以家庭为中心的双相情感障碍患者照料者治疗。
Family-focused treatment for caregivers of patients with bipolar disorder.
机构信息
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
出版信息
Bipolar Disord. 2010 Sep;12(6):627-37. doi: 10.1111/j.1399-5618.2010.00852.x.
OBJECTIVES
Family members of patients with bipolar disorder experience high rates of subjective and objective burden which place them at risk for adverse physical health and mental health outcomes. We present preliminary efficacy data from a novel variation of Family Focused Treatment [Miklowitz DJ. Bipolar Disorder: A Family-Focused Treatment Approach (2(nd) ed.). New York: The Guilford Press, 2008] that aimed to reduce symptoms of bipolar disorder by working with caregivers to enhance illness management skills and self-care.
METHODS
The primary family caregivers of 46 patients with bipolar I (n = 40) or II (n = 6) disorder, diagnosed by the Structured Clinical Interview for DSM-IV Axis I Disorders, were assigned randomly to receive either: (i) a 12-15-session family-focused, cognitive-behavioral intervention designed to provide the caregiver with skills for managing the relative's illness, attaining self-care goals, and reducing strain, depression, and health risk behavior [Family-Focused Treatment-Health Promoting Intervention (FFT-HPI)]; or (ii) an 8- to 12-session health education (HE) intervention delivered via videotapes. We assessed patients pre- and post-treatment on levels of depression and mania and caregivers on levels of burden, health behavior, and coping.
RESULTS
Randomization to FFT-HPI was associated with significant decreases in caregiver depressive symptoms and health risk behavior. Greater reductions in depressive symptoms among patients were also observed in the FFT-HPI group. Reduction in patients' depression was partially mediated by reductions in caregivers' depression levels. Decreases in caregivers' depression were partially mediated by reductions in caregivers' levels of avoidance coping.
CONCLUSIONS
Families coping with bipolar disorder may benefit from family interventions as a result of changes in the caregivers' ability to manage stress and regulate their moods, even when the patient is not available for treatment.
目的
双相情感障碍患者的家属经历着较高的主观和客观负担，这使他们面临不良身心健康后果的风险。我们呈现出一种新型家庭焦点治疗[Miklowitz DJ. 《双相情感障碍：家庭焦点治疗方法（第 2 版）》。纽约：吉尔福德出版社，2008]的初步疗效数据，该治疗旨在通过与照顾者合作来增强疾病管理技能和自我护理，从而降低双相情感障碍的症状。
方法
46 名双相 I（n=40）或 II（n=6）障碍患者的主要家庭照顾者，由 DSM-IV 轴 I 障碍的结构临床访谈诊断，被随机分配接受以下治疗之一：（i）接受 12-15 节家庭焦点、认知行为干预，旨在为照顾者提供管理亲属疾病、实现自我护理目标和减少压力、抑郁和健康风险行为的技能[家庭焦点治疗-健康促进干预（FFT-HPI）]；或（ii）通过录像带接受 8-12 节健康教育（HE）干预。我们在治疗前和治疗后评估患者的抑郁和躁狂程度，以及照顾者的负担、健康行为和应对方式。
结果
随机分配到 FFT-HPI 与照顾者抑郁症状和健康风险行为的显著减少有关。在 FFT-HPI 组中，患者的抑郁症状也观察到更大的减少。患者抑郁的减少部分通过照顾者抑郁水平的降低来介导。照顾者抑郁的减少部分通过照顾者回避应对水平的降低来介导。
结论
应对双相情感障碍的家庭可能受益于家庭干预，因为这可以改变照顾者管理压力和调节情绪的能力，即使患者无法接受治疗。
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