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Cognitive therapy in addition to standard care was more cost effective than standard care alone in bipolar disorder

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 Q In patients with bipolar disorder, is the addition of cognitive therapy to standard care cost effective?

Clinical impact ratings Psychiatry ★★★★★★☆


Embedded ImageDesign:

randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with 30 months’ follow up.

Embedded ImageSetting:

Maudsley and Bethlem NHS Trust, London, UK.

Embedded ImagePatients:

103 outpatients who were 18–70 years of age (mean age 44 y, 56% women), had DSM-IV bipolar I disorder, relapsed frequently despite the use of mood stabilisers (ie, ⩾2 episodes in previous 2 y or ⩾3 episodes in 5 y), and did not currently fulfil criteria for a bipolar episode. Exclusion criteria: actively suicidal (Beck Depression Inventory suicide item scored 3) or met criteria for substance use disorder.

Embedded ImageIntervention:

51 patients received cognitive therapy plus standard care, and 52 patients received standard care alone.

Embedded ImageOutcomes:

number of bipolar free days. Costs related to cognitive therapy and contact with mental …

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  • * See glossary.

  • For correspondence: Professor D H Lam, University of Hull, Hull, UK. Lam{at}

  • Source of funding: South London and Maudsley Hospital’s research and development fund.

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