Tern Paul Jie Wen, Abdaal Ali, Tobin Jake, Macfarland Katherine, Hunt Molly, Agius Mark
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Psychiatr Danub. 2017 Sep;29(Suppl 3):183-193.
The current card sort exercise described by Agius et al. in 2006 provides a tool for patients and their families to characterise the temporal pattern of occurrence of both stereotyped and idiosyncratic prodromal symptoms that serve as early warning signs predicting a relapse. This 'individual relapse signature' is highly specific for bipolar relapse, and aids identification of a relapse such that patients can be channeled into appropriate early intervention pathways. This review examines the role of the card sort exercise in the treatment of bipolar disorder, and evaluates the evidence for its efficacy. Few studies involve the card sort exercise, and those that do paired it with other early therapeutic interventions, such that it was difficult to assess the true contribution of the card sort exercise alone to outcome measures such as time-to-relapse or hospitalisation avoidance. We went back to first principles and evaluated the literature concerning various factors necessary for the card sort exercise to be useful. We concluded that there is good evidence that replicable relapse signatures exist as early warning signs for bipolar relapse, and that a certain subgroup of patients and their families can reliably use these signs to seek help and activate therapeutic interventions to abort the relapse episode. Early intervention is both possible and efficacious, which makes early identification of relapse yet more important. The card sort is of less use for depressive relapses, where prodromal symptoms are harder to pinpoint. The card sort exercise is useful in elucidating the relapse signature for each patient, which can then be used in psychoeducation or identification of future relapse episodes. However, more research is needed directly assessing the usefulness of the card sort exercise in helping patients and their families gain insight into the possibility of an imminent relapse.
阿吉乌斯等人在2006年描述的当前卡片分类练习为患者及其家属提供了一种工具，用于描述刻板和特异的前驱症状出现的时间模式，这些症状可作为预测复发的早期预警信号。这种“个体复发特征”对双相情感障碍复发具有高度特异性，有助于识别复发情况，从而使患者能够进入适当的早期干预途径。本综述探讨了卡片分类练习在双相情感障碍治疗中的作用，并评估了其有效性的证据。很少有研究涉及卡片分类练习，而那些涉及的研究将其与其他早期治疗干预措施相结合，因此很难单独评估卡片分类练习对诸如复发时间或避免住院等结局指标的真正贡献。我们回归基本原则，评估了与卡片分类练习有用性所需的各种因素相关的文献。我们得出结论，有充分证据表明，可复制的复发特征作为双相情感障碍复发的早期预警信号存在，并且特定亚组的患者及其家属可以可靠地利用这些信号寻求帮助并启动治疗干预措施以中止复发发作。早期干预既可行又有效，这使得早期识别复发更为重要。卡片分类练习对抑郁复发的作用较小，因为抑郁前驱症状更难确定。卡片分类练习有助于阐明每位患者的复发特征，然后可用于心理教育或识别未来的复发发作。然而，需要更多的研究直接评估卡片分类练习在帮助患者及其家属洞察即将复发可能性方面的有用性。
