Miklowitz David J
Department of Psychology, University of Colorado at Boulder, Boulder, CO 80309-0345, USA.
J Clin Psychiatry. 2006;67 Suppl 11:28-33.
Various forms of psychosocial intervention have been found efficacious as adjunctive treatments for bipolar disorder, including family-focused therapy, interpersonal and social rhythm therapy, cognitive-behavioral therapy, and individual or group psychoeducation. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. Family-focused therapy seeks to reduce the high levels of stress and conflict in the families of bipolar patients, thereby improving the patient's illness course. Interpersonal and social rhythm therapy focuses on stabilizing the daily and nightly routines of bipolar patients and resolving key interpersonal problems. Cognitive-behavioral therapy assists patients in modifying dysfunctional cognitions and behaviors that may aggravate the course of bipolar disorder. Group psychoeducation provides a supportive, interactive setting in which patients learn about their disorder and how to cope with it. This article discusses each of these interventions and summarizes the evidence for their efficacy in randomized trials. Recommendations for implementing psychosocial interventions in clinical practice are also given.
已发现各种形式的心理社会干预作为双相情感障碍的辅助治疗方法是有效的,包括以家庭为中心的治疗、人际和社会节律治疗、认知行为治疗以及个体或团体心理教育。当与药物治疗联合使用时,这些干预措施可能会延长复发时间、减轻症状严重程度并提高药物依从性。以家庭为中心的治疗旨在减轻双相情感障碍患者家庭中的高度压力和冲突,从而改善患者的病程。人际和社会节律治疗侧重于稳定双相情感障碍患者的日常和夜间作息,并解决关键的人际问题。认知行为治疗帮助患者改变可能加重双相情感障碍病程的功能失调的认知和行为。团体心理教育提供了一个支持性的互动环境,患者可以在其中了解自己的疾病以及如何应对。本文讨论了每种干预措施,并总结了它们在随机试验中的疗效证据。还给出了在临床实践中实施心理社会干预的建议。