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*166. A Randomized Trial of Patient Education in Improving Course in Manic-Depressive Disorder

MS Bauer, Providence VAMC & Brown University; L McBride, Providence VA Medical Center; N Shea, Providence VA Medical Center; G Kirk, Perry Point VA CSPCC; W Williford, Perry Point VA CSPCC

Objectives: The Life Goals Program is a structured, manual-driven group psychotherapy program aimed at improving illness management skills for patients with manic-depressive disorder and thereby improving clinical and functional outcome. Feasibility studies have been promising and the manual has been published (Springer, 1996). The intervention has been used as part of multi-modal interventions for manic-depressive disorder in VA Cooperative Study #430 and in a NIMH-funded RCT at Group Health Cooperative of Puget Sound. This RCT seeks to test the intervention as a sole treatment added on to medication management vs. waiting list control.

Methods: 50 outpatients with manic-depressive disorder were randomized to 5 weeks of Phase 1 of the Life Goals Program (focusing on patient education) followed by 6 months of Phase 2 (focusing on functional deficits) vs. waiting list control. Patients were assessed with structured clinical interviews at baseline, the end of phase 1 (or 5 weeks) and after 6 months of Phase 2 (or waiting list).

Consistent with focus on effectiveness rather than efficacy, patients were not excluded for any comorbid conditions such as substance abuse, medical illnesses, or PTSD; the only exception was moderate to severe dementia that precluded effective education.

Primary outcome variables assessed were disease course (LIFE ratings for mania and depression), functional outcome (SAS-IIB ratings), medication compliance, and service utilization. Additional process-rlated variables included established instruments to measure self-efficacy, locus of control, and patient perception of role in medical decision-making.

Results: Data analysis is taking place at the Perry Point VA Cooperative Studies Coordinating Center. To date, the data set was successfully closed with minimal loss of data despite the chronic and relapsing course of the disease. The data have been cleaned and are in the process of being analyzed using two-group comparisons for repeated measures over time, controlling as necessary for any differences in patient characteristics across the groups at baseline.

Conclusions: Results will indicate whether the Life Goals Group as a stand-alone intervention added to medical model treatment can improve outcome and several measures of patient illness management skills.

Impact: If positive, results will provide evidence that severe mental illnesses can be managed with some of the same "chronic illness management skills" applied to medical illnesses such as COPD, diabetes, etc.