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Psychosocial treatments in bipolar disorder

2016; Elsevier BV; Volume: 3; Issue: 4 Linguagem: Inglês

10.1016/s2215-0366(16)00100-0

2215-0374

Sameer Jauhar, Peter J. McKenna, Keith R. Laws,

Mental Health Research Topics

We read with interest the Comment by Tim Kendall and colleagues, in response to our Personal View on NICE guidance on psychosocial treatments in bipolar disorder.1Jauhar S McKenna PJ Laws KR NICE guidance on psychological treatments for bipolar disorder: searching for the evidence.Lancet Psychiatry. 2016; 3: 386-388Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar We feel that this Comment raises more questions than it answers. Two issues seem particularly important. Despite carrying out almost 200 meta-analyses on fewer than 50 studies, more than half being meta-analyses of single trials, Kendall and colleagues remain unconcerned about multiple comparisons. They refer to Schulz and Grimes,2Schulz KF Grimes DA Multiplicity in randomised trials II: subgroup and interim analyses.Lancet. 2005; 365: 1657-1661Summary Full Text Full Text PDF PubMed Scopus (242) Google Scholar who stated that using the sort of correction we propose might sabotage interpretation of clinical trials reporting several endpoints. Few clinical trials, however, contain 200 endpoints and Schulz and Grimes further state that if a trial reports results on, say, 15 endpoints with one being significant, appropriate caution should be displayed. Furthermore, we did not propose using Bonferroni correction (as alluded to by Kendall and colleagues), we recommended the less conservative false discovery rate (FDR) approach. As noted by Matt and Cook,3Matt GE Cook TD Threats to the validity of generalized inferences.in: Cooper H Hedges LV Valentine JC The handbook of research synthesis and meta-analysis. 2nd edn. Russell Sage Foundation, New York, NY, US2009: 537-660Google Scholar “Although research syntheses may combine findings from hundreds of studies and thousands of respondents, they are not immune to inflated type I error when many statistical tests are conducted without adequate control for error rate” and they refer to the threat of “capitalising on chance in meta-analysis”. Kendall and colleagues’ explanation for exclusion of the study by Scott and colleagues4Scott J Paykel E Morriss R et al.Cognitive–behavioural therapy for severe and recurrent bipolar disorders.Br J Psychiatry. 2006; 188: 313-320Crossref PubMed Scopus (438) Google Scholar from the meta-analysis of relapse was that it included patients who were not euthymic at baseline. We considered this, but discounted it after discovering another trial in the same meta-analysis included patients who were explicitly depressed or hypomanic at baseline.5Ball JR Mitchell PB Corry JC Skillecorn A Smith M Malhi GS A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change.J Clin Psychiatry. 2006; 67: 277-286Crossref PubMed Scopus (133) Google Scholar Two other trials6Cochran SD Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders.J Consult Clin Psychol. 1984; 52: 873-878Crossref PubMed Scopus (287) Google Scholar, 7Perry A Tarrier N Morriss R McCarthy E Limb K Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.BMJ. 1999; 318: 149-153Crossref PubMed Scopus (476) Google Scholar in the same meta-analysis did not specify whether their patients were euthymic at baseline: it seems unlikely that such information would be reliably retrievable in one of these studies,6Cochran SD Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders.J Consult Clin Psychol. 1984; 52: 873-878Crossref PubMed Scopus (287) Google Scholar done over 30 years ago. The response by Kendall and colleagues still does not account for why the study by Scott and colleagues was included in meta-analyses for depressive and manic relapse considered separately, as we pointed out. We declare no competing interests. NICE guidance on psychological treatments for bipolar disorderWe wish to respond to the points raised by Jauhar and colleagues in their Personal View published online on February 4, 2016.1 We will outline how the National Institute for Health and Care Excellence (NICE) guideline on bipolar disorder2 was developed, using the process established by the NICE. Notably, this process is different to the development of a Cochrane meta-analysis and, indeed, many other guidelines. We also address six specific points raised by Jauhar and colleagues.1 Full-Text PDF