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A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED).
In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models.
In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems.
The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.
Bipolar disorder is commonly accompanied by substantial comorbidity, including high rates of anxiety disorders and also of substance and alcohol-use disorders. This chapter considers evidence-based pharmacotherapy for the three main clinical scenarios-episodes of bipolar depression, manic or mixed episodes, and the prevention of relapse. In new episodes of bipolar depression, the three approaches with the strongest evidence base at present are the use of quetiapine, lamotrigine, and the optimization of existing long-term treatments. The evidence for the use of conventional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in bipolar depression has weakened in recent years. Studies in bipolar disorder have for the most part employed valproate in the form of divalproex. A recentmeta-analysis identified four small randomized placebo-controlled trials of valproate in bipolar I or bipolar II depression. Strong evidence guides first-line choices for episodes of bipolar depression, manic or mixed episodes, and for relapse prevention.
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