Hausmann Armand, Hörtnagl Christine, Müller Markus, Waack Julie, Walpath Michaela, Conca Andreas
Medizinische Universität Innsbruck, Univ.-Klinik für Psychiatrie, Tagesklinik für Affektive Erkrankungen.
Neuropsychiatr. 2007;21(2):102-9.
The treatment of bipolar disorders is a demanding task involving patients, therapists and relatives. As bipolar disorders are associated to multiple psychosocial disturbances, the management of a bipolar disease should focus on psychosocial interventions. Despite an exploding literature on this topic, psychopharmacological interventions applied as a monotherapy have shown unsatisfactory outcomes. In order to enhance outcome, psychotherapy, such as cognitive behavioural therapy (CBT), psychoeducation, a modified form of interpersonal psychotherapy (IPSRT) or family focussed psychotherapy (FFT) were investigated. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. These combinations are currently considered being the golden standard in the treatment of bipolar disorders. Psychotherapeutic interventions as an add-on strategy exert better effects when patients are euthymic at entry. Prevention of manic episodes seems to be more successful as compared to the prevention of depressive episodes. There are currently no hints for a method specific efficacy. Efficacy of psychoeducation seems to be rather short lived. Currently not yet evaluated booster-sessions might help. More data are needed in order to identify patients with a putative good response to psychotherapeutic interventions.
双相情感障碍的治疗是一项艰巨的任务,涉及患者、治疗师和亲属。由于双相情感障碍与多种心理社会障碍相关,双相情感障碍的管理应侧重于心理社会干预。尽管关于这一主题的文献激增,但作为单一疗法应用的心理药物干预已显示出不尽人意的结果。为了提高疗效,人们对心理治疗进行了研究,如认知行为疗法(CBT)、心理教育、人际心理治疗(IPSRT)的改良形式或家庭聚焦心理治疗(FFT)。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。目前,这些联合治疗被认为是双相情感障碍治疗的黄金标准。当患者在开始治疗时处于心境正常状态时,作为附加策略的心理治疗干预效果更好。与预防抑郁发作相比,预防躁狂发作似乎更成功。目前尚无特定方法疗效的线索。心理教育的疗效似乎相当短暂。目前尚未评估的强化治疗可能会有所帮助。需要更多数据来识别可能对心理治疗干预有良好反应的患者。