Bipolar Disorders Program, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain.
Curr Psychiatry Rep. 2009 Dec;11(6):494-502. doi: 10.1007/s11920-009-0075-0.
Although pharmacotherapy is the mainstay of treatment for bipolar disorder, the combination of evidence-based psychological interventions and drug treatment enhances overall effectiveness, mostly by further protecting patients from relapse/recurrence. In recent years, well-designed controlled studies have added weight to evidence favoring specific psychotherapy modalities for bipolar disorders. However, critical issues that may limit the benefits of psychotherapy in day-to-day clinical practice have emerged. In this article, we critically examine the effectiveness of psychosocial approaches to bipolar illness by reviewing the literature, which has been substantially enriched during the past 5 years. Recent studies further support the fact that psychoeducation and cognitive-behavioral therapy are effective in bipolar disorder, especially the early stages. Family interventions based on a psychoeducational model are also effective. Intensive psychotherapies may be more effective than short, managed care-based ones. Group psychoeducation seems to have long-lasting effects and to be cost-effective. Future studies should focus on neurobiological markers of response to psychotherapy and tailor interventions to specific subtypes.
虽然药物治疗是双相情感障碍的主要治疗方法，但将基于证据的心理干预措施与药物治疗相结合可以提高整体疗效，主要是通过进一步防止患者复发/复发。近年来，精心设计的对照研究为支持特定心理治疗模式治疗双相情感障碍的证据提供了更多支持。然而，在日常临床实践中可能限制心理治疗益处的关键问题已经出现。在本文中，我们通过回顾文献，对双相情感障碍的心理社会方法的有效性进行了批判性地评估，在过去 5 年中，文献得到了极大的丰富。最近的研究进一步证实了心理教育和认知行为疗法在双相情感障碍中的有效性，尤其是在早期阶段。基于心理教育模式的家庭干预也是有效的。强化心理治疗可能比短期的、基于管理的治疗更有效。小组心理教育似乎具有持久的效果，并且具有成本效益。未来的研究应集中于对心理治疗反应的神经生物学标志物，并针对特定亚型调整干预措施。
