{
  "abstract": "Background: Adjunctive psychoeducation can reduce recurrence of mood episodes in bipolar disorder (BD), but evidence from low-resource settings is scarce. We evaluated whether culturally adapted psychoeducation (CaPE) plus treatment-as-usual (TAU) prolongs time to recurrence in adults with BD in remission in Pakistan, a lower-middle-income country. Methods: In this multi-centre, assessor-masked randomised controlled trial, adults with remitted bipolar I or II disorder at seven urban centres in Pakistan were randomly assigned to CaPE plus TAU or TAU alone. CaPE comprised 12 weekly individual sessions delivered by master's-level psychologists. The primary outcome was time to recurrence of any mood episode over 48 weeks, assessed with the Longitudinal Interval Follow-up Evaluation. Secondary outcomes included recurrence of depressive and manic/hypomanic episodes and clinical and quality-of-life measures. The trial is registered with ClinicalTrials.gov ( NCT05223959 ). Findings: Between June 2022 and March 2025, 303 participants were randomly assigned (148 TAU, 155 CaPE plus TAU); 12-month data were available for 284 of 303 (93.7%). Over 48 weeks, CaPE prolonged time to recurrence of any mood episode versus TAU (adjusted hazard ratio 0.54, 95% CI 0.42–0.69; p < 0.001). At 12 months, CaPE improved recovery (measured with the Bipolar Recovery Questionnaire, on which higher scores indicate greater recovery; adjusted difference 144.8, 95% CI 51.5–238.1; p = 0.002), knowledge and attitudes (78.2, 22.6–133.8; p = 0.006), medication adherence (−0.4, −0.8 to −0.1; p = 0.013), and depressive symptoms (−5.3, −7.8 to −2.7; p < 0.0001). All adjusted estimates account for age, sex assigned at birth, marital status, weeks since diagnosis, and weeks in treatment. Interpretation: Individual culturally adapted psychoeducation added to routine care reduced recurrence risk and improved clinical outcomes in Pakistani adults with BD, and could optimise maintenance treatment in Pakistan and other low-resource settings. Funding: Canadian Institutes of Health Research .",
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  "authors": [
    {
      "name": "M. Ishrat Husain",
      "orcid": "0000-0001-5771-5750"
    },
    {
      "name": "Muqaddas Asif"
    },
    {
      "name": "Ameer B. Khoso"
    },
    {
      "name": "Madeha Umer"
    },
    {
      "name": "Suleman Shakoor"
    },
    {
      "name": "Tayyeba Kiran"
    },
    {
      "name": "M. Ramzan Tahir"
    },
    {
      "name": "Aatir H. Rajput"
    },
    {
      "name": "Mohsin Saqib"
    },
    {
      "name": "M. Omair Husain"
    },
    {
      "name": "Saad Masood"
    },
    {
      "name": "Ali A. Mufti"
    },
    {
      "name": "Farooq Naeem"
    },
    {
      "name": "Moti Ram Bhatia"
    },
    {
      "name": "K.M. Sajjad Siddiqui"
    },
    {
      "name": "Asad Tamizuddin"
    },
    {
      "name": "Claire de Oliveira",
      "orcid": "0000-0003-3961-6008"
    },
    {
      "name": "Wei Wang"
    },
    {
      "name": "Siqi Xue",
      "orcid": "0000-0002-6937-9552"
    },
    {
      "name": "Juveria Zaheer"
    },
    {
      "name": "Nusrat Husain"
    },
    {
      "name": "Nasim Chaudhry"
    },
    {
      "name": "Benoit H. Mulsant",
      "orcid": "0000-0002-0303-6450"
    },
    {
      "name": "Imran B. Chaudhry"
    }
  ],
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  "doi": "10.1016/j.eclinm.2026.104271",
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  "published": "2026-10-24",
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  "title": "Culturally adapted psychoeducation for bipolar disorder: a multicentre, assessor-masked, randomised controlled trial",
  "title_text": "Culturally adapted psychoeducation for bipolar disorder: a multicentre, assessor-masked, randomised controlled trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:06Z",
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