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Trial registered on ANZCTR
Registration number
ACTRN12617001348347p
Ethics application status
Submitted, not yet approved
Date submitted
13/09/2017
Date registered
25/09/2017
Date last updated
17/10/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Social rhythm therapy for treatment-resistant Bipolar Disorder
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Scientific title
Effect of social rhythm therapy on mood symptoms for treatment-resistant Bipolar Disorder
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Secondary ID [1]
292872
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None
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Universal Trial Number (UTN)
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Trial acronym
SRT-TR
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Linked study record
None
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Health condition
Health condition(s) or problem(s) studied:
Bipolar Disorder
304720
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Condition category
Condition code
Mental Health
304029
304029
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0
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Other mental health disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Social rhythm therapy is an adaptation of Interpersonal and Social Rhythm Therapy. It is 12-session face-to-face and online course of Social Rhythm Therapy over 12-14 weeks. In most cases this will be completed over 12 weeks but in order to maintain a patient-centred approach we have built in the flexibility for an extension of two weeks if patients are unable to attend some sessions.
The goals of SRT are to improve sleep quality, monitor and assess social rhythmicity, regularise social rhythms in the context of promoting self-awareness of how BD is impacting on each person’s life. It is a structured therapy and incorporates two generic psychotherapy components (promotion of self-awareness and articulation of the experience of BD symptoms) and one specific component (promotion of social rhythm regularity). It will be delivered by psychotherapists with at least 6 years experience in the Psychological Medicine Clinical Research Unit, University of Otago, Christchurch. The intervention will be delivered as 1 x one hour session per week for 12 sessions.
The intervention is manualised and sessions will be audio-recorded and reviewed by a psychotherapy supervisor. Fidelity will be assessed using an adaptation of the fidelity scale developed by Frank et al 2005.
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Intervention code [1]
299114
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Treatment: Other
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Mood symptoms measured using The Longitudinal Interval Follow-up Evaluation (LIFE) (Keller et al. 1987)
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Assessment method [1]
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Timepoint [1]
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Baseline and 6 months from baseline.
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Secondary outcome [1]
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Quality of life assessed using QoL-BD (Michalak and Murray 2010)
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Assessment method [1]
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Timepoint [1]
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Baseline, following 12 session of SRT and 6 months from baseline
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Secondary outcome [2]
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Social rhythm stability measured using social rhythm matrix (Frank 2005)
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Assessment method [2]
338810
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Timepoint [2]
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From baseline daily for two weeks; daily following during weeks 11 and 12 of SRT; and 6 months from baseline
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Secondary outcome [3]
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Level of functioning using The Functioning Assessment Short Test (Rosa et al. 2007)
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Assessment method [3]
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Timepoint [3]
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Baseline, following 12 sessions of SRT and 6 months from baseline
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Eligibility
Key inclusion criteria
aged 18 years +; currently under community mental health service care; diagnosis of Bipolar I or Bipolar II; treatment resistant BD (have been in treatment with mental health services for two years during which time they have spent at least 4 months in each year in an episode of depression, mania, hypomania or mixed mood); must have been trialled on three mood stabilisers including a trial of Lithium; able to access internet.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
BD not primary diagnosis; unable to provide informed consent; unable to participate in a 12-week psychotherapy.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The primary analysis will compare scores on LIFE (mood symptoms) generated at baseline (from the 6 months prior to baseline) and those generated 6 months post baseline (from the 6 months after baseline) using paired T-tests. Other comparisons will also be by simple paired t-tests in order to generate effect size differences to power a more definitive randomised controlled trial.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
22/01/2018
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Actual
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Date of last participant enrolment
Anticipated
6/12/2019
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Actual
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Date of last data collection
Anticipated
6/06/2020
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
9205
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New Zealand
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State/province [1]
9205
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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University of Otago, Christchurch
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Address [1]
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4 Oxford Tce
Christchurch
8011
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
University of Otago, Christchurch
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Address
4 Oxford Tce
Christchurch
8011
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Country
New Zealand
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Secondary sponsor category [1]
296508
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None
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Name [1]
296508
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Address [1]
296508
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Country [1]
296508
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
298601
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HDEC
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Ethics committee address [1]
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Ministry of Health Health and Disability Ethics Committees PO Box 5013 Wellington 6140
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
298601
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10/10/2017
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Approval date [1]
298601
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Ethics approval number [1]
298601
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Summary
Brief summary
While medication is considered the first line of treatment in BD, there is increasing evidence that the course of BD can be further modified by interventions targeted at the social and environmental context. Most people with BD are discharged within 4-6 months there is a sub-group who spend years on community mental health service caseloads because they do not respond to medication, may have a rapid cycling form of the disorder and/or do not recover from mood episodes. There are no formal adjunctive therapies available for BD in usual practice. SRT is a clinical adaptation of Interpersonal and Social Rhythm Therapy (IPSRT) (Frank 2005). It is based on the stress-vulnerability model. Design This study is an open-label trial of SRT for patients under the care of community mental health services with treatment resistant BPD. The aim of the study is to examine whether SRT is effective in stabilizing social rhythms in patients with treatment resistant BD. Participants Twenty patients will be recruited from community mental health services for 12 weeks of SRT as an adjunct to their usual care. Participants will remain under the care of mental health services but will have weekly one-hour SRT sessions. Primary hypothesis: Following 12 sessions of SRT and 6 months from baseline patients will demonstrate improved mood symptoms. Secondary hypotheses: Following 12 weeks of SRT patients will have: o Improvement in quality of life o Improvement in social rhythm stability o Improvement in level of functioning Measurement: • Mood symptoms will be measured using The Longitudinal Interval Follow-up Evaluation (LIFE) (Keller et al. 1987) at baseline and 6 months to determine the occurrence of episodes of hypomania, major depressive disorder or mania. • Stability in social rhythms will be measured using the Social Rhythm Matrix (Monk et al. 1991). This is a daily self-report of social rhythm activities: sleep, eating, activities. Stability will be measured as < 45-minute discrepancy between the times of target and actual social rhythms. Stability is defined as a score indicating that all social rhythms have been occurring within a 45-minute window over the final 2 weeks of SRT. • Quality of life will be measured using QoL-BD (Michalak and Murray 2010) a validated measure for those with BD. • Level of functioning will be measured using The Functioning Assessment Short Test (Rosa et al. 2007). Qualitative interviews Qualitative interviews will be conducted at baseline exploring the participants’ experiences of BD and treatment, and their perceptions on what they need to recover. The primary analysis will compare scores generated at baseline (from the 6 months prior to baseline) and those generated 6 months post baseline (from the 6 months after baseline) using paired T-tests. Other comparisons will also be by simple paired t-tests in order to generate effect size differences.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Richard Porter
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Address
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Dept of Psychological Medicine
University of Otago, Christchurch
PO Box 4345
Christchurch 8011
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Country
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New Zealand
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Phone
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+64 3 3720400
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Fax
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Email
77622
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[email protected]
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Contact person for public queries
Name
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Professor Richard Porter
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Address
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Dept of Psychological Medicine
University of Otago, Christchurch
PO Box 4345
Christchurch 8011
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Country
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New Zealand
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Phone
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+64 3 3720400
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Fax
77623
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Email
77623
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[email protected]
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Contact person for scientific queries
Name
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Richard Porter
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Address
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Dept of Psychological Medicine
University of Otago, Christchurch
PO Box 4345
Christchurch 8011
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Country
77624
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New Zealand
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Phone
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+64 3 3720400
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Fax
77624
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Email
77624
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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