Reinares María, Colom Francesc, Sánchez-Moreno José, Torrent Carla, Martínez-Arán Anabel, Comes Mercè, Goikolea José M, Benabarre Antoni, Salamero Manel, Vieta Eduard
Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBER-SAM, University of Barcelona, Barcelona, Spain [corrected]
Bipolar Disord. 2008 Jun;10(4):511-9. doi: 10.1111/j.1399-5618.2008.00588.x.
OBJECTIVE: Although there are some randomized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder, no trials using contemporary methodologies have analyzed the specific effect of working with caregiver-only groups. The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients. METHOD: A total of 113 medicated euthymic bipolar outpatients who lived with their caregivers were randomized into an experimental and a control group. Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills. The patients did not attend the groups. Caregivers assigned to the control group did not receive any specific intervention. Patients were assessed monthly during both the intervention and the 12 months of follow-up. The primary outcome was time to any mood recurrence. RESULTS: Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence (chi2 = 6.53; p = 0.011) and longer relapse-free intervals (log-rank chi(2) = 4.04; p = 0.044). When different types of episodes were analyzed separately, the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence (chi2 = 5.65; p = 0.017) and the time to such an episode (log-rank chi2 = 5.84; p = 0.015). The differences in preventing depressive and mixed episodes were not significant. CONCLUSIONS: A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences, particularly mania and hypomania, in bipolar disorder.
目的:尽管有一些随机对照试验强调了在双相情感障碍的药物治疗基础上增加以家庭为中心的治疗的积极作用,但尚无采用当代方法的试验分析仅针对照顾者群体开展工作的具体效果。本研究的目的是评估针对处于缓解期的双相情感障碍患者的照顾者开展的心理教育团体干预的疗效。 方法:总共113名正在接受药物治疗且处于缓解期的双相情感障碍门诊患者及其照顾者被随机分为实验组和对照组。实验组的照顾者接受了12次为时90分钟的团体心理教育课程,内容聚焦于双相情感障碍的知识以及应对技能培训。患者不参加这些课程。分配到对照组的照顾者未接受任何特定干预。在干预期间以及随访的12个月内,每月对患者进行评估。主要结局指标是出现任何情绪复发的时间。 结果:针对双相情感障碍患者的照顾者开展的心理教育团体干预降低了出现任何情绪复发的患者百分比(卡方=6.53;p=0.011),并延长了无复发间隔时间(对数秩卡方(2)=4.04;p=0.044)。当分别分析不同类型的发作时,对于经历轻躁狂/躁狂复发的患者数量(卡方=5.65;p=0.017)以及出现此类发作的时间(对数秩卡方=5.84;p=0.015),效果均显著。在预防抑郁发作和混合发作方面的差异不显著。 结论:针对双相情感障碍患者的照顾者开展的心理教育团体干预是患者常规治疗的有益辅助手段,可降低双相情感障碍复发的风险,尤其是躁狂和轻躁狂复发的风险。
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