psychological intervention with a comparator in BD maintenance treatment in patients aged over 18 were systematically reviewed. Exclusion criteria were a small sample size, a study sample not exclusively composed of bipolar patients and the absence of a control group. PI is a novel metric indicating the relative antimanic versus antidepressive preventive efficacy of treatments. PI was retrieved by calculating the ratio of the number needed to treat (NNT) for prevention of depression and the NNT for prevention of mania. PI >1.0 indicates a relatively higher antimanic prophylactic efficacy and PI <1.0 a greater antidepressive efficacy., Results: A total of 9 studies were included. PI was 0.33, 0.63 and 0.89 for cognitive-behavioral therapy, 0.42 for family-focused therapy, 0.73 and 0.78 for psychoeducation, 1 for enhanced relapse prevention, 1.78 for caregiver group psychoeducation and 3.36 for brief technique-driven interventions. With regard to the PI for 1 cognitive-behavioral study, enhanced relapse prevention and brief technique-driven interventions may not be reliable since those trials were negative., Conclusions: The PI provides a measure of how much depression-preventive or (hypo) mania-preventive an intervention is and may guide the choice of adjunctive psychotherapy in the context of individualized long-term treatment of BD., (Copyright © 2013 S. Karger AG, Basel.)

Objective: To highlight gaps or limitations in applying evidence-based psychological therapies as an adjunct to medication in the management of bipolar disorders., Method: General and specific gaps in knowledge or perceived limitations were determined by the authors and published examples were identified illustrating these potential barriers to the use or application of adjunctive therapies., Results: Research on the benefits of psychological therapies in bipolar disorders has progressed dramatically in the last decade. There are some uncertainties that need to be further investigated. These can be broadly classified as: for whom should therapy be provided, what therapy and when should therapy be commenced. The latter can be seen from the perspective of both current mental state as well as length of history and number of recurrences. Other issues frequently highlighted by researchers in the field relate to mediators and moderators of therapy effects., Conclusion: Gaps in our knowledge about therapy for bipolar disorder mirror those that exist whenever new treatments, including medications, are introduced into routine clinical practice. Many of these key questions relate to differences between efficacy and effectiveness of adjunctive therapies, the long-term durability of any benefits and mechanisms by which therapies achieve their effects. These can be explored using currently existing scientific paradigms., (2008 S. Karger AG, Basel)

Introduction: Cognitive aspects of hypomania have been historically neglected. Although they do not have an etiological role, they may be essential to understand factors underlying the hypomanic ascent in bipolar disorders and constitute key modulators of the course of illness., Methods: We have performed a critical review of the existing literature on the role of cognition during hypomania, considering outputs coming from very different fields of knowledge., Results: There is a nuclear cognitive change occurring in most hypomanic phases that we have defined as 'anastrophic' thinking. This key cognitive procedure has several implications--going from social sciences and philosophy to basic sciences., Conclusions: Hypomania has received certain attention from cognitive theorists. Unfortunately, this attention has not been translated into a cognitive model that is as robust as the one seen in depression. The inclusion of certain psychological aspects in models of hypomania should give rise, as occurred with depression, to an increased emphasis on psychoeducation and cognitive modification of behavioral patterns in the management of this disorder with combined psychological and pharmacological tools., (2007 S. Karger AG, Basel)

Although cognitive dysfunctions in psychosis have classically been associated with schizophrenia, there is clinical evidence that some bipolar patients show cognitive disturbances either during acute phases or in remission periods. The authors critically review the data on cognitive impairment in bipolar disorder. The main computerized databases (Medline, Psychological Abstracts, Current Contents) have been consulted crossing the terms 'cognitive deficits', 'neuropsychology', 'intellectual impairment', 'mania', 'depression' and 'bipolar disorder'. Changes in the fluency of thought and speech, learning and memory impairment, and disturbances in associational patterns and attentional processes are as fundamental to depression and mania as are changes in mood and behavior. Moreover, a significant number of bipolar patients show persistent cognitive deficits during remission from affective symptoms. However, there are several methodological pitfalls in most studies such as unclear remission criteria, diagnostic heterogeneity, small sample sizes, absence of longitudinal assessment, practice effect and poor control of the influence of pharmacological treatment. Most studies point at the presence of diffuse cognitive dysfunction during the acute phases of bipolar illness. Most of these deficits seem to remit during periods of euthymia, but some of them may persist in approximately one third of bipolar patients. Methodological limitations warrant further research in order to clear up the relationship between neuropsychological functioning and clinical, demographic and treatment variables in bipolar disorder., (Copyright 2000 S. Karger AG, Basel.)