Disorder-specific psychosocial interventions for bipolar disorder--a systematic review of the evidence for mental health nursing practice.

Aims: To systematically review the evidence for the efficacy of psychosocial interventions for bipolar disorder and examine the implications for mental health nursing practice.

Background: Bipolar disorder is associated with significant psychosocial impairment and high use of mental health services. Generally medication is effective in the treatment of acute episodes but there is increasing evidence that while a large majority of patients recover from these episodes of mania and/or depression, many do not achieve a functional recovery. In response a range of psychotherapies have either been adapted or developed.

Design: An extensive review of the literature was performed using Medline, Cinahl and PsycINFO databases and 35 relevant research studies were chosen that met inclusion criteria.

Findings: All the identified psychosocial interventions were structured, adhered to manualized protocols and had solid evidence demonstrating their effectiveness when used as an adjunct to psychopharmacology. The identified psychosocial interventions all incorporated some features of a psycho-education including developing an acceptance of the disorder, awareness of its prodromes and signs of relapse, and communication with others; and several emphasise regular sleep and activity habits.

Conclusion: Mental health nurses have an important role to play in integrating psychosocial interventions into their clinical practice settings and in conducting high quality trials of their clinical effectiveness. Nurses are well-positioned to lead pragmatic trials of the clinical effectiveness of these psychosocial interventions in mental health services because of their experience and expertise in working with patients with bipolar disorder.