Satterfield J M
Division of General Internal Medicine, University of California, San Francisco 94143-0320, USA.
Psychiatry. 1999 Winter;62(4):357-69. doi: 10.1080/00332747.1999.11024883.
A basic biopsychosocial model of episode onset in rapid-cycling bipolar disorder is presented with a special emphasis on cognitive and other psychosocial contributors. A three-pronged, face-valid, cognitive-behavioral treatment protocol meant to supplement medications is deduced from the available research literature. The concrete treatment components focus on prevention of mood cycles, early detection of cycle onset, and mood restabilization during cycles. The treatment protocol was pilot tested on a rapid-cycling bipolar patient who first received pharmacotherapy only followed by pharmacotherapy plus adjunctive cognitive-behavioral therapy (CBT). Detailed treatment measures were collected before, during, and after treatment. A comparison of Beck Depression Inventory and Young Mania Scale scores in pharmacotherapy versus pharmacotherapy plus CBT conditions suggest the addition of CBT produces significant clinical gains. Scores on the Beck Anxiety Inventory and Hopelessness Scale provide further support for the CBT treatment model. These preliminary results suggest cognitive-behavioral or similarly structured psychosocial treatment models could greatly enhance the medical treatment of rapid-cycling bipolar patients and warrants further controlled investigation.
本文提出了一个快速循环型双相情感障碍发作的基本生物心理社会模型，特别强调认知因素和其他心理社会因素。从现有研究文献中推导得出一个旨在辅助药物治疗的、具有表面效度的三管齐下的认知行为治疗方案。具体的治疗组成部分聚焦于预防情绪周期、早期发现周期发作以及在周期中使情绪重新稳定。该治疗方案在一名快速循环型双相情感障碍患者身上进行了初步测试，该患者最初仅接受药物治疗，随后接受药物治疗加辅助认知行为疗法（CBT）。在治疗前、治疗期间和治疗后收集了详细的治疗措施。在药物治疗与药物治疗加CBT两种情况下，贝克抑郁量表和杨氏躁狂量表得分的比较表明，添加CBT能带来显著的临床改善。贝克焦虑量表和绝望量表的得分进一步支持了CBT治疗模型。这些初步结果表明，认知行为或结构类似的心理社会治疗模型可以极大地增强对快速循环型双相情感障碍患者的药物治疗效果，值得进一步进行对照研究。
