Bipolar disorder may well be a heterogeneous group of conditions with varying forms of biphasic mood dysregulation and a changing course across a lifetime. A collaborative therapeutic relationship, psychoeducation, and psychotherapy can be the basis for effective management. As the concept of bipolar disorder has broadened, the condition is being identified with increasing frequency in many clinical settings. It is a relapsing and recurring condition. It is now recognized that in addition to rational pharmacotherapy, there is a need to encourage a high level of treatment adherence while providing a holistic package of interventions.
Available studies are initial and of highly variable methodological rigour.
Evidence is most robust for the efficacy of psychoeducation and family therapy, and these received the highest level of recommendation as interventions. Availability of only a single interpersonal and social rhythms therapy trial limited the confidence of the recommendation for this intervention. Controlled trials are needed to replicate early outcome studies and guide treatment recommendations. Accumulated evidence of favourable psychosocial intervention outcomes supports, with variable confidence, their use as adjuncts to pharmacotherapy in the treatment of bipolar disorder. Articles published on treatment of acute mania, mixed states, and rapid cycling were reviewed and rated for quality of evidence using Periodic Health Examination guidelines.