Relapse rate and outcome correlates in Egyptian patients with bipolar disorder treated with behavioural family psychoeducation Nahla Nagy, Walaa Sabry, Doaa Khalifa, Reem Hashem, Nasser Zahran and Afaf H. Khalil Department of Psychiatry, Ain Shams University Hospitals, Cairo, Egypt Correspondence to Walaa Sabry, MD, Department of Psychiatry, Ain Shams University Hospitals, 19511 Cairo, Egypt Tel: +20 127 847 7746; e-mail: sabrywalaa@yahoo.com Received 21 February 2015 Accepted 10 May 2015 Middle East Current Psychiatry 2015, 22:121–131 Background Despite the extensive use of mood stabilizers, a high percentage of patients with bipolar affective disorder continue to experience frequent relapses. There is only a small and heterogeneous body of evidence on the effectiveness of behavioural family- oriented approaches for relapse prevention in patients with bipolar disorder. Aim The aim of the study was to compare the relapse and hospitalization/rehospitalization rates in a group of patients with bipolar disorder who received behavioural family psychoeducation therapy and pharmacotherapy with the rates in a second group of bipolar patients who received supportive psychotherapy and pharmacotherapy. In addition, the study aimed to investigate the various sociodemographic correlates and clinical variables that affect the outcome of these patients. Patients and methods Bipolar patients (N = 111) and their relatives were recruited immediately after an acute illness episode. They were randomly divided into two groups: group I and group II. Group I received 21 sessions of behavioural family therapy (BFT), and group II received a comparison treatment involving supportive psychotherapy sessions. Patients were simultaneously maintained on mood-stabilizing medications. We used the following parameters for assessment: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I); Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D); Wisconsin Quality of Life Index Client Questionnaire (W-QLI); and the Social Functioning Questionnaire (SFQ). The main outcome measures included response rates, relapse rates and rate of rehospitalization. Results Patients assigned to BFT had fewer relapses (25.3%) and hospitalizations/ rehospitalizations (1.49%) during the study year compared with patients who received supportive psychotherapy (34.3 and 50%, respectively). None of the sociodemographic or clinical profile variables correlated with change in the outcome measures. Conclusion BFT in combination with pharmacotherapy improves the outcome of bipolar illness by reducing relapse and hospitalization/rehospitalization rates. The study also demonstrated that BFT is effective for all patients across different sociodemographic and clinical backgrounds. Keywords: behavioural family therapy, bipolar disorder, correlates, outcome, psychoeducation, psychosocial intervention, relapse rate Middle East Curr Psychiatry 22:121–131 & 2015 Institute of Psychiatry, Ain Shams University 2090-5408 Introduction Several clinical trials have revealed that mood-stabilizing and antipsychotic agents are effective in stabilizing acute symptoms of bipolar I disorder [1]. However, minimizing the percentage of bipolar affective disease relapses and recurrences continues to pose a great challenge for mental health providers, as up to 60% of patients have recurrences within 2 years following an acute episode even when drug regimens are optimized [2,3], and at least 50% experience significant interepisode symp- toms [4]. Taking into consideration the limitations of pharma- cotherapy alone, there are several recommendations toward developing adjunctive psychosocial interventions as a central focus for research on bipolar disorder [5,6]. Adjunctive psychosocial interventions for bipolar disorder target many of the issues that are not addressed by medication alone, including nonadherence, efficacy– effectiveness gap, and functionality. Psychosocial interven- tions have been found to reduce relapse, particularly for the depressive pole, and to improve functionality. Approaches such as psychoeducation, cognitive behavioural therapy, Original article 121 2090-5408 & 2015 Institute of Psychiatry, Ain Shams University DOI: 10.1097/01.XME.0000466278.16335.8f Copyright r 2015 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited.