CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

5.1.3. Interpersonal therapy
The lifestyle or social rhythms of stabilised people with bipolar disorder (BD) are different to
those of people who do not suffer from the disease 7 . The Interpersonal and Social Rhythm Therapy
(IPSRT) is an adaptation of interpersonal psychotherapy that is based on the fact that stability and
regularity of the social routine and interpersonal relations act as a protection factor in mood disorders.
The treatment focuses on the relationship between the mood symptoms, the quality of social
roles and relations, and the importance of maintaining daily routines on a regular basis, as well
as identifying and managing potential events that trigger the circadian or biological rhythm 72 . In
short, the IPSRT aims to stabilise the social rhythms and sleep patterns of people with BD, as well
as teach how to manage internal and external stress in order to avoid relapses 73 .
Question to be answered
• Is interpersonal therapy effective in the treatment of people with SMI?
Frank et al 72 perform a cross-over RCT (n = 175) in two phases, where participants are randomised
into four treatment strategies:
• T1 Acute phase and IPSRT maintenance phase (IPSRT/IPSRT)
• T2 Acute phase and ICM maintenance phase (ICM/ICM)
• T3 IPSRT acute phase followed by ICM maintenance (IPSRT/ICM)
• T4 ICM acute phase followed by IPSRT maintenance (ICM/IPSRT).
In the first acute phase, patients are randomised to one of the two interventions. Once the patients
are stabilised, they enter the second phase where they are once again randomised to IPSRT
or ICM (intensive clinical management). The elements that include it are: education about the
disease, symptoms, medication, sleep patterns, adverse events effects and how to manage them.
The sessions last between 20 and 25 minutes. The patients are intervened weekly until they are
stabilised. Visits in the preventive phase take place every two weeks for 12 weeks and then every
month until the end of the 2 years’ maintenance phase.
Interpersonal therapy for people with SMI and a diagnosis of bipolar disorder (BD).
Frank et al 72 , when comparing between (T1 + T3) vs. (T2 + T4) indicate that RCT (1+)
the patients assigned to the IPSRT group in the acute phase of the treatment
spend more time without affective episodes (P = 0.01).
However, when Scott, Colom and Vieta 73 re-analyse the results of
the study by Frank et al 72 where they compare ICM vs. IPSRT, they indicate
that there are no statistically significant differences in the relapse ratios, in
those who received the same treatment in both phases (acute and maintenance),
[T1 (41%) and T2 (28%] They also state that, according to Frank et Experts’
al, the participants that were re-assigned to the treatment alternative in the opinion (4)
second phase (IPSRT followed by ICM, or ICM followed by IPSRT), had
higher relapse ratios and symptoms when they were monitored after two
years. This suggests that the stable and constant model of the therapy may
be more important than the treatment that was used in this population (no
data are provided).
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 51