Zaretsky Ari, Lancee William, Miller Cheryl, Harris Andrea, Parikh Sagar V
Mood Disorder Clinic, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario.
Can J Psychiatry. 2008 Jul;53(7):441-8. doi: 10.1177/070674370805300709.
Psychosocial research in bipolar disorder (BD) has not yet assessed the relative benefits of a short course of psychoeducation (PE), compared with a longer course of cognitive-behavioural therapy (CBT) containing psychoeducational principles. This pilot study evaluated the efficacy and added benefit of adding a course of CBT to a standard course of brief PE, as maintenance therapy for BD.
Seventy-nine consenting adult men and women with BD on stable medication regimens, who were in full or partial remission from an index episode (BD I = 52; BD II = 27), were randomized to receive either 7 sessions of individual PE, or 7 sessions of PE followed by 13 additional individual sessions of CBT. Weekly mood and medication adherence was rated using the National Institute of Mental Health's Life Chart Method, while psychosocial functioning and mental health use were assessed monthly.
Forty-six participants completed the entire study. Participants who received CBT in addition to PE experienced 50% fewer days of depressed mood over the course of one year. Participants who received PE alone had more antidepressant increases compared with those who received CBT. There were no group differences in hospitalization rates, medication adherence, psychosocial functioning, or mental health use.
Pilot data from this real-world study suggest that even after medication treatment has been optimized, a longer course of adjunctive CBT may offer some additional benefits over a shorter course of PE alone for the maintenance treatment of BD. Larger randomized controlled trials with equal treatment lengths are indicated.
双相情感障碍（BD）的心理社会研究尚未评估短期心理教育（PE）与包含心理教育原则的较长疗程认知行为疗法（CBT）相比的相对益处。这项初步研究评估了在标准的简短PE疗程基础上增加一个CBT疗程作为BD维持治疗的疗效和额外益处。
79名同意参与的成年男性和女性BD患者，他们的药物治疗方案稳定，且处于首次发作的完全或部分缓解期（BD I = 52；BD II = 27），被随机分配接受7次个体PE治疗，或7次PE治疗后再接受13次额外的个体CBT治疗。使用美国国立精神卫生研究所的生活图表法对每周的情绪和药物依从性进行评分，同时每月评估心理社会功能和心理健康服务利用情况。
46名参与者完成了整个研究。除PE外还接受CBT的参与者在一年中抑郁情绪的天数减少了50%。与接受CBT的参与者相比，仅接受PE的参与者抗抑郁药增加的情况更多。在住院率、药物依从性、心理社会功能或心理健康服务利用方面，两组之间没有差异。
这项现实世界研究的初步数据表明，即使药物治疗已得到优化，较长疗程的辅助CBT可能比单独较短疗程的PE在BD维持治疗方面提供一些额外益处。需要进行更大规模、治疗时长相等的随机对照试验。
