Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.
Bipolar Disord. 2020 Aug;22(5):517-529. doi: 10.1111/bdi.12894. Epub 2020 Mar 13.
Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms.
In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample.
Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs.
Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
大多数双相情感障碍（BD）患者在首次（轻躁狂或）躁狂发作前出现前驱症状。具有符合严重精神疾病（SMI）风险标准的显著临床症状的患者需要有效和安全的治疗。认知行为心理治疗（CBT）已在 BD 的早期阶段和精神病高危患者中显示出良好的效果。我们旨在研究小组 CBT 是否可以改善有 SMI 风险的年轻患者出现阈下双相症状的症状和功能缺陷。
在一项多中心、随机、对照试验中，有 SMI 风险的阈下双相情感障碍年轻患者（年龄 15-30 岁）被随机分配到 14 周的 BD 特异性 CBT 或非结构化小组会议。主要疗效终点是 14 周时情感症状和心理社会功能的差异。风险状态定义为阈下双相症状、心理社会功能下降和（分裂）情感障碍家族史的组合。在目标样本的 75%时进行了预设的中期分析。
在 128 名筛选参与者中，有 75 名被随机分配到 CBT 组（n = 38，完成者 = 65.8%）和非结构化小组会议（n = 37，完成者 = 78.4%）。两组患者在第 14 周（P <.001）和 6 个月（P <.001）时的情感症状和心理社会功能均显著改善，两组之间无显著差异。研究结果受到分析的中期性质、使用不完全有效的早期检测访谈、新改编的干预手册和大量脱落的限制。
结果表明，有 SMI 风险的年轻患者出现阈下双相症状，可从早期小组治疗中受益。需要进一步阐明所需的特异性和心理治疗的相互作用。
