Frank Ellen, Kupfer David J, Thase Michael E, Mallinger Alan G, Swartz Holly A, Fagiolini Andrea M, Grochocinski Victoria, Houck Patricia, Scott John, Thompson Wesley, Monk Timothy
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Arch Gen Psychiatry. 2005 Sep;62(9):996-1004. doi: 10.1001/archpsyc.62.9.996.
Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population.
To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.
Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years.
Research clinic in a university medical center.
One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.
Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.
Time to stabilization in the acute phase and time to recurrence in the maintenance phase.
We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).
Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.
大量研究表明,仅采用药物疗法预防治疗双相I型障碍效果不佳。近期调查显示,在此类人群中,药物疗法联合心理教育或心理治疗具有益处。
比较两种心理社会干预措施:人际与社会节律疗法(IPSRT)和强化临床管理(ICM)方法在双相I型障碍治疗中的效果。
随机对照试验,涉及4种治疗策略:急性和维持期均采用IPSRT(IPSRT/IPSRT)、急性和维持期均采用ICM(ICM/ICM)、急性采用IPSRT随后维持期采用ICM(IPSRT/ICM)或急性采用ICM随后维持期采用IPSRT(ICM/IPSRT)。预防性维持阶段持续2年。
大学医学中心的研究诊所。
从住院和门诊、临床转诊、双相情感障碍公开讲座及其他公共信息活动中招募的175名双相I型障碍急性病患者。
人际与社会节律疗法,这是对克莱曼和魏斯曼人际心理治疗法的一种改编,增加了社会节律调节成分,以及ICM。
急性期病情稳定时间和维持期复发时间。
我们观察到各治疗策略在病情稳定时间上无差异。在控制生存时间协变量后,我们发现,无论维持期治疗分配如何,在急性治疗阶段分配到IPSRT的参与者在无新情感发作的情况下存活时间更长(P = 0.01)。IPSRT组参与者在急性治疗结束时社会节律的规律性更高(P<0.001)。急性治疗期间提高社会节律规律性的能力与维持期复发可能性降低相关(P = 0.05)。
人际与社会节律疗法似乎为双相I型障碍的管理增添了临床手段,尤其是在预防新发作方面。