Colom Francesc, Vieta Eduard, Reinares María, Martínez-Arán Anabel, Torrent Carla, Goikolea José Manuel, Gastó Cristòbal
Bipolar Disorders Program, IDIBAPS-Hospital Clinic Barcelona, Barcelona Stanley Research Center, Barcelona, Spain.
J Clin Psychiatry. 2003 Sep;64(9):1101-5. doi: 10.4088/jcp.v64n0917.
Several previous studies have established that low treatment adherence is common among bipolar patients and may explain high rates of recurrence. On the other hand, some patients keep relapsing even when they strictly follow their prescribed somatic treatments. Psychological interventions such as psychoeducation may foster early recognition of prodromal symptoms and minimize the risk of relapse. To date, studies assessing the usefulness of psychoeducation in fully compliant patients are lacking.
This was a single-blind, randomized, prospective clinical trial on the efficacy of group psychoeducation in remitted fully compliant DSM-IV bipolar I patients (N = 25) who were compared with a group with similar characteristics (N = 25) who did not receive psychoeducation. All patients received naturalistic pharmacologic treatment. Recruitment began in 1997 and follow-up was completed in January 2002. The follow-up phase comprised 2 years during which all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly on several outcome measures.
At the end of the 2-year follow-up, 23 subjects (92%) in the control group fulfilled criteria for recurrence versus 15 patients (60%) in the psychoeducation group (p < .01). The number of total recurrences and the number of depressive episodes were significantly lower in psychoeducated patients.
Although the present study has the limitation of small sample size, psychoeducation showed its efficacy in preventing relapses in bipolar I patients who were adherent to drug treatment. The action of psychoeducation seems to go beyond compliance enhancement and may support a tripod model composed by lifestyle regularity and healthy habits, early detection of prodromal signs followed by prompt drug intervention, and finally treatment compliance.
此前的多项研究证实，双相情感障碍患者中治疗依从性低的情况很常见，这可能是复发率高的原因。另一方面，一些患者即便严格遵循规定的躯体治疗，仍会复发。心理教育等心理干预措施可能有助于早期识别前驱症状，并将复发风险降至最低。迄今为止，尚缺乏评估心理教育对完全依从患者有效性的研究。
这是一项单盲、随机、前瞻性临床试验，旨在研究团体心理教育对已康复且完全依从的DSM-IV双相I型障碍患者（N = 25）的疗效，将其与未接受心理教育但具有相似特征的一组患者（N = 25）进行比较。所有患者均接受自然主义药物治疗。招募工作始于1997年，随访于2002年1月完成。随访阶段为期2年，在此期间所有患者继续接受自然主义治疗，未进行心理干预，并每月通过多项指标进行评估。
在2年随访结束时，对照组中有23名受试者（92%）符合复发标准，而心理教育组中有15名患者（60%）符合复发标准（p <.01）。接受心理教育的患者的总复发次数和抑郁发作次数显著更低。
尽管本研究存在样本量小的局限性，但心理教育在预防坚持药物治疗的双相I型障碍患者复发方面显示出了疗效。心理教育的作用似乎不仅限于提高依从性，还可能支持一个由生活方式规律和健康习惯、前驱症状的早期发现并随后迅速进行药物干预以及最终的治疗依从性组成的三脚架模型。
