Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische University Dresden, Dresden, Germany.
Early Interv Psychiatry. 2014 Feb;8(1):3-11. doi: 10.1111/eip.12082. Epub 2013 Aug 22.
Accumulating data show that patients with bipolar disorder (BD) experience substantial symptomatology months or years before full manifestation. Based on the need for early preventive interventions in BD as well as data suggesting effectiveness of psychotherapeutic interventions for BD, we aimed to review the evidence for psychotherapeutic treatments in help-seeking individuals considered at risk for BD (At-Risk-BD).
Searching PubMed and PsycINFO, clinical trial registries and recently published systematic reviews, a systematic review was performed of psychoeducational and psychotherapeutic intervention studies in At-Risk-BD individuals.
Only three completed studies were identified, two of which were randomized trials (n = 77) and one was an open pilot study (n = 13). Two ongoing studies (projected n = 150 and n = 100, respectively) were found in trial registries. The available evidence suggests potential effectiveness of multi-family psychoeducational psychotherapy and family-focussed therapy for symptom reduction and prevention of BD conversion.
Psychotherapeutic treatments are a reasonable starting point for At-Risk-BD subjects when symptom severity, distress and impairment are sufficiently significant to initiate treatment. Ongoing studies will further clarify the effectiveness and timing of psychotherapeutic interventions for At-Risk-BD individuals and whether or not they should be given alone or in conjunction with other treatments. Large multi-site studies with standardized procedures/manuals are needed to advance the field.
越来越多的数据表明，双相情感障碍（BD）患者在完全发病前数月或数年前就已经出现了大量症状。基于在 BD 中进行早期预防干预的需求，以及心理治疗干预对 BD 有效性的数据，我们旨在回顾针对被认为处于 BD 风险（At-Risk-BD）的寻求帮助的个体的心理治疗方法的证据。
通过搜索 PubMed 和 PsycINFO、临床试验登记处和最近发表的系统评价，对 At-Risk-BD 个体的心理教育和心理治疗干预研究进行了系统评价。
仅确定了三项已完成的研究，其中两项是随机试验（n=77），一项是开放的初步研究（n=13）。在试验登记处发现了两项正在进行的研究（预计分别有 n=150 和 n=100）。现有证据表明，多家庭心理教育心理疗法和家庭为中心的疗法在减少症状和预防 BD 转化方面具有潜在的有效性。
当症状严重程度、痛苦和功能障碍足以开始治疗时，心理治疗是 At-Risk-BD 受试者的合理起点。正在进行的研究将进一步阐明针对 At-Risk-BD 个体的心理治疗干预的有效性和时机，以及它们是否应该单独或与其他治疗一起使用。需要进行具有标准化程序/手册的大型多中心研究来推进该领域。
