Bipolar4LifeSupport

NIMH, the NIH Office of Behavioral and Social Sciences Research, and the National Institute of Justice (NIJ) have announced a significant collaboration on a new 4-year, $6.8 million study called Suicide Prevention for at-Risk Individuals in Transition or “SPIRIT.” The study will address a critical gap in evidence-based suicide prevention and focus on the high-risk individuals who are transitioning from jail to community. The study is NIMH’s largest major investment in suicide prevention in the justice system.

Jennifer E. Johnson, Ph.D ., C. S. Mott Endowed Professor of Public Health, Michigan State University College of Human Medicine, andLauren M. Weinstock,  Ph.D., Associate Professor of Psychiatry and Human Behavior (Research) at Brown University and Clinical Psychologist at Butler Hospital are co-principal investigators on the study.

With nearly 12 million admissions per year and short stays, US jails serve as a catchment area for at-risk individuals at a time of high life stress and high suicide risk, providing an important opportunity for suicide prevention intervention. In fact, about 10 percent of all those who die by suicide are estimated to have had some type of recent criminal legal stressor (often an arrest and jail detention). Recent data from justice settings show high rates of suicide during jail detention (46 deaths per 100,000 people). Studies of post-release detainees find even higher rates (almost 3 times higher) of suicide deaths in the year following release. This study uses the jail setting as an opportunity to prevent suicide among high-risk individuals as they return to the community.

SPIRIT will use trained community mental health center providers to test a practical approach to reducing suicide by comparing it to standard care. SPIRIT researchers plan to enroll 800 detainees as they leave two different community jails: Genesee County Jail in Flint, Michigan and Rhode Island Department of Corrections in Cranston, Rhode Island. Participants will randomly be assigned to either standard care or the Safety Planning Intervention with telephone follow-up. Researchers will track improvements in suicidal behavior, and psychiatric and substance abuse outcomes as well as service use and re-arrest rates for both types of care. Findings from the research comparing the two types of care will help correctional setting and behavioral health program directors identify more effective programs for suicide prevention.

Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). The results are published in the April 2007 issue of the Archives of General Psychiatry.Bipolar disorder is a debilitating illness marked by severe mood swings between depression and mania that affects 2.6 percent of Americans in any given year. “We know that medication is an important component in the treatment of bipolar illness. These new results suggest that adding specific, targeted psychotherapy to medication may help give patients a better shot at lasting recovery,” said NIH Director Dr. Elias A. Zerhouni.

“STEP-BD is helping us identify the best tools—both medications and psychosocial treatments—that patients and their clinicians can use to battle the symptoms of this illness,” said NIMH Director Thomas R. Insel, M.D.

Psychotherapy is routinely employed as a means to treat bipolar illness in conjunction with medication, but the extent to which psychotherapy is effective has been unclear. In addition, most psychotherapeutic studies have been limited to a single site and compared only one type of treatment to routine care. Thus, in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations.

With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

• family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;
• cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
• interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication studyreported in the New England Journal of Medicine on March 28, 2007. The researchers compared patients’ time to recovery and their stability over one year.

Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. Discontinuation rates among the groups were similar—36 percent of those in the intensive programs discontinued and 31 percent of those in collaborative care discontinued. None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.

“Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person’s chances for recovering from depression and staying healthy over the long term,” said Dr. Miklowitz. “It should be considered a vital part of the effort to treat bipolar illness.”