Colom Francesc, Vieta Eduard, Sánchez-Moreno José, Martínez-Arán Anabel, Torrent Carla, Reinares María, Goikolea José Manuel, Benabarre Antonio, Comes Mercè
Bipolar Disorders Program, Hospital Clinic University of Barcelona, IDIBAPS, Spain.
Bipolar Disord. 2004 Aug;6(4):294-8. doi: 10.1111/j.1399-5618.2004.00127.x.
The co-occurrence of personality and bipolar disorders is quite common. Bipolar patients with personality disorders have been described as having poorer outcome than 'pure' bipolar patients. However, from a combined-approach point of view, a little has been done to improve the course of these patients. Psychoeducation has shown its efficacy in the prevention of relapses in the bipolar population but, to date, no data is available on its efficacy in the management of bipolar patients with personality disorders.
The present study shows a subanalysis from a single-blind randomized prospective clinical trial on the efficacy of group psychoeducation in bipolar I patients. Bipolar patients fulfilling DSM-IV criteria for any personality disorder were randomized to either psychoeducational treatment or a non-structured intervention. There were 22 patients in the control group and 15 in the psychoeducation group. All patients received naturalistic pharmacological treatment as well. The follow-up phase comprised 2 years where all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly for several outcome measures.
At the end of the follow-up phase (2 years), a 100% of control group patients fulfilled criteria for recurrence versus a 67% in the psychoeducation group (p < 0.005). Patients included in the psychoeducation group had a higher time-to-relapse and a significantly lower mean number of total, manic and depressive relapses. No significant differences regarding the number of patients who required hospitalization were found but the mean duration of days spent in the hospitalization room was significantly higher for the patients included in the control group.
Psychoeducation may be a useful intervention for bipolar patients with comorbid personality disorders. Further studies should address the efficacy of specifically tailored interventions for this common type of patients.
人格障碍与双相情感障碍同时出现的情况相当常见。有研究称，患有双相情感障碍且伴有其他人格障碍的患者，其治疗效果比“单纯”双相情感障碍患者更差。然而，从综合治疗的角度来看，针对改善这类患者病情进展所做的工作较少。心理教育已被证明在预防双相情感障碍患者复发方面具有疗效，但迄今为止，尚无关于其对伴有其他人格障碍的双相情感障碍患者治疗效果的数据。
本研究展示了一项单盲随机前瞻性临床试验的亚组分析结果，该试验旨在研究团体心理教育对双相I型障碍患者的疗效。符合《精神疾病诊断与统计手册》第四版（DSM-IV）中任一人格障碍标准的双相情感障碍患者被随机分为心理教育治疗组或非结构化干预组。对照组有22名患者，心理教育组有15名患者。所有患者同时接受常规药物治疗。随访期为2年，在此期间所有患者持续接受常规治疗，不进行心理干预，并每月接受多项疗效指标评估。
在随访期结束时（2年），对照组100%的患者达到复发标准，而心理教育组这一比例为67%（p < 0.005）。心理教育组的患者复发时间更长，总的、躁狂和抑郁复发的平均次数显著更低。两组在需要住院治疗的患者数量上没有显著差异，但对照组患者的平均住院天数显著更长。
心理教育可能是治疗伴有其他人格障碍的双相情感障碍患者的有效干预措施。进一步的研究应针对这类常见患者群体，探讨量身定制的干预措施的疗效。
