M Crowe, B Beaglehole, M Inder

What is known on the subject Environmental factors are important influences on the course of bipolar disorder. Three interconnected pathways to relapse have been identified as stressful life events, medication non- adherence, and disruptions in social rhythms (daily activity routine). What this paper adds to existing knowledge There is some emerging evidence supporting the use of interpersonal and social rhythm therapy and sleep/light manipulation to target social rhythms to promote mood stability. What are the implications for practice Mental health nurses have a responsibility to discuss the importance of social rhythms, particularly the sleep/wake cycle, with people who have bipolar disorder. Strategies for promoting social rhythm stability could be a useful adjunctive intervention for mental health nurses to implement in practice. Introduction Three interconnected pathways to relapse have been identified as stressful life events, medication non-adherence and disruptions in social rhythms (daily activity and routine). The role of medication and stressful life events is generally better understood than the role of social rhythms. There is no previous review of interventions that target social rhythms. Aim To identify the evidence for the effectiveness of interventions that target social rhythms for improving mood symptoms. Method A quantitative systematic review was conducted. Results Seven studies were included in the review: four reporting interpersonal and social rhythm therapy (IPSRT) interventions and three sleep/light interventions. Discussion The results suggest that IPSRT may have a potential benefit in improving mood symptoms and relapse, but it is not clear whether this is of greater benefit than an intensive supportive care intervention of similar duration. The sleep/light interventions demonstrated rapid mood improvements; however, it was not clear how long this improvement was sustained. Implications for practice Attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.